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Over the last decade, a growing number of health interventions (eg, medical assistance in dying and mitochondrial donation) have become legalised or decriminalised globally. Newly legalised health interventions share characteristics that are distinct from other health interventions, making their implementation more challenging. They are often highly emotive, controversial and associated with strong opinions and ethical dilemmas, with some of them being high-stake and irreversible. This study aimed to identify, systematise and map the factors that affect the implementation of health interventions that have recently been legalised. A systematically conducted review. PubMed, Scopus, EMBASE and CINAHL were searched to identify studies published between 2014 and 2024. We included studies if they evaluated the implementation of health interventions that were newly legalised or newly decriminalised. Data were extracted and synthesised through descriptive analysis. Both deductive and inductive thematic analyses were applied to map the barriers, facilitators and implementing strategies that influence the implementation of newly legalised health interventions in healthcare settings. The search strategy yielded 1510 publications, of which 78 were included in this review. Findings showed that several newly legalised health interventions, including medical assistance in dying (n=56 studies); medical abortion (n=13); assisted human reproduction (n=3); psychedelic-assisted therapies (n=3); use of medical cannabis (n=2) and use of biosimilars (n=1) were addressed. The analysis identified a total of 880 diverse barriers, facilitators and strategies in five domains across system, organisational and individual levels: (1) patients/service users/consumers; (2) healthcare providers; (3) healthcare organisation; (4) legal processes and (5) system. These were further divided into 27 themes of barriers, 18 themes of facilitators and 17 themes of strategies. Implementing newly legalised health interventions is complex. Our findings can support the development of an implementation plan for the spread and scaling of future health interventions, maximising the impact of interventions and making them accessible to more people and health organisations.

Participatory organizational interventions (POIs) may improve workers' mental health and work performance, but evidence from systematic reviews and meta-analyses of cluster-randomized controlled trials (cRCTs) remains limited: The meta-analysis has not been updated since 2015; a previous study focused on healthcare workers; and potential outcomes have not been adequately examined. This systematic review and meta-analysis aimed to investigate the effects of POIs on mental health and work performance among workers. The current study searched PubMed, EMBASE, PsycINFO, PsycARTICLES, and Japan Medical Abstracts Society for papers published by November 11, 2022. Eligible studies were cRCTs assessing the effects of POIs on mental health or work performance. The risks of bias were evaluated by using the Cochrane risk-of-bias tool for cRCTs and performed meta-analysis using a random effects model. Fourteen cRCTs were included in the systematic review, and eight cRCTs in the meta-analysis. The meta-analysis showed non-significant beneficial effect on mental health conditions [the standardized mean differences (SMD) = -0.04, 95%CI; -0.10 to 0.03], positive mental health (SMD = -0.004, 95%CI; -0.077 to 0.068), and work performance (SMD = 0.01, 95%CI; -0.10 to 0.13). This study did not confirm that POIs had a statistically significant effect on mental health or work performance. However, several studies that reported favorable results tended to emphasize active and structured participation, alignment with workers' needs, and attention to organizational context. Further research is needed to identify the conditions under which the interventions are effective. Trial registration: The study protocol was registered at the UMIN registry (registration number: UMIN000049453).

In forensic genetics, the allele and haplotype frequencies of relevant populations are required to determine the weight of evidence for DNA matches. In recent years, ethical concerns have been raised about population studies published in forensic journals and compiled in Forensic Genetics Frequency Databases (FGFDs), particularly regarding consent procedures for sample collection, the overrepresentation of vulnerable groups, and the risk of donor re-identification. A comprehensive review of ethical practices in forensic population genetics research on identity DNA polymorphisms and ancestry informative markers was conducted, focusing on papers published in Forensic Science International: Genetics and indexed in MEDLINE (2007-2025) and Forensic Science International: Reports (2019-2025). A decline in the number of published forensic population genetics papers was observed following the adoption of dedicated ethical guidelines in 2020. However, increased attention to ethical issues, such as the need for informed consent (IC) of sample donors and approval by pertinent ethical review boards (ERB), predates 2020, with a linear increase over time in the proportion of papers reporting IC and ERB approval. Among the included papers, 48.7% were conducted by or in collaboration with law enforcement laboratories, 39.1% involved minority populations, and 14.3% used forensic casework samples, all of which represent potential sources of ethical concern. In most studies conducted by multinational teams, researchers from the countries of the sampled populations were involved, with the notable exception of Africa, with 31.0% of studies having no African-affiliated authors. Furthermore, even after 2020, a substantial proportion of studies (11.8%) reported complete genotypes of DNA markers associated with a high risk of re-identification. The most common form of non-compliance with the 2020 ethical guidelines was the failure to report written informed consent (40.0%). Overall, the proportion of studies classified as ethically "low risk" according to the Forensic Database Advisory Board increased significantly after 2020, reaching 78.5% of the papers published in that period. Notably, during the preceding period (2010-2020), the proportion of low risk studies was significantly higher for DNA markers for which editorial guidelines required quality control by an FGFD (42.1%) than for other markers (30.3%). To support editors and peer reviewers, suggestions are proposed to improve ethical guidelines for the publication of forensic population genetics data, with particular attention to ERB approval documentation, secondary use of biological samples, and recognition of the role of researchers from the country of population samples collection in multinational studies.

Broadband Near-Infrared Spectroscopy (bNIRS) has emerged as a promising technique for non-invasive monitoring of the redox state of cytochrome-c-oxidase (CCO), a key enzyme in cellular energy production. While early work focused on linear approaches based on the modified Beer-Lambert Law (MBLL), recent decades have seen substantial diversification in both instrumentation and computational strategies. To capture this evolution, we conducted a systematic review following PRISMA guidelines across PubMed, Web of Science, ScienceDirect (limited to the journal NeuroImage), and IEEE Xplore, identifying 35 studies that reported novel hardware or algorithmic approaches to CCO reconstruction. Hardware developments ranged from broadband lamps and supercontinuum lasers to LED and CMOS-based miniaturised systems, reflecting a trade-off between spectral coverage, portability, and sensitivity. Algorithmic innovations encompassed refinements of MBLL, diffusion theory, stochastic Monte Carlo modelling, and emerging machine learning methods, each addressing challenges of scattering, spectral overlap, and low signal-to-noise. Despite progress, the field remains limited by variability in instrumentation, standardised validation protocols, and the inherent weakness of the CCO signal relative to haemoglobin. We conclude that advancing bNIRS toward robust, clinically relevant metabolic monitoring will require integration of wearable system design, high-performance computational modelling, and shared benchmarking datasets. This review provides a structured synthesis of hardware and algorithmic advances, highlighting the underlying physics that govern light-tissue interaction and reconstruction, and identifying key directions for future research at the intersection of optical modelling, biomedical engineering, and translational neuroscience.

Medical assistance in dying (MAiD) became a legal end-of-life option on December 10, 2015, in Québec, and on June 17, 2016, in the rest of Canada. Since its legalization, there has been a steady increase in the number of MAiD requests and provisions. Across permissive jurisdictions, Québec now has the highest rate of assisted death. Despite the growing use of MAiD, research examining the factors driving this increase remains limited and fragmented. Existing studies offer partial and sometimes contradictory explanations, with little integration of legal, institutional, societal, and individual dimensions. Further research is needed to better understand the determinants of MAiD requests and practices, particularly in the Canadian and Québec contexts. This research aims to understand the factors influencing changes in MAiD requests and administrations in Québec by examining laws, practices, societal perspectives, organization of care and services, and individual characteristics of those requesting MAiD, as well as their interrelationships. We present the protocol developed by the Consortium interdisciplinaire de recherche sur l'aide médicale à mourir, an interdisciplinary research consortium, including an international advisory committee, set up for this research. The design of this protocol is multimethods and convergent mixed methods, including (1) an international cross-thematical approach with 4 main research methods (a scoping review, key informant interviews, focus groups with health care professionals, and a population-based survey) chosen to partially answer research questions across the entire study and to compare with other jurisdictions and (2) 11 theme-specific methods (including community forums, media coverage analysis, comparative legal analyses, case studies of triads, individual interviews, and system mapping) to enrich and complement findings from the cross-thematical approach. When this 3-year funded study started in July 2024, several research methods not requiring ethics committee approval (because no human participants were involved) were initiated, including scoping and systematic reviews, media coverage analysis, and comparative legal analyses. By August 2025, interviews with key informants were completed, and analyses took place in September. Concurrently, other subteams started data collection (focus groups December 2025) or are getting ready to seek ethics approval for their protocols and data collection processes involving human participants: case studies of triads, individual interviews, and community forums. Findings from the international cross-thematical approach and theme-specific methods will provide a comprehensive understanding of the factors influencing the use of MAiD in Québec. This study has strengths, including the use of a specific theoretical framework, a variety of complementary methods, and an integrated knowledge mobilization strategy. As for its limitations, we foresee challenges with the comparison of jurisdictions in terms of language, culture, and legal systems, as well as access to data about MAiD cases, since reporting systems may differ between jurisdictions. DERR1-10.2196/83549.

Today's primary care physicians are being asked to address patients' health-related social needs (HRSN) as part of their routine care practices. An aging population, with a growing complement of intersecting medical and social needs, increases this burden on primary care. Medical-legal partnerships (MLP) are interprofessional collaborations that combine clinical and legal expertise to address HRSN involving housing, public benefits, employment, and other domains remediable by civil legal assistance. A value-based approach to integrating MLP into the health system may help primary care practices more effectively address HRSN and, in turn, better balance revenue and expenses. At the practice and healthcare system levels, a key operational component is data coordination between medical and legal partners, which will enable MLP to define patient populations whose needs are amenable to legal intervention. At the state and federal levels, policy coordination will play a similar role, assessing existing authorities under Medicaid and other federal programs and advocating for data-justified enhancements. Health systems, hospitals, clinics, and primary care practices should recognize the potential for MLP to improve the value of clinical care delivery for patients with HRSN, their families, and communities.

Vaccine mandates were widely implemented against COVID-19, and a large and multidisciplinary literature has emerged as a result, covering fields such as epidemiology, economics, ethics, and law. We compiled an openly available repository of this literature, including 503 studies on COVID-19 vaccine mandates. We identified them through a manual multi-database search and performed the data extraction using a large language model. The dataset stores information, for each study, on the scope and sanctions of the relevant mandate(s), the study design, target population, outcomes, and themes, allowing users to quickly navigate this complex literature. We use the dataset to present key statistical facts and insights about this literature, and we leave to other scholars the opportunity of interrogating it further. As a worked example, we conduct a narrative review of quasi-experimental studies on COVID-19 vaccine mandates. These consistently show short-run increases in first-dose uptake following mandate announcements, with limited evidence on long-run uptake and downstream social, health, and economic outcomes. We provide all data and code to support secondary analyses and future evidence syntheses.

In recent years, missed nursing care (MNC) has been a major concern for healthcare systems. Although existing literature highlights moral sensitivity (MS), moral distress (MD), and patient safety climate (PSCL), as important factors contributing to this issue, the precise relationship between these factors and MNC remains inadequately understood. This study aimed to explore the relationship between MS, MD, and PSCL with MNC in clinical nurses. The systematic review used several international databases, including PubMed, Web of Science, Scopus, EMBASE, ProQuest as well as Google Scholar search engine. The search covered publications from January 1, 1995, to August 31, 2025; thirteen articles were included in this review. Quality was assessed using the 8-item Joanna Briggs Institute (JBI) critical appraisal tool for analytical cross-sectional studies. The findings showed varying links between MS and PSCL with MNC, spanning from no significant correlation to a significant negative one. Also, the findings revealed that the eligible included studies reported different relationships between MD and MNC, varying from no significant connection to a significant positive one. The study identified MS, MD, and the PSCL as potentially influencing factors for clinical nurses' MNC. Health policymakers and clinical nursing managers should focus on these specific factors to create initiatives that aim to minimize clinical nurse' MNC and improve the quality of care provided. Not applicable.

The contributions of Leonard Furlow to plastic surgery were made over 6 decades, influencing the fields of cleft palate repair, flexor tendon healing, and reconstructive transplantation. Beyond surgical technique, his essays on surgical pioneers and reflections on specialty evolution underscore his belief in plastic surgery as a discipline driven by innovation and intellectual curiosity. To construct this narrative, we reviewed the publications of Furlow and identified developments of his ideas and their applications. Over the length of his career, Furlow made significant original contributions to flap anatomy and design, flexor tendon healing and management of flexor tendon injuries, reconstructive transplantation, and cleft palate repair. His historical works included descriptions of the development of surgical ideas as well as portraits of teachers and colleagues. Furlow also published commentaries and editorials that explore the roles of concept and innovation in the ongoing development of plastic surgery. The career of Furlow, as documented by his publications, demonstrates the great scope and wealth of his contributions to plastic surgery practice and progress.

Peripartum depression (PPD) affects ~12-25% of pregnant and postpartum women worldwide, yet routine screening often fails to capture real-time symptom changes. Digital phenotyping (DP), using data from digital devices such as text entries, sleep tracking, physical activity, social media behavior, and ecological momentary assessments, has been proposed as a complementary approach to support the prediction and early identification for PPD. This systematic review (PROSPERO: CRD42023461325) examined 14 studies published between 2014 and March 2025 that explored passive and active DP data across the antenatal and postnatal periods. Most studies employed observational designs and used the Edinburgh Postnatal Depression Scale as the primary outcome. Passive DP data related to sleep and circadian rhythms were frequently associated with depressive symptoms, whereas findings for physical activity were inconsistent. Active DP data, including language features from text entries, mood logs, semi-random ecological momentary assessments, and social media behavior, were often reported as informative, particularly when combined with personal history or self-reported measures. However, considerable variation across study designs, data sources, analytical approaches, and validation strategies limits direct comparison of findings and prevents causal interpretation. Overall, the evidence remains largely exploratory, and findings should be interpreted cautiously pending more rigorous validation.

The aim of this study was to evaluate the association between obstructive sleep apnea (OSA) and periodontitis using an umbrella meta-analysis (MA). PubMed, MEDLINE, Web of Science, Scopus, Embase, and Google Scholar databases were systematically searched before December 2025. MAs reporting odds ratios (OR) for the association between OSA and periodontitis were included. Methodological quality was assessed using AMSTAR-2, and certainty of evidence was evaluated using GRADE. Random-effects MA was performed. Egger's test and trim-and-fill analysis were used to assess the publication bias. Seven MAs encompassing over 225,000 participants were included. A significant association was found between OSA and periodontitis (OR 1.96, 95% CI 1.68-2.29, p&#x2009;<&#x2009;0.0001), with substantial heterogeneity (I2&#x2009;=&#x2009;69.5%). After using trim-and-fill method to adjust for publication bias, the association strengthened (OR 2.24, 95% CI 1.92-2.60, p&#x2009;<&#x2009;0.0001). A dose-response pattern emerged, with severe OSA showing higher odds (OR 2.25) compared to mild-moderate OSA (OR 1.82), though not statistically different (p&#x2009;=&#x2009;0.44). The association remained consistent among different study qualities and sample sizes. The GRADE assessment rated the certainty of evidence of the main outcome as low due to heterogeneity and publication bias. Further, a high overlap ratio of 26.8% was observed among the included MAs. The results of this review suggest a significant association between OSA and periodontitis, with a greater association of severe OSA with periodontitis. Future studies should examine the impact of periodontal therapy on OSA severity and vice versa. CRD420251241137.

India's sporting ecosystem remains deeply entrenched in binary classifications of sex, despite the country's long-standing cultural recognition of gender diversity and its progressive constitutional jurisprudence on gender identity. This paper examines India's engagement with transgender, non-binary, and sex-variant athletes, highlighting the disconnect between legal recognition and sporting governance. While landmark judicial decisions such as NALSA vs. Union of India (2014) have affirmed the right to self-determined gender identity and constitutional guarantees of dignity, equality and non-discrimination, these principles have yet to be meaningfully operationalised within Indian sport. Through a socio-legal analysis of prominent Indian case studies of Anaya Banger, Aryan Pasha, Dutee Chand, Shanthi Soundararajan, and Nandini Agasara, the paper illustrates how athletes who fall outside normative sex-based classifications face invasive scrutiny, regulatory exclusion, privacy violations, and social stigma. These cases demonstrate how sports authorities frequently conflate transgender identity with intersex variations and natural biological diversity, resulting in inappropriate eligibility standards and coercive medical practices. The paper situates these experiences within broader international developments, including fragmented global sporting regulations. The analysis further explores India's constitutional framework, statutory protections under the Transgender Persons (Protection of Rights) Act, and relevant international human rights obligations, arguing that the principal barrier to inclusion is not the absence of rights but the failure to implement them within sport-specific governance. The paper concludes by proposing pathways for reform, including the adoption of uniform national guidelines, affirmative support measures, institutional sensitisation, and evidence-based policy design. It argues that inclusive sport is not merely a matter of competitive fairness, but a measure of democratic belonging, dignity, and substantive equality in practice.

Ketamine is a dissociative anesthetic with potential for treating mood, anxiety, and related disorders; however, concerns have emerged regarding hepatotoxicity in the context of chronic treatment. Systematic searches of PubMed, Scopus, and Ovid databases were conducted from inception to August 2025. Eligible studies included randomized controlled trials (RCTs), observational studies, and case reports/series reporting liver function outcomes following therapeutic ketamine administration for mood, anxiety, or related psychiatric disorders. Of 635 screened records, 13 met inclusion criteria: five RCTs, three observational studies, and five case reports/series, encompassing 1017 patients receiving ketamine primarily for major depressive disorder (MDD) and bipolar disorder (BD). Across RCTs (n&#xa0;=&#xa0;879), 75 hepatic adverse events were reported, predominantly mild and transient aminotransferase elevations, with rare cases of liver impairment, but no cases meeting Hy's Law criteria. Observational studies identified three instances of liver impairment, RCTs identified one case as indicated by elevated bilirubin, and case reports described more severe presentations, including bile duct dilation and gall bladder distention, which improved with dose reduction or discontinuation. Evidence identified here suggests that ketamine at dosing regimens typically used for mood disorders may cause liver enzyme elevations, but impaired liver function and serious hepatotoxicity appears rare. However, considering the instances of impaired liver function identified herein and real-world data associating severe drug-induced liver injury (DILI) with higher exposures, routine liver monitoring remains justified throughout ketamine treatment.

Necrotizing enterocolitis (NEC) and sepsis/late-onset sepsis (LOS) are significant contributors to preterm infant morbidity and mortality, with prematurity and low birth weight representing major risk factors for these interconnected conditions. Although the pathogenesis of NEC and LOS is not fully understood, there is a clear association with an immature intestinal mucosal barrier, which may enable bacterial invasion and translocation, resulting in an inflammatory cascade. Increasing recognition of the gut microbiome as a marker for health and disease has driven interest in probiotics, particularly Bifidobacterium spp. and Lactobacillus spp., as potential adjunctive agents for the prevention and management of NEC and LOS in preterm infants, which is the area of focus of this review. The focus of this paper was to analyze clinical studies using different probiotic strains, and compare single-strain versus multi-strain probiotic formulations. Several studies support that probiotic supplementation in preterm infants has the potential to decrease NEC incidence and, to a lesser extent, sepsis/LOS. Nonetheless, inconsistent results due to strain differences and clinical heterogeneity limit the widespread adoption of this mode of therapy, as do safety concerns in this vulnerable population. Further high-quality standardized studies are necessary to establish consistent guidelines for probiotic use in preterm infants.

The thin labial alveolar wall (LAW) of anterior maxillary teeth is prone to resorption after flap surgery, jeopardizing aesthetic outcomes. This study evaluated whether extended guided bone regeneration (GBR) to cover the LAW of adjacent teeth mitigates this bone loss. In this retrospective cohort study, we categorized adjacent teeth into three groups according to the intraoperative extension of the graft relative to the LAW: Non-Extended GBR (NE-GBR; graft confined to edentulous site), Partially Extended GBR (PE-GBR; graft on partial BBW), and Fully Extended GBR (FE-GBR; graft covering BBW to the crest). Horizontal LAW thickness and vertical distance from cementoenamel junction to the alveolar crest were measured on superimposed pre-operative and 6-month post-operative CBCT scans. Analysis included 135 adjacent teeth (80 patients). Significant horizontal resorption occurred in the NE-GBR (-&#x2009;0.40&#x2009;&#xb1;&#x2009;0.32&#xa0;mm) and PE-GBR (-&#x2009;0.43&#x2009;&#xb1;&#x2009;0.44&#xa0;mm) groups (p&#x2009;<&#x2009;0.001), while the FE-GBR group maintained stable dimensions (0.15&#x2009;&#xb1;&#x2009;0.75&#xa0;mm, p&#x2009;=&#x2009;0.523). Vertically, the FE-GBR group showed a significant dimensional gain (0.43&#x2009;&#xb1;&#x2009;1.10&#xa0;mm, p&#x2009;<&#x2009;0.001), unlike the resorption seen in other groups. Mixed-effects models confirmed FE-GBR as a significant positive predictor for both horizontal (&#x3b2;&#x2009;=&#x2009;0.48, p&#x2009;<&#x2009;0.001) and vertical (&#x3b2;&#x2009;=&#x2009;0.48, p&#x2009;=&#x2009;0.001) dimensional preservation. Fully extended GBR to cover the LAW up to the crest appears to counteract post-surgical reduction, better preserving radiographic alveolar ridge dimensions in the aesthetic zone over a 6-month period. This study protocol was approved by the Institutional Review Board (LCYJ20250303005) and was registered in the Chinese Clinical Trial Registry (ChiCTR2500099603).

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Since 2019, numerous reports (both official and charity-led) have been published detailing patient care and safety failings in areas of women's healthcare in hospitals across the UK. A common theme that has emerged from these reports is a sense that the voices of women and people seeking maternity care and/or treatment for female health conditions are frequently dismissed and silenced. While many of the examples detailed in these reports have been appropriately recognized as both individual and systemic failings in patient care, here we apply Miranda Fricker's epistemic injustice framework to these issues. We argue that testimonial injustice (a form of discriminatory epistemic injustice) forms a core part of the experience of some of these patients' care resulting in a compounding of their experience of harm. Despite various exhortations within the reports that women should be listened to, the evidence demonstrates that women's testimonial knowledge is systematically devalued. We thus contend that a fundamental reframing of the issue is required and that understanding how and why epistemic injustice occurs is critical to developing a better understanding of how to avoid it, both in the provision of women's healthcare and in its regulation.

Large language models (LLMs) and related generative artificial intelligence (AI) systems are rapidly entering clinical workflows, including in gastroenterology and hepatology, where text-heavy documentation, guideline-driven care, and high-volume patient messaging create a strong demand for decision support and automation. Deployment raises distinctive risks: hallucinations and unsafe recommendations, automation bias, privacy and confidentiality threats, inequitable care, intellectual property and licensing uncertainty, and unclear allocation of responsibility across clinicians, institutions, and vendors. Regulators are increasingly emphasizing a lifecycle approach to trustworthy AI, including validation, risk management, human oversight, cybersecurity, monitoring, and transparency. Frameworks for healthcare protection regulate how health information may be shared with external model providers and how outputs should be logged, audited, and retained. This review synthesizes practical guidance for responsible LLM use, organized around (1) tiered use cases and risk stratification; (2) ethical principles (beneficence, non-maleficence, autonomy, justice, and accountability); (3) core legal and regulatory considerations; and (4) operational governance, evaluation, and monitoring strategies. Actionable checklists to support institutional adoption, use, and transparency are provided. Responsible use requires aligning LLM capabilities with risk, preventing inappropriate data sharing, validating performance in representative populations, ensuring human oversight and clear accountability, mitigating harm, and maintaining an evidence-based, continuously monitored deployment lifecycle. Language models in GI care Large language models (LLMs) are powerful AI tools that can help clinicians by drafting notes, summarizing information, and assisting with patient messages. They are becoming common in gastroenterology and hepatology as the field relies heavily on written documentation and synthesis of complex clinical data. However, these tools can sometimes produce confident but incorrect information, overlook important details, or reflect biases found in their training data. Owing to these risks, LLMs must always be used with human oversight, not as independent medical decision&#x2011;makers. Privacy remains a major concern. When LLMs process patient information, organizations must follow strict rules such as Health Insurance Portability and Accountability Act (HIPAA) and General Data Protection Regulation (GDPR) to protect confidentiality, manage cybersecurity risks, and ensure that data shared with vendors is appropriately controlled. To use LLMs safely, health systems should match the tool to the level of clinical risk, from simple administrative tasks to high&#x2011;stakes decision support. They should build in safeguards like human review, high&#x2011;quality medical sources, transparency about AI use, and continuous monitoring for errors or drift in performance. LLMs also need to be checked for fairness, since they may unintentionally reproduce biased medical assumptions, which can contribute to inequitable care. Overall, LLMs can reduce burden and support high&#x2011;quality care in gastroenterology and hepatology, but only when paired with strong governance, human oversight, privacy protections, and responsible workflows.

The sources of judicial dissatisfaction with, and criticism of, expert healthcare evidence are traced to unqualified, careless, overworked and unscrupulous experts and a failure on the part of some experts to work collaboratively with their instructing lawyers during the litigation process. The suggested remedies are: adherence to the clear professional standards that already exist, appropriate training for which the foundations should be laid during undergraduate medical education, continuing professional development, credentialing complemented by instructing solicitors and counsel ensuring that the expert is appropriate for the case and aware of their duties, collaborative working between expert and instructing lawyer, peer and institutional support and quality control including peer review of reports and case-based discussion of reports.