Background: Medical mediation offers a patient-centered, collaborative alternative to traditional resolution methods for healthcare conflicts that is gaining international traction in an increasingly complex environment of advancing technology and diverse patient populations. This systematic review aims to synthesize the literature on medical mediation and analyze its clinical applications, conflict typologies, involved actors, mediation methodologies, legal frameworks, and theoretical underpinnings. Methods: A systematic search was conducted in PubMed and Scopus for English-language articles published between 1984 and 2025. Results: Of 656 initial records, 152 studies met the inclusion criteria and were categorized across six domains: clinical context, actors involved, conflict type, mediation framework, legal/policy structure, and theoretical foundations. Most studies originated from high-income countries, particularly the U.S. and U.K., with notable expansion after 2010. Medical mediation was most frequently applied in bedside care, end-of-life decision-making, and managed-care disputes. While ethics consultants were the primary mediators, increasing involvement of trained clinicians and institutional actors was also observed. Most studies emphasized generic bioethical mediation frameworks, with some focused on formalized models and training. Legal frameworks varied, and an increasing number of countries have been adopting institutional or national programs to support mediation. Conclusions: Medical mediation is an efficient tool for resolving complex clinical conflicts, enhancing communication, and preserving therapeutic relationships. Its institutionalization, through law and training, is key to the promotion of justice, transparency, and ethical integrity in modern healthcare systems.

Several diseases caused by tick-borne pathogens, including Lyme borreliosis (LB) and spotted fever group rickettsioses, are endemic in the Balkan Peninsula, positioned between Central Europe and the Middle East. This cross-sectional study aimed to assess serological exposure to Borrelia spp. and spotted fever group Rickettsiae (SFGR) among individuals with recent tick bites and healthy controls in two Balkan countries—Serbia and North Macedonia. Serum samples from 223 participants were tested for anti-Borrelia and anti-SFGR IgG antibodies. SFGR exposure was significantly higher in tick-exposed individuals from Skopje (North Macedonia) compared to those from Novi Sad (Serbia) (30.9% vs. 8.0%; p = 0.003). In contrast, anti-Borrelia IgG was more frequently detected in Novi Sad, though differences did not reach statistical significance. The findings support a north-to-south gradient in Borrelia exposure and a reverse trend for SFGR, consistent with earlier studies and regional tick infection data. Given the high SFGR exposure and limited clinical reporting in North Macedonia, the results highlight the likelihood that tick-borne rickettsioses remain under-recognized. Additionally, Borrelia exposure in North Macedonia warrants further investigation. These findings emphasize the need for enhanced tick-borne disease surveillance, identification of endemic zones, and improved diagnostic and public health infrastructure in both countries.

One Health envisions integrated governance across human, animal, and environmental systems to prevent and respond to complex health threats. Despite its global endorsement, One Health implementation often falters due to institutional fragmentation, power asymmetries, and ethical tensions that erode trust and cooperation. This paper proposes the integration of medical-bioethics mediation within One Health governance as a structured, relational mechanism to manage conflict, foster ethical deliberation, and strengthen trust between sectors and communities. We develop a conceptual framework to apply the mediation principles of neutrality, confidentiality, respect, and shared problem-solving beyond clinical ethics toward multisectoral One Health contexts. The framework is illustrated through domain-specific examples from zoonotic disease control, antimicrobial resistance, and environmental health. Medical bioethics mediation can advance conflict transformation, ethical reflection, participatory decision-making, and policy alignment, thereby supporting transparent negotiation of values and institutionalized dialogue of different One Health actors. Future research should pilot mediation-based governance models and assess their effects on intersectoral trust, collaborative capacity, and integrated health outcomes.

Background: Non-typhoidal (NT) Salmonella spp. constitutes a major cause of foodborne illness. Culture is the gold standard, but it is time consuming, whereas multiplex nucleic acid amplification tests (NAATs)/Polymerase Chain Reaction (PCR) offer faster detection with variable reported performance. Objectives: To compare the diagnostic accuracy of multiplex NAAT/PCR and culture for Salmonella spp. using various statistical models with or without a gold standard assumption. Methods: A systematic search (PubMed, Web of Science, Scopus; up to April 2024) identified 44 studies (55 comparisons). Diagnostic performance was evaluated using the frequentists bivariate model (BM) and Split Component Synthesis (SCS) and the Bayesian bivariate models (BBMs) and hierarchical summary ROC (BHSROC). Results: Across models, multiplex NAAT/PCR demonstrated high specificity (>98%) but model-dependent variability in sensitivity (85.5–94.8%), consistently substantial between study heterogeneity and threshold variation. The BM and BBM yielded a higher sensitivity estimate with narrower non-overlapping confidence intervals while SCS and BHSROC models, which are more robust to threshold differences, produced more conservative estimates with wider uncertainty. In Bayesian latent class analyses, culture remained highly accurate (Se: 97.17%, 95% CrI: 70.3–99.99; Sp: 96.06%, 95% CrI: 78.9–99.99), but with wide credible intervals indicating variation between studies, perhaps due to the different protocols used. Conclusion: Model choice affects inferred diagnostic accuracy, particularly when high heterogeneity is present. Both multiplex NAAT/PCR and culture showed high accuracy; hence, a combination of the two tests could optimise rapid diagnosis and treatment. Future research should include cost effectiveness and decision analysis to update the diagnostic algorithms.

One Health (OH) envisions integrated governance across human, animal, and envi-ronmental systems to prevent and respond to complex health threats. Despite its global endorsement, OH implementation often falters due to institutional fragmentation, power asymmetries, and ethical tensions that erode trust and cooperation. This paper proposes the integration of medical-bioethics mediation within OH governance as a structured, relational mechanism to manage conflict, foster ethical deliberation, and strengthen trust among sectors and communities. We develop a conceptual framework to apply the me-diation principles of neutrality, confidentiality, respect, and shared problem-solving- beyond clinical ethics toward multisectoral OH contexts. The framework is illustrated through domain-specific examples from zoonotic disease control, antimicrobial resistance, and environmental health. Medical-bioethics mediation can advance conflict transfor-mation, ethical reflection, participatory decision-making, and policy alignment, thereby supporting transparent negotiation of values and institutionalized dialogue of different OH actors. Future research should pilot mediation-based governance models and assess their effects on intersectoral trust, collaborative capacity, and integrated health outcomes.

Medical malpractice disputes often impose significant economic and time burdens on healthcare systems, patients, and providers. Mediation is a promising, efficient and cost-effective alternative to litigation. Our objective was to develop a quantitative tool that quantifies the economic and time savings associated with the adoption of mediation in medical malpractice cases. We created a user-friendly, freely available R/Shiny application to estimate the net present value (NPV) of monetary and time savings from mediation versus traditional litigation. Substantial economic and time savings were projected across all scenarios. In high-income countries, a decade of implementing mediation for 2,000 annual claims yielded an estimated NPV of €115.22 million (95% CrI €81.73–€149.27 million) and 13,349 court-years saved. Corresponding savings for middle- and low-income countries were €47.97 million and €13.77 million, with 16,052 and 12,705 court-years saved, respectively. The tool enables interested stakeholders and policymakers to quantify the benefits of medical mediation under different settings as its flexible structure allows users to define their own input distributions and assumptions according to local policy and legal contexts.