Problemy sotsial'noi gigieny, zdravookhraneniia i istorii meditsinyV G Zilov, L V Kosmodemyansky
The article considers placement of methods of traditional and complementary medicine in the public health system of the Russian Federation, focusing on prevention and management of chronic non-communicable diseases. The analysis of the evidence base on key methods of traditional and complementary medicine (acupuncture, phytotherapy, homeopathy, manual therapy, osteopathy) was carried out, including differentiated estimate of level of evidence for forms of homeopathy based on the latest systematic review of meta-analyses. The legal framework of its application in Russia are explored. The corresponding collisions and barriers are identified. The following proposals concerning integrative health care model are formulated: differentiated register of methods, clinical guidelines, pilot integration into compulsory health insurance system and enhancement of research.
Journal of robotic surgeryEdmundo Inga-Zapata, Heidi Silva, Christian Perez, Elena Ruiz-Úcar, Cinthia Espinoza, Jesús Guarecuco, Jaime T Lee, Rodolfo J Oviedo
The rapid worldwide adoption of robotic surgery often outpaces high-level comparative evidence. While evidence-based medicine relies on a hierarchical pyramid where causal inference resides at the apex, most of the scientific output is concentrated at the non-comparative base. It remains unknown whether the directional conclusions of these literature layers are symmetrically aligned. This study aimed to map the structural distribution of conclusions across the evidence hierarchy in visceral robotic surgery to evaluate potential narrative discordance. A stratified random sampling of intracavitary robotic surgery publications (thoracic, abdominal, and pelvic) was conducted from PubMed (1997-2026). Our sample size was calculated to achieve maximum representativeness (n = 800). Publications were equally partitioned into two pragmatic functional layers based on the presence of a control group: the Upper Hierarchy Zone (comparative layer, n = 400) and the Lower Hierarchy Zone (non-comparative layer, (n = 400). Directional orientations of author conclusions were operationally categorized as Favorable, Neutral, or Unfavorable. To ensure non-biased processing and scalability, semantic classification was executed via a Large Language Model (GPT-5.4), previously validated against a three-evaluator human pilot trial (absolute agreement 92%, Cohen's kappa > 0.81). Statistical analysis utilized Chi-square tests and Odds Ratio (OR) calculation with 95% Confidence Intervals (CI), with a secondary bipartite analysis (favorable vs. non-favorable). The global overview of the entire dataset (n = 800) demonstrated an illusion of literary equilibrium: 51.75% (n = 414) favorable, 45.50% (n = 364) neutral, and 2.75% (n = 22) unfavorable conclusions. However, stratification revealed a massive structural asymmetry (chi^2 = 312.9, p < 0.001). Within the upper hierarchy, conclusions were overwhelmingly non-favorable (79.50% vs. 20.50% favorable), dominated by neutral comparative outcomes (77.75%). Conversely, the lower hierarchy was heavily skewed toward favorable outcomes (83.00% favorable vs. 17.00% non-favorable). The lower zone also served as a sharper sensor of surgical failure, reporting a higher raw unfavorable rate (3.75%) than the apex (1.75%). Pragmatic bipartite analysis demonstrated that a publication at the base of the evidence pyramid has nearly 19 times higher odds of reporting a favorable conclusion compared to those at the comparative apex (OR 18.93, 95% CI: 13.84-26.87). A profound structural asymmetry exists within the robotic surgery literature. The disproportionate volume of highly favorable, lower-tier evidence numerically overwhelms comparative data, creating a phenomenon of "pseudo-publication bias." This structural distortion generates a powerful narrative inertia that drives global clinical adoption and shapes professional perception through cumulative enthusiasm rather than demonstrated methodological superiority.
Prehospital and disaster medicineLane L Frasier, Aaron Alindogan, Nina Hoskins, Lance McGinnis, Christopher Bennett, Krystal Delgado, Gregory Burnett, William Davis
INTRODUCTION: Clinical decision support (CDS) tools have been demonstrated to improve patient care and outcomes yet remain under-utilized in many clinical domains, including en route care. STUDY OBJECTIVE: This study evaluated whether a decision-tree CDS tool integrated within the government-created Battlefield Assisted Trauma Distributed Observation Kit (BATDOK; AFRL) clinical care software improves adherence to Joint Trauma System (JTS) guidelines for severe traumatic brain injury (TBI). METHODS: In a randomized crossover simulation of military clinicians (N = 24), paired participants managed a patient with elevated intracranial pressure (ICP) using either usual care (UC) or BATDOK with TBI CDS in a simulated fixed-wing air transport mission. Outcomes included completion of critical actions by simulation conclusion, time to completion of critical actions, adherence to tiered interventions as outlined in JTS Clinical Practice Guideline (CPG), and user evaluations of the CDS tool using the validated instrument, System Usability Scale (SUS). RESULTS: There were no significant differences in the primary outcome, percentage of critical items completed. Teams completed a median 83.3% of the critical items in the UC scenario, compared to 91.7% in the CDS scenario (P = 0.58; median difference 4.2%, 95% CI of the difference -8.1% to 16.4%). The mean SUS score for the CDS platform was 77.6 (SD = 16.0), which is associated with a "good" usability rating. Most participants rated the CDS platform favorably on every item of the SUS. CONCLUSION: The BATDOK with TBI CDS did not statistically increase completion of critical tasks in this initial evaluation of usability. However, these data suggest that BATDOK enhanced with CDS improved tiered guideline-concordant sequencing of ICP interventions outlined by the JTS CPG and was favorably rated by users, suggesting feasibility for operational integration.
Journal of the Medical Library Association : JMLAJuliana Magro
BACKGROUND: Librarians providing feedback on Evidence-Based Medicine (EBM) assignments face time constraints. This case report describes implementing a semi-automated rubric - defined here as a tool that automatically calculates scores from grader-selected ratings while narrative feedback is still written by the instructor - to reduce grading time for an EBM capstone assignment for first-year medical students. CASE PRESENTATION: Two cohorts of approximately 100 students completed the same EBM assignment. The 2023 cohort received manual feedback, while the 2024 cohort received feedback using the semi-automated rubric. Grading time was logged for both cohorts. The rubric, adapted from a template, automatically calculates scores based on selected criteria, streamlining the feedback process. CONCLUSIONS: The semi-automated rubric reduced grading time by 30%, from an average of seven minutes per assignment to five minutes. This simple, adaptable intervention can help reduce educator workload, improve feedback timeliness, and enhance assessment consistency. While limited by its single-grader and single institution design, this case report offers practical insights for educators seeking to improve feedback efficiency in EBM and other disciplines.
Deutsche medizinische Wochenschrift (1946)Nathalie Brigitte Blaue, Niels Rodenstein, Sebastian Wolfrum
Accounting for 4-8% of all patients in emergency departments, dyspnea is one of the most common presenting symptoms 11 22. Its clinical significance is reflected in the high rate of admission to the intensive care unit (16-18%) 11 and an in-hospital mortality rate of approximately 9% 22. The concurrent presence of multiple organ pathologies often poses a diagnostic challenge 33. This article translates the current evidence from 2025/2026 into action-oriented strategies: from pathophysiology and AI-supported triage to critical airway management and the discussion of specialized dyspnea units 44.
JMIR cancerYen-Nien Hou, Jyothirmai Gubili, Pulkit Jain, Chun Sing Lam, Avijit Chatterjee, Jun J Mao
Our study describes the development and evaluation of a retrieval-augmented generation-based large language model to improve the quality of responses to provider questions about herbs and dietary supplements.
Human fertility (Cambridge, England)Leying Hou, Qian Feng, Maria Mazi, Sarah Lensen, Abha Maheshwari, Ben W Mol
Add-ons are non-essential interventions offered in addition to standard infertility treatments, mainly in vitro fertilisation (IVF) and associated procedures, aimed at improving chances of pregnancy and live birth. While existing guidelines provide recommendations on the use of add-ons, they often overlook the trustworthiness of the underlying randomised controlled trials (RCTs), which may lead to misleading conclusions. Furthermore, some add-ons that may offer genuine benefits have been dismissed due to misinterpretation of trial results, or they are reserved for repeated implantation failure based on strategic rather than evidence-based arguments. Here, we propose a framework for an evidence synthesis process to guide the rational use of add-ons. The evaluation should begin with establishing effectiveness through systematic reviews of trustworthy RCTs, ignoring RCTs that do not meet trustworthiness criteria. When assessing effectiveness, the evaluation should consider evidence relating to the biological mechanisms targeted by the add-on, in addition to clinical outcomes such as live birth. For diagnostic add-ons, evaluations should focus on the group of patients whose test result leads to a change in clinical management, rather than analysing all test-exposed patients. Once effectiveness is confirmed, evaluating cost-effectiveness becomes crucial. Its cost per additional live birth should be compared to a benchmark (e.g., $27,000 or £20,000 for a live birth via standard IVF). Finally, once proven cost-effective, add-ons should be offered early, rather than delayed until after repeated treatment failures. It might be that effectiveness and cost-effectiveness increase with progression along the continuum of diagnosis or IVF failure such as recurrent implantation failure. In that case, add-ons may be offered as soon as they are considered cost-effective.
BACKGROUND: This study aims to synthesize the highest quality evidence for the anticoagulation management of extracorporeal membrane oxygenation (ECMO) in adults, providing an evidence-based foundation for clinical practice in ECMO anticoagulation. METHODS: An evidence summary approach was employed, adhering to the evidence summary reporting standards established by the Evidence-Based Nursing Center of Fudan University. Utilizing the "6S" evidence hierarchy model, comprehensive searches were conducted across both domestic and international databases for evidence pertaining to anticoagulation in ECMO patients. The literature types encompassed guidelines, expert consensus statements, best practices, and systematic reviews. The search period extended from January 1, 2019, to May 31, 2024. Two evidence-based reviewers independently extracted and synthesized relevant data from qualifying literature. RESULTS: The initial search yielded 553 articles, from which 10 were selected following rigorous screening. These comprised 3 clinical guidelines, 3 clinical decisions, 2 systematic reviews, and 2 expert consensus articles. In total, 30 best evidence statements were distilled, categorized into pre-anticoagulation evaluation, individualized anticoagulation strategies, complication prevention and treatment, and nursing care. Among these, 25 were strong recommendations, 5 were weak recommendations, and 14 were secondary evidence. CONCLUSION: The study identified 30 best evidence statements for anticoagulation management in adult ECMO. Given the diverse origins of these evidence statements, clinical practitioners must consider contextual factors such as specific clinical settings and patient conditions prior to application. Future research should focus on the clinical application of this evidence summary to foster evidence implementation and to develop standardized clinical nursing protocols.
Zhonghua nei ke za zhiHelicobacter pylori Study Group, Chinese Society of Gastroenterology, Chinese Medical Association
Helicobacter pylori infection remains a significant public health concern in China. Effective prevention and control require a coordinated "three-in-one" approach encompassing standardized expert recommendations, consistent physician implementation, and active patient participation. However, comprehensive, systematic, and scientifically robust clinical practice guidelines for Helicobacter pylori infection to support clinical decision-making have been lacking. This guideline adopts a "from practice to practice" development framework, systematically identifying key clinical questions through extensive investigation and adhering to rigorous methodological standards to formulate practical, evidence-based recommendations. The multidisciplinary expert panel, incorporating perspectives from front-line clinicians, ensures that recommendations address real-world considerations, including resource availability, operational feasibility, and social ethics of healthcare. The development of this guideline directly addresses the critical bottleneck of the disconnect between consensus guidelines and clinical practice in current treatment and prevention efforts. While upholding the rigorous evidence-based medicine principle, it innovatively integrates with clinical practice needs, transforming complex bodies of professional evidence into clear, concise, and actionable key points. This guideline includes 45 key clinical topics and aims to serve as a bridge between professional medical evidence and healthcare practice, promote standardized, uniform clinical services, and enhance the overall prevention and control of Helicobacter pylori infection in China.
Giornale italiano di cardiologia (2006)Raffaele De Lucia, Giulio Zucchelli, Matteo Parollo, Davide A Mei, Giuseppe Boriani
In recent decades, clinical practice has been founded on the principles of evidence-based medicine, where therapeutic decisions arise from the integration of clinical expertise, patient preferences, and scientific evidence derived from controlled studies and meta-analyses. The advent of artificial intelligence (AI) in health care, however, is driving a significant evolution in clinical research, owing to its ability to analyze large volumes of heterogeneous data and overcome the limitations of traditional statistical approaches. The availability of large-scale datasets, increasing computational capability, and reduced storage costs have supported the transition towards a "data-intensive" research model, progressively integrated with conventional methods. Within cardiology, arrhythmology represents one of the fields in which AI finds extensive application. The analysis of complex electrophysiological signals, data from implantable devices, advanced cardiac imaging, and clinical parameters enables the development of algorithms capable of identifying patterns not detectable by human interpretation. These tools have already demonstrated practical utility in the early diagnosis of arrhythmias, risk stratification, procedural planning and guidance for catheter ablation, prediction of response to cardiac stimulation therapies, and optimization of remote device monitoring. Among the key emerging benefits, AI promises increasingly personalized care, enabling more targeted interventions while reducing overtreatment. Furthermore, the development of "digital twins" opens the possibility of simulating patient-specific therapeutic scenarios to support complex clinical decision-making. This manuscript provides an overview of current evidence, emerging applications, and remaining challenges related to the integration of AI in arrhythmology, highlighting its potential to drive a transition towards predictive, preventive, and personalized cardiovascular medicine.
Journal of the American College of Clinical Pharmacy : JACCPJennifer Phillips, Katherine Sarna, Faria Munir, Heather Ipema
BACKGROUND: Generative artificial intelligence (AI) tools are increasingly used in health professional education, including for automated writing evaluation (AWE). While AI-based grading may reduce faculty workload and variability, its alignment with human grading remains unclear. This study compared rubric-based grading of pharmacy student drug information papers by faculty and ChatGPT (Open AI, San Francisco, CA). METHODS: We conducted a retrospective comparative analysis of 159 de-identified assignments from a required evidence-based medicine course. Faculty-assigned grades were paired with scores generated by a custom generative pretrained transformer (GPT) configured with the assignment rubric. The primary outcome was the difference in mean total scores; secondary outcomes included rubric section-level scores, variability, and agreement metrics. Paired t-tests, Lin's concordance correlation coefficient, and Cohen's weighted kappa were used for analysis. RESULTS: Aggregate mean total scores were higher for ChatGPT versus faculty (51.3 vs. 49; p = 0.0004, mean difference, 2.3; 95% confidence interval, 1.015-3.595), with differences in five of seven rubric sections. Faculty scores exhibited greater variability than ChatGPT scores (standard deviation, 7.4 vs. 3.7). Concordance between faculty and AI grading at the individual student level was poor (Lin's coefficient for total score = 0.06; kappa for overall grade = 0.03). ChatGPT also assigned more "B" grades and fewer failing grades compared with faculty. CONCLUSION: AI-based grading produced similar aggregate letter grades and reduced variability but demonstrated poor agreement with faculty scores at the individual level. AI grading may complement, not replace, faculty evaluation for assignments requiring critical appraisal, but further studies are needed.
European respiratory review : an official journal of the European Respiratory SocietyJian Wang, Chenxi Shi, Yingxiang Lin
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) represent a major driver of disease progression, healthcare utilisation and mortality worldwide. Despite robust guideline recommendations, substantial variability persists in the real-world management of AECOPD, particularly during hospitalisation and the vulnerable post-discharge period. Care bundles, defined as a small set of evidence-based interventions delivered collectively and reliably, have emerged as a pragmatic strategy to bridge the evidence-practice gap. This narrative review synthesises contemporary evidence on the structure, implementation strategies and clinical impact of AECOPD care bundles across the continuum of care. We summarise core bundle components during the acute in-hospital phase and the transition-to-discharge phase, critically appraise their effects on readmission, length of stay and mortality, and explore the heterogeneity between efficacy under controlled conditions and effectiveness in real-world settings. Drawing on principles from implementation science, we analyse multilevel barriers at system, provider and patient levels, and highlight facilitators including multidisciplinary team models, digital health-enabled decision support and iterative quality-improvement cycles. We propose that AECOPD care bundles function not merely as collections of interventions, but as delivery frameworks that improve the reliability of evidence-based care across the admission-to-discharge pathway. Current evidence suggests potential benefit for selected short-term outcomes, particularly readmission-related measures, but overall effectiveness remains heterogeneous and highly dependent on implementation fidelity, service organisation and post-discharge support. Future progress will depend on clearer bundle specification, context-sensitive design, integration of digital tools and greater emphasis on patient-centred outcomes.
Zhonghua yi xue za zhiM Xue, J F Xie, H B Qiu, L Liu
The 2026 Surviving Sepsis Campaign guidelines represent a systematic update built upon the 2021 version. The core changes are reflected not only in the adjustment of clinical recommendations but also, more significantly, in the restructuring of the methodological framework. This article provides an in-depth analysis of the new guidelines across four key dimensions: methodological innovations, evolution of clinical diagnostic and treatment strategies, extension of whole-course management, and the establishment of an independent recommendation system for resource-limited settings. The 2026 guidelines achieve four major paradigm shifts: transitioning from simple evidence updates to methodological restructuring, from uniform recommendations to risk-stratified precision medicine, from acute-phase treatment to whole-course management, and from a high-resource medical center perspective to a global health equity perspective. However, systematically identifying evidence gaps, integrating effective strategies into clinical practice, and placing greater emphasis on patients' long-term functional recovery and life quality remain future research priorities.
Studies in health technology and informaticsRobin Blouin, Karima Sedki, Jean-Baptiste Lamy
Clinical Practice Guidelines CPGs are the foundation of Evidence-Based Medicine but their long, complex and unstructured format makes them difficult to integrate in Clinical Decision Support Systems CDSS. While Large Language Models LLMs are great at reading text, their tendency to hallucinate and act as black boxes makes them unsafe for autonomous medical decisions. To solve this, we propose an automated pipeline that safely turns CPGs in raw PDF format into a structured, computable database of medical evidence expressed as formal arguments. First, we use computer vision to accurately extract complex tables and preserve the document's layout. Then, we constrain the LLM using strict clinical frameworks PICO and Toulmin to guarantee that every extracted claim is traceable and accurate. Finally, we use clustering and pruning methods to remove duplicate information and organize the data. The result is a clean, trustworthy knowledge base that lays the essential groundwork for formal argumentation graphs and reliable CDSS.
Research continues to inadequately integrate gender and diversity, reflecting the longstanding model in which the male body has been considered the universal standard. To address these gaps, initiatives like the SAGER (Sex And Gender Equity in Research) and SAGER-swissethics guidelines have emerged, to encourage the integration of sex and gender into research, from the design to the dissemination of results. Clinical guidelines rarely include sex- or gender-specific recommendations. It is unclear whether this lack reflects the absence of differences or, conversely, a lack of data to establish specific differences. While awaiting an update in the data, clinicians are invited to critically read the literature, adjust dosages to body compositions, and value patients' experiences to ensure equitable care.
The use of dermal fillers has emerged over the past two decades as one of the fastest-growing interventions in aesthetic medicine. While hyaluronic acid-based fillers account for the largest market share, alternative materials such as calcium hydroxylapatite, poly-L-lactic acid, and polymethylmethacrylate-based products are gaining increasing importance. Advances in injection strategies, anatomical precision, rheological product differentiation, and safety standards have led to a marked improvement in clinical outcomes. However, the profile of rare but potentially severe complications-particularly vascular occlusions-remains a central challenge. The aim of this review is to provide a comprehensive, evidence-based analysis of the current literature regarding materials, mechanisms of action, anatomical risk zones, injection techniques, indications, complication management, and future developments in filler therapy.
BMC health services researchEmma Bergstedt, Ann-Charlotte Nedlund
BACKGROUND: There is a strong emphasis globally that health policy and practice can be improved by leveraging best available evidence in decision-making processes. The dynamic political context of policy means, however, that decision-making processes are highly complex. A growing field of inquiry examines how the evidence-informed approach impacts on and interacts with real-world policy development. Despite the growing recognition of the complexity of health policy development little is known about policy narratives underpinning evidence-informed decision-making. Analysis of policy narratives over time can reveal how recognition of policy problems and their corresponding solutions emerge and shift through a contestation of different ideas and interests and how they legitimise different political courses of action. The aim of this study is to explore policy narratives underpinning evidence-informed decision-making within Swedish healthcare, tracing their formulation and development from 1992 to 2024. METHODS: The study is based on a textual analysis of Swedish government documents published 1992-2024. Drawing on theories of policy narratives, a thematic content analysis of 132 Swedish government-issued documents during this period was conducted. RESULTS: Four episodes with a dominant narrative in each emerged from the analysis. They differ in ideas connected to policy problems and solutions in healthcare and evidence-informed decision-making. Besides ideas on the substance of the policy solutions, the ideas include different assumptions about problems they are solving, how healthcare actors are connected to problems and solutions, values that motivate the solutions, and assumptions about mechanisms that will promote sound decision-making and resource use in healthcare. These four policy narratives include one of efficiency, provision of information, and deliberation; one of equality, data, and standardisation; one of integration, synthesis of perspectives, and collaboration; and one of responsiveness and the local context of decisions. CONCLUSION: The study offers insights into the governance of evidence-informed decision-making in healthcare. The findings contribute to a broader understanding of implications of the evidence-informed approach on healthcare policy, and how healthcare policy is shaped by competing ideas, values and assumptions. They also contribute to the theoretical debate on policy narratives, and discursive practice in general in healthcare governance.
BACKGROUND: Polyendocrine Metabolic Ovarian Syndrome (PMOS) is recognized as the most prevalent endocrine disorder among women of reproductive age, with an estimated prevalence of approximately 18% according to current Rotterdam diagnostic criteria. Conditions such as dyslipidemia, insulin resistance, hyperandrogenism, central adiposity, and chronic inflammation are frequently observed in women diagnosed with PMOS. These conditions predispose such individuals to an increased risk of developing Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), which is the most prevalent chronic liver disease worldwide, affecting approximately 25% of the global population. PMOS and MASLD represent two interconnected metabolic disorders that share overlapping risk factors. OBJECTIVE: The purpose of this narrative review is to investigate the underlying pathophysiological connections between PMOS and MASLD and to assess the efficacy of targeted nutritional interventions. METHODS: An analysis of nearly 30 articles concerning nutritional strategies for PMOS and MASLD was conducted, including studies on dietary patterns, macronutrient-focused dietary strategies, and dietary supplement interventions. RESULTS AND CONCLUSIONS: The review concludes that a combined approach-comprising an anti-inflammatory dietary pattern, omega-3 supplementation, and myo-inositol-serves as a good evidence-based initial strategy for clinicians and dietitians managing women with coexisting PMOS and MASLD. It is noteworthy that most of the evidence for these recommendations comes from studies that focus solely on either PMOS or MASLD populations. Studies involving individuals with both conditions are currently lacking. Future research should prioritize long-term randomized controlled trials involving women from diverse backgrounds diagnosed with both PMOS and MASLD. These conditions, whether independently or concurrently, are imposing an increasing burden on women of reproductive age worldwide. As further research is conducted, nutritional interventions may serve as primary rather than supplementary therapeutic strategies for the management of PMOS and MASLD.
La Clinica terapeuticaAndrea Mele, Patrizio Rossi, Felice Marco Damato, Raffaella Rinaldi
Despite the undeniable improvements made by research and therapy that have led to better prognosis and quality of life for many cancer patients, when the prognosis remains unfavorable, both in terms of survival and residual quality of life, the risk of suicide increases. If depression or another psychiatric disorder arises, the reconstruction of the causal link is more straightforward. The path appears less straightforward when this evidence is lacking, and one must question the awareness of the inevitability of the prognosis. Starting from cases of occupational neoplastic disease, in which annuity holders committed suicide, the Authors reconstruct the correct investigative methodology to follow for reconstructing the causal link, necessary to ensure Inail protection to the heirs. According to evidence-based medicine, the admissibility in the specific case of what is postulated in general must be evaluated. This requires some fundamental requirements: the diagnosis of occupational disease with unfavorable prognosis; the precise and documented knowledge of one's fate by the insured (through the development or not of a psychiatric illness already diagnosed and documented at the time of death); the absence of pre-existing (or subsequent) alternative causes independent of the occupational disease. The methodological framework adopted for neoplasias with unfavorable prognosis could also be applied to traumatic events that cause severe and drastic irreversible impairment in the subject's autonomy or to diseases that involve a progressive and worsening loss of autonomy, but in this case, the need for a well-documented psychiatric disorder, causally correlated to the consequences of the accident/disease, within which to inscribe the suicidal behavior, appears unavoidable. Some reflections from the Inail indemnity perspective must be formulated in recently observed cases of "assisted suicide," to understand how the Institute should behave if the subject's choice is related to the disability derived from a work accident or occupational disease. The Authors finally emphasize the importance of interventions useful for preventing suicidal events, measures that INAIL is beginning to implement, as demonstrated by the recent Implementation Agreement with the National Council of the Order of Psychologists.