This article attempts to highlight the importance of including research sustainability as imperative when assessing human medical research in terms of ethical principles. Using a scoping review of recent literature, the complexity of research sustainability is highlighted with key themes and concepts surrounding this important topic being recognized and discussed. An overall paucity of guidance documents was identified and recommendations have been made to practically address this deficiency. An example of a research sustainability evaluation tool which is currently being piloted has been provided for possible adaptation and use by Ethics Committees and Institutional Review Boards to bolster the concept and inclusion of sustainability during the research approval process.

BACKGROUND: The genetic composition of embryos generated by in vitro fertilization (IVF) can be examined with preimplantation genetic testing (PGT). Until recently, PGT was limited to detecting single-gene, high-risk pathogenic variants, large structural variants, and aneuploidy. Recent advances have made genome-wide genotyping of IVF embryos feasible and affordable, raising the possibility of screening embryos for their risk of polygenic diseases such as breast cancer, hypertension, diabetes, or schizophrenia. Despite a heated debate around this new technology, called polygenic embryo screening (PES; also PGT-P), it is already available to IVF patients in some countries. Several articles have studied epidemiological, clinical, and ethical perspectives on PES; however, a comprehensive, principled review of this emerging field is missing.
OBJECTIVE: This review has four main goals. First, given the interdisciplinary nature of PES studies, we aim to provide a self-contained educational background about PES to reproductive specialists interested in the subject. Second, we provide a comprehensive and critical review of arguments for and against the introduction of PES, crystallizing and prioritizing the key issues. We also cover the attitudes of IVF patients, clinicians, and the public towards PES. Third, we distinguish between possible future groups of PES patients, highlighting the benefits and harms pertaining to each group. Finally, our review, which is supported by ESHRE, is intended to aid healthcare professionals and policymakers in decision-making regarding whether to introduce PES in the clinic, and if so, how, and to whom.
METHODS: We searched for PubMed-indexed articles published between 1/1/2003 and 1/3/2024 using the terms \'polygenic embryo screening\', \'polygenic preimplantation\', and \'PGT-P\'. We limited the review to primary research papers in English whose main focus was PES for medical conditions. We also included papers that did not appear in the search but were deemed relevant.
RESULTS: The main theoretical benefit of PES is a reduction in lifetime polygenic disease risk for children born after screening. The magnitude of the risk reduction has been predicted based on statistical modelling, simulations, and sibling pair analyses. Results based on all methods suggest that under the best-case scenario, large relative risk reductions are possible for one or more diseases. However, as these models abstract several practical limitations, the realized benefits may be smaller, particularly due to a limited number of embryos and unclear future accuracy of the risk estimates. PES may negatively impact patients and their future children, as well as society. The main personal harms are an unindicated IVF treatment, a possible reduction in IVF success rates, and patient confusion, incomplete counselling, and choice overload. The main possible societal harms include discarded embryos, an increasing demand for \'designer babies\', overemphasis of the genetic determinants of disease, unequal access, and lower utility in people of non-European ancestries. Benefits and harms will vary across the main potential patient groups, comprising patients already requiring IVF, fertile people with a history of a severe polygenic disease, and fertile healthy people. In the United States, the attitudes of IVF patients and the public towards PES seem positive, while healthcare professionals are cautious, sceptical about clinical utility, and concerned about patient counselling.
CONCLUSIONS: The theoretical potential of PES to reduce risk across multiple polygenic diseases requires further research into its benefits and harms. Given the large number of practical limitations and possible harms, particularly unnecessary IVF treatments and discarded viable embryos, PES should be offered only within a research context before further clarity is achieved regarding its balance of benefits and harms. The gap in attitudes between healthcare professionals and the public needs to be narrowed by expanding public and patient education and providing resources for informative and unbiased genetic counselling.

BACKGROUND: Body contouring surgery (BCS) in adolescents, particularly following bariatric surgery, involves a complex array of ethical, psychological, and medical factors. This review focuses on adolescents who have experienced significant weight loss, often due to bariatric surgery, and subsequently require body contouring to address excess skin and soft tissue.
METHODS: A literature narrative review was conducted using PubMed and Google Scholar databases. Relevant articles were screened and selected based on their discussion of post-bariatric and massive weight loss body contouring surgeries in adolescents, focusing on prevalence, outcomes, and ethical considerations.
RESULTS: The prevalence of BCS among adolescents is rising, influenced by social media and societal perceptions of beauty. However, the percentage of adolescents receiving BCS after bariatric surgery remains low. Adolescents undergoing BCS experience improvements in physical functioning, body image, and psychological well-being. Complications, although common, are mostly minor. Ethical considerations include ensuring informed consent, assessing emotional maturity, managing patient expectations, and involving adolescents in decision-making. Comparative analysis reveals similar outcomes in adults and adolescents, but adolescents face unique ethical challenges related to autonomy, long-term effects, and ongoing physical and emotional development.
CONCLUSIONS: BCS in adolescents following bariatric surgery can lead to improved physical and psychological outcomes. However, the decision to undergo BCS must be carefully considered, taking into account the adolescent\'s maturity, expectations, and long-term well-being. Ethical considerations are paramount, emphasizing the need for informed consent, realistic expectations, and a multidisciplinary approach. Further research is needed to assess long-term outcomes and the specific ethical implications of BCS in adolescents compared to adults.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

This narrative explores the impact of deinstitutionalization policies on the quality of life and care outcomes for individuals with Alzheimer\'s disease and related dementias. We offer a historical perspective on these policies, their implications on dementia care, and the barriers to deinstitutionalization. The potential benefits of deinstitutionalization, such as improved quality of life and access to community-based support and services, are highlighted. Challenges and controversies surrounding safety, caregiver burden, and resource allocation are also examined. Ethical considerations related to the autonomy and decision-making capacity of people living with dementia are discussed. We present best practices and innovative models in dementia care that balance deinstitutionalization with appropriate care. We further put forth recommendations for future research and policy development in dementia care and deinstitutionalization, emphasizing the need for a balanced approach that respects the autonomy and preferences of people living with dementia while ensuring their safety and well-being.

Implantable cardioverter defibrillators (ICDs) reliably prevent death due to life-threatening arrhythmias; this may become less relevant in people with more severe heart failure who are reaching the end of life (EOL). This review aimed to explore the ICD deactivation process and identify ethical issues, especially around the initiation of relevant discussions among professionals and patients. Available literature was reviewed using four electronic databases to identify issues that may deter healthcare professionals from having important deactivation discussions and to address considerations for ICD management prior to the EOL. The search resulted in the retainment of 12 studies. Three themes emerged from the data: barriers and facilitators, ethical considerations in clinical practice, and nurse\'s role. Lack of knowledge, which has been associated with cultural differences, has been found among the barriers, and interdisciplinary education and open communication appeared as facilitators. As clinicians\' ethical considerations and fears emerged from the literature, nurses\' special role has not been sufficiently supported. Complex care requires facilitation by multidisciplinary teams and education around the device\'s function regarding EOL issues. Establishing expert consensus statements on advance care planning might help define the distinct roles of each healthcare practitioner involved. Further research is needed in addressing the identified gaps.

Internet addiction is a pervasive and complex issue that has gained increasing attention in the digital age. This comprehensive review provides an in-depth exploration of clinical interventions and modalities for managing internet addiction. It begins by examining the diagnostic criteria and assessment tools used to identify internet addiction, highlighting the diverse subtypes and varying degrees of severity. Subsequently, the review delves into various clinical interventions, including psychotherapeutic approaches like cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and mindfulness-based interventions. Pharmacological interventions, technology-based tools, and integrative approaches are also thoroughly analyzed. The review also outlines various treatment settings and modalities such as inpatient treatment centers, outpatient clinics, telehealth, support groups, and prevention programs for schools and communities. Furthermore, it discusses the efficacy and challenges associated with managing internet addiction, emphasizing the need for effective interventions, relapse prevention, ethical considerations, and addressing stigma and access barriers. In conclusion, the review offers practical implications for clinical practice. It emphasizes future research\'s importance in refining diagnostic criteria, exploring emerging technologies, and adapting interventions to an ever-evolving digital landscape. This comprehensive review is a valuable resource for clinicians, researchers, and policymakers seeking to understand and address the complexities of internet addiction.

This comprehensive review explores the transformative impact of artificial intelligence (AI) on hospital management, delving into its applications, challenges, and future trends. Integrating AI in administrative functions, clinical operations, and patient engagement holds significant promise for enhancing efficiency, optimizing resource allocation, and revolutionizing patient care. However, this evolution is accompanied by ethical, legal, and operational considerations that necessitate careful navigation. The review underscores key findings, emphasizing the implications for the future of hospital management. It calls for a proactive approach, urging stakeholders to invest in education, prioritize ethical guidelines, foster collaboration, advocate for thoughtful regulation, and embrace a culture of innovation. The healthcare industry can successfully navigate this transformative era through collective action, ensuring that AI contributes to more effective, accessible, and patient-centered healthcare delivery.

This comprehensive review explores the potential of salpingectomy as a groundbreaking strategy for the prevention of ovarian cancer. The discussion encompasses the biological rationale behind salpingectomy, emphasizing its foundation in the tubal hypothesis, which posits the fallopian tubes as a possible origin site for certain ovarian cancers. Ongoing clinical trials and observational studies provide evolving evidence supporting the safety and efficacy of salpingectomy, particularly in high-risk populations. The procedure\'s ethical considerations, including its impact on fertility and equitable access, are thoroughly examined. Implications for clinical practice underscore the importance of informed decision-making, risk-benefit assessments, and the integration of emerging evidence into reproductive health discussions. Looking ahead, the future landscape of ovarian cancer prevention involves continued research, technological innovations, and collaborative efforts to ensure a holistic and evidence-based approach. The goal is to forge a future where ovarian cancer is not only treatable but also preventable, with salpingectomy potentially playing a pivotal role in this transformative journey.

Robotic innovations in breast surgery have ushered in a new era of precision, safety, and patient-centred care. This comprehensive review explores the multifaceted realm of robotic breast surgery, from preoperative planning to postoperative outcomes, learning curves for surgeons, and the implications for healthcare policies. We examine the ethical considerations, cost-effectiveness, and future directions, including integrating artificial intelligence and telesurgery. Key findings reveal that robotic systems provide improved surgical precision, reduced complications, and enhanced patient satisfaction. Ethical concerns encompass informed consent, resource allocation, and equitable access. The future of breast surgery lies in continued research and development, ensuring that robotics becomes a standard of care accessible to all patients. This technology is reshaping breast surgery and offering new possibilities for minimally invasive, patient-centred care, ultimately redefining the standards of care in this critical field of medicine.

This comprehensive review explores the applications of platelet-rich plasma (PRP) in the context of compound fracture care, providing a thorough examination of its biological mechanisms, preparation techniques, and clinical implications. The analysis highlights PRP\'s potential in accelerating bone healing, enhancing soft tissue repair, reducing inflammation and infection risks, and managing pain during fracture recovery. The review underscores the importance of ethical and regulatory considerations in integrating PRP into orthopaedic practice, emphasising informed consent, transparent patient communication, and ongoing monitoring of ethical concerns. Looking ahead, the implications for the future of compound fracture care suggest a transformative shift with the potential for personalised medicine approaches and emerging technologies. However, the conclusion calls for a balanced perspective, acknowledging the promising applications of PRP while emphasising the need for responsible and ethical use. The collaborative efforts of healthcare professionals, researchers, and regulatory bodies are crucial in navigating this evolving landscape and harnessing the healing power of PRP to redefine orthopaedic care for individuals with compound fractures.