Health workforce migration is an important challenge for healthcare systems across Europe, with Romania facing one of the most significant impacts following its accession into the European Union. This article examines the trends, drivers, and consequences of health workforce migration in Romania, particularly physicians and nurses, explores policy interventions aimed at mitigating its effects and assesses their effectiveness. The analysis highlights the strategies employed to retain and attract healthcare workers, including financial incentives, regulatory reforms, and expanded educational opportunities. The study shows a two-thirds reduction in the annual migration of Romanian doctors to mainly countries of the WHO European Region, decreasing from 1532 in 2012 to just 461 in 2021, demonstrating the significant impact of policy interventions on workforce retention. While these interventions have successfully increased the overall number of health professionals in Romania and reduced overseas migration, challenges remain in ensuring equitable distribution and addressing workforce shortages in key specialties and occupations. Romania's experience offers valuable lessons for other European countries facing similar challenges and offers policy lessons for addressing one of Europe’s most pressing healthcare priorities.

Romania's health system faces a challenge of health workforce maldistribution, especially in rural and non-university urban areas. A national policy reform was launched in 2024-2025, supported by the National Recovery and Resilience Plan and WHO technical assistance. The reform's objective was to equip and empower local authorities to improve the recruitment, retention, and motivation of health professionals in their communities. The reform involves the development and nationwide dissemination of the "Solutions for Human Resources in Health: Guide of Local Actions". Developed through a participatory, evidence-based process with stakeholders, this guide is a practical toolkit for local authorities and hospital managers. It consolidates underused legal frameworks and curates national and international best practices examples across four main pillars: Education, Incentives, Regulation, and Support. The primary expected outcome is an improvement in the geographical distribution of the health workforce, resulting in better-staffed facilities in underserved regions. A key secondary outcome is the boost in local authorities' administrative capacity and proactive involvement in the health workforce management, which fosters greater ownership and a more sustainable, decentralized approach to addressing staffing challenges. These outcomes will become measurable over the medium-to-long term as local authorities implement the guide's provisions. The collaborative, evidence-based process used for the guide exemplifies a best practice model for stakeholder-driven policy development. The Romanian experience provides a transferable framework for countries with decentralized health systems to empower local actors in addressing health workforce maldistribution, though long-term success depends on local implementation and political will.

The WHO Regional Office for Europe conducted 9 country studies of migration of doctors and nurses. This paper identifies similarities and variations in migratory flows, factors that influence them, and related policy responses. The 9 countries include 4 that integrate the European Economic Area (EEA), Ireland, Malta, Norway, and Romania, and 5 non-EEA, Albania, Armenia, Georgia, Moldova, Tajikistan. Case writers used a common study template that covered international outflows and inflows, mobility push, and pull factors, and related policy interventions. Data sources include the WHO/Europe-OECD-Eurostat joint questionnaire and country databases. Emigration is motivated by low wages, dissatisfaction with working conditions, inadequate practice environment, excessive workloads and lack of opportunities for professional development. Flows for doctors and nurses vary in volume over time, and in countries of origin and destination. Pull factors include the free circulation of persons within the EEA for citizens of member states, easy access to work permits, common or easily learned language, and the presence of a diaspora in a destination country. Policies to improve retention include increasing the number of training places, making remuneration and working conditions more attractive and compulsory service. All countries have some health workforce development plan, but implementation is a challenge everywhere. Policies should be tailored to country labour market conditions, migration trends, and institutional capacity. Better understanding of migration flows will improve the effectiveness of policy responses.

Central and Eastern Europe (CEE) carries some of the widest immunisation gaps in Europe, and improving coverage there is often treated as a problem of access infrastructure. On 14 May 2026, a multi-stakeholder meeting hosted at the Romanian Parliament brought together around twenty-five speakers, among some fifty participants in all, from Romania, Poland, the Czech Republic, and Bulgaria, together with international contributors, to agree which barriers to vaccine confidence matter most in the region, which interventions are deliverable within 12 to 24 months, and how responsibility for them should be divided among stakeholders. This Perspective synthesises that discussion as a set of strategies for coverage. Meeting-derived priorities are set against published coverage and confidence data for the region and against the published intervention literature. We argue that the central problem across the region is eroded trust rather than missing information, because misinformation succeeds mainly where trust has already broken down, a process deepened by a historically conditioned, post-communist distrust of public institutions. The two recommendations carried most strongly, as both high in expected impact and achievable within 12 to 24 months, were continuing professional education for primary care on vaccine communication and the resourcing of locally trusted community figures, including health mediators working with marginalised populations. We then show how system-design reforms already demonstrated in the region, in particular pharmacy-based vaccination, direct reimbursement, and targeted outreach to under-vaccinated and marginalised groups, turn restored confidence into measurable coverage while narrowing inequities. We close with a 12-to-24-month agenda for CEE, organised around a clear multi-stakeholder division of labour. These are stakeholder-derived priorities that now require implementation and evaluation.

Introduction: Extracranial arteriovenous malformations (AVMs) are rare but challenging vascular anomalies characterized by direct arteriovenous connections that bypass the capillary network, leading to progressive lesion growth, hemorrhage, and functional impairment. The management of these lesions remains complex due to high recurrence rates and the need for multidisciplinary therapeutic approaches. Case Presentation: We report the case of a 51-year-old female presenting with a left retroauricular pulsatile mass, headaches, and audible bruits. Magnetic resonance imaging (MRI) revealed an extracranial AVM with a 17 × 30 mm nidus. Surgical resection was performed following preoperative evaluation, involving meticulous dissection, selective vascular control, and complete excision of the malformation. The patient had a favorable postoperative course, with no neurological deficits and early hospital discharge. Discussion: Extracranial AVMs pose significant diagnostic and therapeutic challenges. While embolization serves as an adjunctive measure to reduce intraoperative bleeding, complete surgical resection remains the definitive treatment. However, lesion recurrence is common due to residual microscopic arteriovenous shunts and neovascularization. Advances in molecular pathology have identified key angiogenic pathways involved in AVM progression, opening new avenues for targeted therapies. Conclusion: This case highlights the importance of early diagnosis, comprehensive imaging assessment, and individualized surgical planning for optimal patient outcomes. Multimodal strategies integrating endovascular techniques and surgical resection remain crucial in managing extracranial AVMs. Long-term follow-up is essential to detect potential recurrence and guide future therapeutic decisions.

Neurofibromatosis type 1 (NF1) is a common monogenic disorder with diverse clinical manifestations. Imaging is essential for diagnosis and follow-up yet international data reveal wide variability in imaging practices. This study aimed to evaluate current NF1 imaging practices across Romania, identify gaps in standardisation, and assess needs for alignment with international guidelines. A national, cross-sectional, questionnaire-based survey was conducted between March and May 2025 among Romanian imaging centres involved in NF1 diagnostics. Nineteen centres, both public and private, participated voluntarily. The survey addressed institutional characteristics, imaging modalities, paediatric protocols, reporting formats, multidisciplinary collaboration, and perceived challenges. Data were analysed descriptively as absolute frequencies and percentages. Marked heterogeneity was observed in imaging practices and institutional capacities. Only 5.3% of centres reported routine use of whole-body magnetic resonance imaging, and 78.9% did not employ structured imaging reports. Paediatric imaging protocols were available in 26.3% of centres. One-third (31.6%) reported multidisciplinary collaboration, while 57.9% lacked NF1 patient registries. Despite these gaps, most centres expressed readiness to adopt standardised protocols, structured reporting, and improved inter-institutional coordination. NF1 imaging in Romania remains fragmented, with limited use of structured reporting, and multidisciplinary integration. This first national survey provides a baseline for harmonising NF1 imaging practices and supports the development of standardised national protocols aligned with the European Reference Network for Genetic Tumour Risk Syndromes and REiNS guidelines.