BACKGROUND:Inconsistent terminology and conceptual overlap among clinical practice guidelines, treatment protocols, and care pathways can lead to confusion in program design and implementation. METHODS:Drawing on the implementation experience of HEARTS in the Americas-the largest regional adaptation of the WHO Global HEARTS Initiative-this communication describes the characteristics, functions, and interrelationships of clinical practice guidelines, treatment protocols, and care pathways. It outlines their respective roles in development, approval, and execution to clarify their contributions to both health system organization and clinical practice. RESULTS:Clinical practice guidelines are composed of evidence-based recommendations grounded in rigorous scientific evaluation to support clinical decision-making. Care pathways serve as implementation tools that translate guidelines into standardized, multidisciplinary plans that organize hypertension management, facilitate task-sharing, and engage patients. Embedded within pathways, treatment protocols offer a simplified, step-by-step approach tailored to most patients, specifying a limited set of medications and dosages to ensure timely blood pressure control, reduce therapeutic inertia, and promote consistent care delivery. CONCLUSIONS:Clarifying the distinctions and synergies among guidelines, protocols, and care pathways might enhance alignment between clinical guidance and service delivery, supporting effective implementation and scale-up of hypertension and chronic disease management programs.
WHO's Global HEARTS is the largest worldwide effort to improve hypertension control through standardised care. HEARTS in the Americas is its regional adaptation. To address the rising burden of cardiovascular, kidney and metabolic conditions, the initiative launched HEARTS 2.0, aiming to promote integrated care, reduce fragmentation and improve quality, access and health outcomes. In phase I, an expert-led consensus identified 45 evidence-based interventions for inclusion in an expanded Clinical Pathway. This report presents findings from phase II on the readiness of 26 Latin American and Caribbean countries to implement these interventions. We used a cross-sectional design and a structured, self-administered questionnaire completed by national implementation teams. It systematically assessed the availability, feasibility, time required and key barriers for each proposed intervention. While many interventions, especially for risk assessment and non-pharmacological treatments, are considered feasible in many countries, their current availability is limited due to ongoing shortages of diagnostics, medicines and infrastructure. Over the next 3 years, 18 countries are projected to implement >30 of the 45 interventions, four countries aim to implement 20-30 and four expect to implement fewer than 20. While primary health systems in most HEARTS-implementing countries do not yet appear ready to deliver integrated cardiovascular, kidney and metabolic care, the scale-up of HEARTS 2.0 presents a strong opportunity to advance this integration. As health systems worldwide face the challenge of increasing multimorbidity in their patients and fragmented care delivery systems, this assessment offers a practical tool for planning and action.
Carbapenemase-producing Enterobacter (CP-Ent) are the third most prevalent species of CP-Enterobacteriaceae worldwide and exhibit greater strain diversity than other CP-species. This study aimed to describe the genomic epidemiology of CP-Ent in south-central Ontario, Canada. CP-Ent isolates collected from colonised/infected patients identified by population-based surveillance in Toronto/Peel Region, Canada (2007-2020), sink/shower drains in 12 regional hospitals (2016-2019), and five municipal wastewater treatment plants (2015, 2017) were analysed to assess relationships between patient and environmental CP-Ent. Clinical data were collected by chart review/patient interview. CP-Ent isolates were sequenced by Illumina. Genomic analysis included Snippy, IQ-Tree, and ClonalFrameML; ≤ 20 single-nucleotide variant differences defined strains. CP-Ent colonisation/infection incidence increased from 2007-2020. Overall, 3.5% of sink/shower drains and 22% of municipal wastewater cultures yielded CP-Ent. Patient and sink/shower drain isolates were similar in species and carbapenemases produced; municipal wastewater isolates were distinct. Forty-one of 116 patients (35%) belonged to 15 transmission clusters: 5/15 (33%) included drain isolates, and 32/41 (78%) patients were linked to others in the same hospital, including 22 (54%) linked by stays in the same ward. Patients were more likely to be linked by ward exposure at different times versus the same time in wards with sink/shower drains yielding CP-Ent versus those without (13/19 vs 2/23, p=<.001). Despite transmission control efforts, a significant proportion of CP-Ent are part of hospital transmission clusters; sink/shower drains may be implicated in transmission. It is likely that undetected patients, drains and/or other reservoirs contribute to CP-Ent transmission in the studied population.
La frecuencia de la tos ferina fue controlada en varios países con la vacunación, aunque ha reemergido en las últimas décadas. Poco se sabe de la historia de esta enfermedad en Colombia; este trabajo resume la historia de la tos ferina en el país desde un enfoque poblacional.Las evidencias sugieren que la tos ferina apareció hacia finales del siglo XV en Persia, y desde esa época ha sido endémica, especialmente entre los menores de edad. Al territorio colombiano debió llegar durante el siglo XVIII o a inicios del XIX. En Colombia, se han presentado importantes epidemias, en especial antes de que existiera la vacuna contra Bordetella pertussis. Las epidemias más importantes tuvieron lugar en Bogotá (1814) y en Cajicá (1922). La vacunación fue muy efectiva en la segunda mitad del siglo XX, aunque hubo brotes entre las poblaciones no vacunadas de las zonas rurales y entre los indígenas de diversos lugares del país. Actualmente, la tos ferina es una amenaza para Colombia por los casos traídos del exterior o en personas sin vacunar.
Artificial intelligence (AI) is rapidly reshaping the landscape of health care, from clinical diagnostics and disease surveillance to the prediction of individual health risks. Yet, its immense promise will only materialize if the tools we deploy work for everyone. Algorithms trained on incomplete or biased datasets risk embedding historical health disparities and can replicate patterns of uneven data representation, thereby limiting accuracy and generalizability across population groups. Addressing algorithmic bias should be treated as a core health quality standard, comparable in importance to safety and efficacy evaluations, to ensure consistent performance across all segments of the population. This paper aims to frame algorithmic bias in health-related AI as a quality, safety, and governance challenge for health systems rather than solely a technical problem for developers. It aims to inform policymakers, regulators, health system leaders, and developers by translating existing scientific evidence and regulatory guidance into operational governance considerations, with particular attention to the realities of low- and middle-income settings in the region of the Americas. This paper synthesizes existing knowledge and institutional experience into a practical, regionally grounded policy perspective. To operationalize this perspective, this paper first outlines the main forms of algorithmic bias relevant to health systems—including representation, measurement, aggregation, and deployment biases—and illustrates how each can emerge across the AI lifecycle. It then situates these technical challenges within the broader digital health context, where structural, commercial, and social dynamics may amplify inequities. This paper discusses the implications of biased data for emerging areas such as precision medicine before proposing a governance-oriented framework for bias mitigation that spans design, validation, deployment, and postmarket monitoring. It concludes with priority governance actions for policymakers, regulators, and health system leaders to embed fairness as a measurable component of health system performance.
