Search Results (4,114)

Tuberculosis (TB) continues to be a significant public health challenge in Europe, despite a sustained decline in disease incidence over recent decades. This narrative review briefly traces the historical development of TB diagnosis and focuses on the evolution of TB control protocols from the early twentieth century to the present across Europe, through a longitudinal comparative analysis of its geographical regions. A literature search was conducted using publications, guidelines, and surveillance reports from the World Health Organization (WHO), the European Centre for Disease Prevention and Control (ECDC), and national public health authorities. The analysis follows a geographical framework encompassing Eastern, Western, Northern, and Southern Europe, reflecting historical, socioeconomic, and healthcare system differences. This study presents the transition from traditional diagnostic approaches based on clinical assessment, chest radiography, and smear microscopy to modern molecular and immunological techniques, including Xpert MTB/RIF assays and interferon-gamma release assays (IGRAs). Similarly, treatment strategies have evolved from sanatorium-based supportive care to standardized, evidence-based short-course regimens employing first- and second-line anti-TB drugs. However, marked regional differences remain in the implementation of contemporary protocols. Western and Northern European countries have largely adopted advanced diagnostic technologies and comprehensive surveillance systems and are approaching TB elimination targets. In contrast, Eastern Europe continues to bear a disproportionate disease burden, driven by multidrug-resistant TB, HIV co-infection, and socioeconomic disparities. TB control protocols in Southern Europe are progressively converging with those of Western Europe through the adoption of modern diagnostic approaches, standardized treatment regimens, and WHO-endorsed guidelines. The findings of this study underscore the need for greater harmonization of TB control protocols across Europe through an initiative coordinated by the ECDC/WHO. Accelerating progress toward TB elimination in the European Region will depend on expanding access to modern diagnostic technologies, implementing targeted interventions in high-burden settings, and strengthening cross-border collaboration through coordinated public health policies. Full article

Placing children in alternative care serves to safeguard their well-being while social workers work to resolve the issues that necessitated their removal from the home. Despite this intention, social workers face numerous difficulties when implementing family reunification services. This article explores the challenges encountered by social workers in South Africa in delivering these services. The study adopted an exploratory sequential mixed-methods design and involved social workers employed at five child protection organisations across the country. Data were gathered through 15 qualitative interviews and 127 completed questionnaires. Thematic analysis, guided by Creswell’s framework, was used to interpret the qualitative data, while quantitative data were processed using a statistical software package for social sciences (SPSS) version 23. The findings reveal a range of institutional, infrastructural, and human resource constraints that hinder effective service delivery. Social workers also reported difficulties arising from uncooperative biological parents and strained relationships between biological and foster parents, often marked by mistrust, suspicion, and hostility. At times, tensions also emerged between biological parents and social workers themselves. The study concludes that recognising these challenges creates an opportunity to address them more effectively. It recommends the development of a rights-based family reunification service model to guide and support social workers in providing timely and effective reunification interventions. Full article

Background: Tetanus remains a life-threatening yet preventable disease, with a disproportionate burden in low- and middle-income countries. Data on non-neonatal tetanus in Somalia, particularly from referral centres managing severe cases, are limited. This study aimed to describe the clinical characteristics, management, and outcomes of patients with non-neonatal tetanus in Mogadishu, Somalia. Methods: This retrospective observational study was conducted at Madina Hospital between July 2024 and January 2026. All patients with clinically diagnosed non-neonatal tetanus presenting to the Emergency Department were included. Data on demographics, clinical features, management, complications, and outcomes were extracted from medical records. Continuous variables were summarized as mean ± standard deviation or median (interquartile range), while categorical variables were presented as frequencies and percentages. Associations were assessed using Fisher’s exact test, with p < 0.05 considered statistically significant. Results: A total of 50 patients were included (mean age 22.24 ± 15.49 years; 84.0% male). Most patients were unvaccinated (80.0%), and severe or very severe disease was present in 64.0% of cases. Generalized muscle spasm was the most common presentation (50.0%). Dysautonomia (42.0%) and respiratory failure (18.0%) were the most frequent complications. The overall in-hospital mortality rate was 26.0%, with respiratory failure accounting for 69.2% of deaths. Mortality was significantly associated with disease severity (p < 0.001), complications (p = 0.006), antibiotic category (p = 0.043), and vaccination status (p = 0.0265). Conclusions: Non-neonatal tetanus in this referral-based setting is associated with high mortality, predominantly affecting young, unvaccinated individuals presenting with advanced disease. Disease severity and complications, particularly respiratory failure, are the main drivers of outcomes. Strengthening adult immunization, improving early recognition and referral, and expanding access to critical care are essential to reduce tetanus-related mortality. Full article

Background/Objectives: Among the most common medical conditions of pregnancy, nausea and vomiting of pregnancy (NVP) and its severe form hyperemesis gravidarum (HG) represent a clinically significant and increasingly researched area of maternal health. However, the global evolution, structural organization, and thematic development of this literature remain insufficiently characterized. This bibliometric study maps five decades of global research on therapeutic and supportive interventions for NVP and HG. Methods: Web of Science Core Collection records were searched on 10 May 2026, restricted to English-language articles and reviews published up to 2025, and deduplicated to 1182 unique documents. A secondary thematic filter was subsequently applied to generate a refined obstetric subset for the country collaboration, keyword co-occurrence, and thematic evolution analyses. Bibliometric performance, collaboration networks, source impact, institutional output, PELT-based changepoint detection, metadata completeness, keyword co-occurrence, and thematic evolution were analyzed using VOSviewer, Bibliometrix/Biblioshiny, and custom Python scripts. Results: Publication output increased markedly after 2010 and reached its maximum in 2025. PELT sensitivity analysis localized the principal transitions to the mid-1990s and early 2010s, informing three broad analytical macroperiods: 1975–1994, 1995–2009, and 2010–2025. The United States dominated cumulative output and collaboration intensity, while Canada, England, Australia, Italy, Germany, and China showed substantial scientific influence. Core publication venues were concentrated in obstetrics, gynecology, reproductive safety, and pregnancy-focused clinical medicine. Keyword and thematic analyses showed a transition from early vomiting, Bendectin, exposure, and pregnancy-safety concerns toward pharmacological treatment, complementary interventions, controlled clinical evaluation, maternal–fetal outcomes, and supportive management. Metadata-completeness analysis identified a major pre-1991 indexing discontinuity, requiring caution when interpreting long-range keyword-based trends. Conclusions: These findings outline the trajectory of the field and highlight priorities for future research, including stronger comparative evidence for pharmacological, complementary, and supportive-care strategies, broader international collaboration, and prospective studies to strengthen the evidence base for managing NVP and HG. Full article

Congenital heart disease is the most common birth defect worldwide. Perinatal detection, either in utero or prior to hospital discharge is important for planning delivery, ordering adjunct testing, and planning for surgical or medical care. In countries with access to ultrasound screening, prenatal detection is highly accurate though with variable sensitivity and specificity around the world. Pulse oximetry screening, in some cases coupled with murmur auscultation in the nursery can also reach very high degrees of sensitivity for critical congenital heart disease. Use of the modalities per guidelines and recommendations is an important aspect of decreasing infant mortality and morbidity worldwide. Full article

Background: Despite noteworthy progress in the Expanded Program on Immunization (EPI) for improving vaccination coverage worldwide, inequalities in vaccine uptake and accessibility persist in several middle- and low-income states. Pakistan’s routine vaccination uptake varies greatly between federal geographical regions and continues to fall below the standard threshold needed to attain optimal herd immunity. The Federal Directorate of Immunization (FDI) in collaboration with the provincial Expanded Program on Immunizations implemented Enhanced Outreach Activities (EOAs) to boost immunization delivery in selected districts in order to address immunization coverage gaps in marginalized and difficult-to-reach communities. The purpose of this secondary data research was to evaluate whether EOAs improved immunization coverage in the country. Methods: The Federal Directorate of Immunization’s longitudinal panel analysis of district–month administrative data for the years 2011–2021 have been analyzed. The research investigation reviewed 158 districts’ monthly vaccination records for multiple antigens, covering regions where EOAs were successfully carried out in particular months. National and subnational analyses were carried out to measure geographical variations in the impact of Enhanced Outreach Activities (EOAs). The average vaccination coverage during EOAs and non-EOAs months was compared using the paired t-test. Results: An aggregate of 2430 months with EOAs were included in the analysis of 19,068 monthly district observations. National level analysis revealed higher average vaccinations during the EOA months for all antigens, but a statistically significant increase was observed for IPV and measles second dose (p < 0.05) only. Provincial-level results indicate that the impact was more evident in underserved regions. Khyber Pakhtunkhwa, Balochistan, Punjab, and Sindh demonstrated statistically significant increases in vaccination counts for most antigens. Due to variations in baseline population coverage, as well as health care sector capability, the extent of improvements differed throughout regions. Conclusions: In Pakistan, routine immunization counts has been improved via enhanced outreach initiatives, especially in provinces with lower initial vaccination rates and restricted accessibility to services. Strengthening outreach strategies, together with consistent fixed-site immunization services, is likely to accelerate progress toward equitable immunization coverage and contribute to achieving the Immunization Agenda 2030 goals. Full article

Background: Modern intensive care paradigms prioritize optimal analgesia over heavy sedation. While morphine, fentanyl, and remifentanil are widely used, sufentanil is relatively unknown in several countries. Aimed primarily at intensive care physicians, this narrative review evaluates the utilization of sufentanil in critically ill adult patients across four fundamental dimensions: (1) translational pharmacology (chemical structure, pharmacokinetics, pharmacodynamics, and pharmacogenomics); (2) indications and safety precautions; (3) clinical evidence in ICU patients; and (4) therapeutic positioning in contemporary ICU analgosedation and future research directions. Methods: A comprehensive literature search was conducted in PubMed/MEDLINE focusing on the translational pharmacology, safety parameters, and clinical studies of sufentanil critically ill adults. The synthesis was structured according to SANRA principles for high-quality narrative reviews and includes articles published up to February 2026. Results: Sufentanil exhibits an exceptionally high affinity for the µ-opioid receptor, providing a potency 10-fold greater than fentanyl and 1000-fold greater than morphine. It has an experimental therapeutic index (LD50/ED50) nearly two orders of magnitude wider than that of fentanyl, enabling safe, highly granular bedside titration. Unlike morphine, hepatic CYP3A4 biotransformation yields completely inactive metabolites, preventing toxic accumulation during acute kidney injury. Furthermore, receptor-binding dynamics suggest a lower propensity for recruiting β-arrestins and activating NMDA pathways, potentially reducing opioid-induced hyperalgesia (OIH). Clinically, pilot trials in neurocritical cohorts demonstrate that sufentanil maintains reliable cerebral hemodynamic stability. In postoperative cardiac surgery and large ICU registries, sufentanil may reduce the mechanical ventilation duration, accelerate extubation, and shorten ICU length of stay. Conclusions: For critically ill adults, sufentanil is an excellent alternative to traditional opioids because it offers high-precision titratability, potent analgesia, and a safer metabolic profile. Full article

Background: Cancer-related psychological distress is a major concern in comprehensive oncology care because it substantially impairs patients’ quality of life and may adversely affect treatment adherence, outcomes, and prognosis. Over the past decade, research in this field has expanded rapidly; however, the overall knowledge structure, global research patterns, major contributors, and emerging hotspots remain insufficiently characterized. A bibliometric analysis is therefore needed to systematically map the development of cancer-related psychological distress research and identify evolving directions for future investigation. Methods: Publications related to cancer-related psychological distress published between 1 January 2015 and 31 December 2024 were retrieved from the Web of Science Core Collection and Scopus databases. The database searches were conducted on 10 March 2025. Bibliometric analyses were performed using VOSviewer (version 1.6.20), CiteSpace (version 6.3.R1), and the R package bibliometrix (version 5.3). Publication trends, country and institutional contributions, journal distribution, author collaboration networks, co-cited references, keyword co-occurrence, burst keywords, and thematic evolution were analyzed. Results: A total of 7063 publications were included in the bibliometric analysis, including 6162 articles and 901 reviews. Annual publication output increased from 465 publications in 2015 to 924 publications in 2024. The main contributing countries were the United States, Australia, China, Germany, and the United Kingdom. The United States ranked first in publication volume and total citations. Psycho-Oncology and Supportive Care in Cancer were the leading journals by publication volume and total citations. Major research themes included quality of life, psychological distress, depression, anxiety, breast cancer, distress screening, survivorship, and palliative care. Seven high-frequency keywords—“cancer,” “quality of life,” “psychological distress,” “depression,” “anxiety,” “breast cancer,” and “distress”—each appeared more than 500 times, representing the core research topics. Emerging keywords such as “informal caregivers,” “young adults,” “guidelines,” and “adult survivors” reflected increasing attention to caregiver support, age-specific psychosocial needs, survivorship care, and standardized clinical management. Conclusions: This bibliometric analysis provides a comprehensive overview of global research on cancer-related psychological distress from 2015 to 2024. The findings reveal publication trends, major contributors, collaboration patterns, core research themes, knowledge structures, and emerging topics in this field. Current research has gradually shifted from general descriptions of psychological distress toward survivorship care, caregiver support, standardized screening, and guideline-based management. Future studies should strengthen interdisciplinary collaboration, improve standardized assessment and screening approaches, and further explore emerging areas such as caregiver support, young adult cancer populations, survivorship care, and digital health and artificial intelligence-assisted approaches, which require further validation before routine clinical implementation. Full article

Background: Access to anti-obesity pharmacotherapy within publicly funded healthcare systems remains limited because of concerns regarding affordability, budget impact, and appropriate patient selection. This study describes the methodological and strategic process that enabled the incorporation and public reimbursement of anti-obesity pharmacotherapy for obesity management within the Mexican public healthcare system. Methods: A descriptive health policy and market-access analysis was conducted. The reimbursement strategy included five sequential phases: identification of reimbursement barriers, definition of a clinically prioritized target population through expert consensus, generation of local epidemiological evidence, development of pharmacoeconomic and budget impact analyses, and implementation of managed-access and risk-sharing mechanisms. Results: Initial reimbursement attempts were unsuccessful because of concerns regarding the large size of the potentially eligible population and projected budget impact. Sequential application of epidemiological, clinical, and healthcare utilization criteria reduced the potential candidate population from 32,392,801 adults with obesity to 20,412 eligible patients receiving care within public healthcare institutions. Pharmacoeconomic analyses demonstrated favorable cost-effectiveness, while budget impact analyses estimated an average annual investment of MXN $286 million, representing less than 1% of the national pharmaceutical budget over five years. These findings supported the development and regulatory approval of a managed-access strategy that subsequently enabled the incorporation of anti-obesity pharmacotherapy into the National Compendium of Health Supplies in December 2023. Conclusions: Combining local epidemiological evidence, population prioritization, pharmacoeconomic evaluation, and innovative reimbursement mechanisms enabled public access to anti-obesity pharmacotherapy in Mexico. This framework may serve as a model for improving access to obesity therapies in middle-income countries. Full article

Background/Objectives: Environmental air pollution and structural barriers to preventive dental care are increasingly recognized as determinants of population health inequalities. However, their combined association with oral disease burden across European Union (EU) Member States remains insufficiently examined. This study evaluated whether ambient particulate matter (PM2.5) exposure is associated with oral health outcomes and whether preventive system capacity modifies this association. Methods: An ecological panel analysis was conducted using country-level data from the 27 EU Member States for the period 2020–2023. Age-standardized prevalence of untreated dental caries (primary outcome), edentulism (secondary outcome), and periodontal diseases (exploratory outcome) were obtained from the Global Burden of Disease database. PM2.5 exposure was operationalized using national mean annual baseline values. Preventive care access was proxied by the percentage of the population reporting unmet dental care needs (Eurostat EU-SILC). Pooled panel regression models with year fixed effects and country-clustered robust standard errors were estimated. An interaction term between PM2.5 exposure and unmet dental care needs was included to assess effect modification. Results: PM2.5 exposure was not independently associated with caries prevalence after adjustment for preventive access and GDP per capita. However, a statistically significant interaction was observed: higher PM2.5 levels were associated with increased caries prevalence in countries reporting greater unmet dental care needs. PM2.5 exposure was positively associated with edentulism prevalence, independent of preventive access. No significant associations were detected for periodontal diseases. Conclusions: Based on this ecological analysis of European Union Member States, higher PM2.5 exposure in combination with greater unmet dental care needs was associated with higher population-level caries prevalence, whereas PM2.5 exposure alone showed a positive association with edentulism prevalence. These findings are exploratory and should be interpreted with caution, given the use of aggregated country-level data, the potential for ecological fallacy, and the absence of causal inference. Further individual-level and longitudinal studies are needed to clarify these relationships and their underlying mechanisms. Full article

Background/Objectives: Iron deficiency anemia (IDA) remains the most prevalent nutritional deficiency worldwide and a leading cause of years lived with disability, particularly in low-income countries. In Egypt, the burden is substantial and compounded by regional socioeconomic, nutritional, and parasitic factors. Despite this, the predictors of diagnostic delay within the Egyptian healthcare system remain poorly characterized. This study aimed to quantify the extent of diagnostic delay among Egyptian patients with IDA and to identify the sociodemographic and clinical risk factors independently associated with prolonged time to diagnostic confirmation. Methods: A single-center retrospective cohort study was conducted at Al-Minia University Hospital, Egypt, between March and April 2026, enrolling 350 adults with confirmed IDA diagnosed between 2015 and 2025. “Diagnostic delay” was defined as the interval in days from the index date (the first documented abnormal complete blood count) to laboratory confirmation of iron deficiency by serum ferritin and/or transferrin saturation. Secondary outcomes included patient delay, system/testing delay, and etiology work-up delay. Time-to-event analysis was performed using Kaplan–Meier curves and Cox proportional hazards regression. All analyses were conducted in R version 4.4.0. Results: The cohort comprised 213 females (60.9%) and 137 males (39.1%), with a median age of 39 and 36 years, respectively. The median primary diagnostic delay was 76.0 days (IQR: 38.0, 182.8), with patient delay accounting for a median of 26.5 days and system/testing delay for 21.0 days. Overall, 155 patients (44.3%) experienced a diagnostic delay of more than 90 days. In the multivariable Cox model, urban residence (aHR = 0.69, 95% CI [0.53, 0.99], p = 0.045) was independently associated with a slower rate of diagnostic confirmation. Conclusions: Diagnostic delay in IDA is substantial in Egypt, driven by both patient-level symptom normalization and counterintuitive systemic bottlenecks. Urban residence was independently associated with prolonged time to diagnostic confirmation; ordering of iron studies at the first visit was associated with delay in bivariate analysis only and was not an independent predictor after multivariable adjustment. Targeted public health education, restructured primary care pathways, and improved laboratory turnaround times are essential to reduce this burden. Full article

Background: Equitable and adequate access to primary care services is essential for reducing healthcare disparities and advancing social justice. In developing countries like China, achieving a balanced primary care provision across urban–rural divides, regions, and population groups represents a critical strategy for improving public health outcomes. Methods: This study integrates high-resolution population data, nationwide point of interest (POI) data, and aggregated individual survey data to analyze the spatial distribution of primary care facilities in China, evaluate their accessibility and equity, and examine the relationships among primary care accessibility, socioeconomic factors, and public health outcomes using geographic analysis and machine-learning methods. Results: (1) Primary care facilities in China exhibit significant spatial clustering and pronounced urban–rural disparities, with 23% of the urban population having access within walking distance; (2) while horizontal equity in primary care accessibility is relatively well-maintained for China’s aging population, vertical equity requires substantial improvement; and (3) primary care accessibility demonstrates significant but nonlinear associations with key socioeconomic indicators, including urban population size, GDP, built-up area, health insurance coverage, and public expenditure. Conclusions: These findings provide valuable insights for health resource allocation and urban planning policies aimed at achieving equitable primary care access. Full article

Background: Artificial intelligence is increasingly influencing health care and policy, yet the global research landscape linking artificial intelligence and health care policy remains underexplored. This study aimed to map publication trends, major contributors, collaboration networks, citation structures, and emerging themes in this field. Methods: A bibliometric analysis was conducted using the Web of Science Core Collection. The search was performed on 3 May 2026, and covered publications from 2000 to 3 May 2026. The final dataset included 347 peer-reviewed English-language original research and review articles. Biblioshiny, VOSviewer, and CiteSpace were used to analyze publication trends, country and institutional contributions, author and journal productivity, collaboration networks, citation and co-citation structures, keyword patterns, and thematic evolution. Results: Publications increased markedly after 2020 and reached their highest annual output in 2025. The 2026 publication count was lower because data for that year were partial at the time of database retrieval. Researchers from 82 countries and 900 institutions contributed to the field, with the United States leading in output, followed by China, England, Canada, and India. Harvard Medical School was the most productive institution, whereas Harvard University had the highest institutional centrality. Frontiers in Public Health published the most articles, and PLOS ONE was the most frequently co-cited journal. The most cited article was “Artificial intelligence and the future of global health.” Key research themes included machine learning, COVID-19, health policy, risk, large language models, interpretable machine learning, neural network-assisted screening, socioeconomic perspectives, and public health applications. Conclusions: Research on artificial intelligence and health care policy has expanded rapidly, particularly in recent years, and is increasingly centered on predictive modeling, public health decision-making, and emerging artificial intelligence technologies. These findings highlight influential contributors, evolving themes, and future directions for researchers, policymakers, and health care leaders. Full article

Background: Climate change is increasingly recognised not only as an environmental emergency but also as a structural determinant of health and health-system performance. Its clinical consequences will not be distributed evenly: high-income countries face rising heat mortality, infrastructure fragility, ageing-related vulnerability, and the need to decarbonise technologically intensive care; middle- and low-income countries face heterogeneous but often more compressed combinations of heat, infectious disease, food insecurity, water stress, displacement, conflict-related fragility, and limited fiscal capacity. Objective: This structured narrative review proposes a comparative framework for understanding how climate change will transform health care across high-, middle-, and low-income settings and identifies adaptation priorities that are resilient, equitable, and low-carbon. Methods: We synthesised major climate-health assessments, peer-reviewed epidemiological studies, modelling papers, systematic and scoping reviews, and health-system decarbonisation literature identified through targeted searches and reference chaining. Five climate-health pathways, specified a priori from established direct, indirect, and socially mediated pathway frameworks, were used to organise the review. Findings: Climate change will reshape health care through five interacting pathways: direct thermal injury and extreme-weather mortality; altered infectious disease ecology; food, water, and nutritional insecurity; mental, maternal-child, and occupational impacts; and damage to the infrastructure, workforce, supply chains, finances, and emissions profile of health systems. In high-income countries, climate stress exposes the limits of hospital-centred, carbon-intensive, just-in-time care. In middle-income countries, expanding coverage and technology coexist with uneven insurance, large informal workforces, and rapidly growing emissions. In low-income and fragile settings, the same hazards interact with undernutrition, weak surveillance, under-resourced primary care, and constrained finance to produce larger marginal health losses. Conclusions: The central contribution is the concept of the climate-health divide: the unequal conversion of shared climate hazards into clinical demand, service disruption, financial stress, and emissions-intensive responses. Climate resilience and healthcare decarbonisation should therefore be designed together rather than treated as separate agendas. Full article

Background/Objectives: Ankyloglossia diagnosis and management remain widely debated in dentistry, with variability reported in clinical decision-making and treatment approaches. Limited international evidence exists comparing how dental professionals diagnose and manage this condition in early childhood. This study aimed to compare the knowledge, diagnostic criteria, and clinical management of ankyloglossia among dental professionals in six countries and to assess whether shared diagnostic and management approaches exist for babies (≤6 months) and infants (>6 months). Methods: A multicountry cross-sectional study was conducted using a validated 27-item online questionnaire distributed between February 2023 and February 2025 to dental professionals in Spain, Italy, Portugal, Brazil, Ecuador, and Chile. Participants included paediatric dentists, oral surgeons, general dentists, and other dental specialists. Only fully completed questionnaires were analyzed. Primary outcomes included self-reported diagnostic practices, use of classification systems, and management strategies for ankyloglossia. Secondary outcomes included professional training, interdisciplinary collaboration, surgical techniques, and pain management practices. Results: A total of 1188 dental professionals participated. Overall, 80.7% reported routinely examining the lingual frenulum, while 42.4% used formal classification systems. Tongue mobility assessment was the most commonly reported diagnostic method, with significant variation across countries and professional groups (p < 0.001). Specific training in diagnosis was reported by 67.2% of participants, whereas 50.6% reported treatment training, with marked inter-country differences (p < 0.001). Surgical intervention was the most commonly reported management strategy (38.7%), particularly in babies ≤ 6 months, with frenotomy/frenulotomy being the predominant procedure. Considerable variability was observed in surgical techniques, pain management, and recommendations for adjunctive therapies. Conclusions: Substantial international variability exists in the diagnosis, classification, and management of ankyloglossia among dental professionals. These findings highlight gaps in training and the absence of standardized, evidence-based clinical guidelines, underscoring the need for consensus-driven protocols to support consistent and multidisciplinary clinical care. Full article