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Community-based digital weight management programs have shown potential to address the public health concern of obesity, but often face implementation barriers. This study aimed to identify and evaluate current implementation barriers, facilitators, and further develop strategies. A prospective qualitative study was conducted via workshops of stakeholders from community-based weight loss management services across Singapore, alongside a separate series of interviews for adopters. A hybrid deductive-inductive approach to thematic analysis was then adopted, informed by the Consolidated Framework for Implementation Research (CFIR), the Theoretical Domains Framework (TDF), and the Expert Recommendations for Implementing Change framework (ERIC). Interview transcripts were qualitatively coded based on relevant CFIR and TDF domains using a coding template. Subsequently, identified barriers and domains were mapped to ERIC strategies. A total of 48 and 145 barriers were identified based on adopter and implementer transcripts, spanning across 26 and 35 subdomains of the TDF and CFIR, respectively. Several barriers were consistently identified by both adopters and implementers, with the main consistency being a mismatch of expectations. These include differing expectations of public awareness on obesity as a disease, expectations on the flexibility of implementations, and expectations on support for personal motivation. Furthermore, 43 adopter and 57 implementer facilitators were identified, spanning across 25 and 28 distinct subdomains of the TDF and CFIR framework, with the provision of incentives, societal and doctor endorsements as common facilitators. A total of 53 distinct ERIC implementation strategies subthemes were also identified. The study identified underlying themes linking barriers and facilitators across implementers and adopters of community-based weight management services. These were mapped to ERIC strategies and contextualized using the Action, Actor, Context, Target, Time (AACTT) framework to specify actors and actions. Many of these strategies could be operationalized by policymakers and nurses, highlighting their central role in facilitating program adoption and delivery.

The capacity for biofilm formation, along with the acquisition of antimicrobial resistance, could be the primary factors enhancing the persistence and spread of Acinetobacter baumannii (AB). We aimed to identify the trends in molecular epidemiology of AB isolated from western Iran. Ninety-nine pathogenic AB isolates were collected from patients in three major hospitals in Sanandaj and Kermanshah (the capitals of Kurdistan and Kermanshah provinces in western Iran, respectively) in one year. Isolates were tested for the presence of class D and B carbapenemases, integrons, and biofilm-associated genes, and their genetic diversity was initially investigated using enterobacterial repetitive intergenic consensus (ERIC) analysis, followed by multilocus sequence typing (MLST) and plasmid profiling. Of the 99 isolates, 91.9% showed resistance to carbapenems. The most common class D and class B carbapenemases were OXA-24-like and VIM type, respectively. The bap, bfmR, and ompA biofilm-related genes were present in all isolates. Class 1 integron was only identified in 10.1% of isolates and contained the sugar dehydrogenase gene cassette. By ERIC, Cluster C was found in three hospitals, and Clone A in two hospitals. By MLST, isolates in Cluster C and Clone A were assigned to ST78 and ST2125, respectively. Plasmid profiling of Cluster C and Clone A isolates showed similar plasmid profiles. Our research offers insights into the epidemiology of AB circulating in western Iran during recent years. The results may suggest a possible inter-hospital spread of these strains; however, further research is needed. We document for the first time the emergence of ST2125 and ST78 in Iran.

This study aimed to explore the facilitators of and barriers to the clinical translation of evidence-based nursing guidelines. A convergent mixed-methods study design. First, 206 nurses from 12 hospitals were selected as study participants, and the Chinese version of the Organizational Readiness to Change Assessment (ORCA) scale was administered to assess the current readiness for guideline implementation. Subsequently, for the qualitative study, purposive sampling was used to select 15 nurses from the quantitative study sample for semistructured interviews. The framework analysis method was applied to code the transcribed texts using the Consolidated Framework for Implementation Research (CFIR), and thematic analysis was employed to identify facilitators and barriers to guideline implementation. Finally, all facilitating and barrier factors were systematically synthesized, and implementation strategies were matched using the Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change (CFIR-ERIC) tool. The organizational change readiness score was moderate-to-high (248.77 ± 33.35). The quantitative study identified 25 facilitating factors (such as the scientific rigor of guideline implementation and a positive departmental culture) and 16 barriers (including insufficient resources to address patient awareness or needs and inadequate communication among team members). The qualitative study identified 25 facilitating factors (such as high self-efficacy in evidence-based practice and leadership support) and 11 barriers (such as implementation complexity and resource constraints). From a mixed-methods analysis, the top three barriers were identified as a lack of incentives, insufficient resources, and interdepartmental communication barriers. Based on the CFIR-ERIC mapping, implementation recommendations targeting the main barriers were identified, including tailoring implementation strategies, modifying incentive mechanisms or compensation structures, and establishing communication networks among team members. This study systematically revealed, through a mixed-methods approach, the current status of nurses' readiness to participate in guideline implementation in China, as well as the facilitating factors and barriers. In the future, targeted strategies should be developed based on the identified barriers to promote the sustained implementation of guidelines.

Background/Objectives: Despite ongoing innovation, few interventions-including Clinical Decision Support Systems (CDSS)-are successfully integrated into routine care. Understanding the process through which innovations are implemented is therefore essential for advancing practice and research. In perinatal settings, evidence on how CDSS implementation unfolds and which strategies support adoption, scale-up, and sustainment remains limited. This study aimed to understand the implementation process, key determinants and implementation strategies of a shared antenatal psychosocial CDSS (i.e., the Born in Belgium Professionals [BIB-Pro]) implemented in a real-world, cross-sectoral perinatal care setting. Methods: A qualitative exploratory case study was conducted between January and March 2025. Data included semi-structured interviews with all seven implementation agents, document analysis of the implementation plan. Directed content analysis was applied using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to categorise contextual determinants and the ERIC taxonomy to classify implementation strategies. Data were synthesised across the four EPIS phases. Results: The implementation process unfolded across all EPIS phases, showing a shift in responsibility from the policy level to the implementation team and healthcare organisations. Implementation was shaped by key determinants across multiple levels: (1) the bridging functions by the BIB-Pro implementation agents connecting policy, innovation, and organisational practice; (2) the system-level leadership and funding by the National Institute for Health and Disability Insurance that enabled initiation and sustainability; and (3) the multilevel stakeholder involvement and inter-organisational collaboration across care settings. In addition, the personal attributes of implementation agents-accessibility, active listening, adaptability, and persistent follow-up-were also identified as relevant factors in the implementation process. Across the implementation process, a broad range of implementation strategies was identified. The most prominent ERIC strategies were developing stakeholder interrelationships, evaluative and iterative strategies, engaging stakeholders, training and educating stakeholders, and providing interactive assistance. Barriers encountered during the implementation process included fragmented care networks, inconsistent regional referral structures, legal uncertainties, and variable digital readiness. In response to these challenges, implementation strategies were applied to support collaboration, clarify procedures and provide targeted support. Conclusions: This study provides insight into how a CDSS was introduced, scaled, and sustained across complex multiple Belgian perinatal care settings. Strong bridging functions, stakeholder interrelationships, iterative evaluation, and system-level support were key factors throughout the implementation process. Across all phases, stakeholder interrelationship strategies and evaluative and iterative strategies were the most prominent and consistently applied, supporting stakeholder engagement and sustained use of the platform. These findings offer actionable guidance for implementing digital tools in multi-organisational and multi-level contexts within perinatal care and other healthcare settings.

In wound care education, there is evidence of competence areas and learning goals. However, evidence of teaching methods needs to be determined. To describe the teaching methods used in wound care education for nursing professionals and students, and to describe how these methods affect or are related to their competence and other outcomes in wound care and prevention. The scoping review followed JBI methodology. Two researchers searched databases including MEDLINE (PubMed), CINAHL (EBSCO), Cochrane Library, Scopus, and ERIC in November 2024. Evidence was selected by screening titles and abstracts, and then reviewing full texts. Evidence was categorised by themes, with outcomes summarised narratively. The search was updated in March 2026. The authors of the 48 articles focused on undergraduate nursing education and pressure ulcer prevention. The six main teaching methods were: technology-enhanced methods, gaming, lecturing, simulation, reflective methods, and workshops. Simulation was most common. Teaching methods indicated mainly positive results, although some outcomes showed no change in students' or professionals' wound care competence. All teaching methods resulted in positive outcomes in at least one dimension of competence among nurses and students. Nurse educators can use these to enhance knowledge and skills. However, findings should be interpreted cautiously due to the scoping nature of the review.

African, Caribbean, and Black (ACB) populations in high-income countries (HICs) continue to experience long-standing health inequities rooted in structural and anti-Black racism embedded in health systems, policies, and institutional practices. From an ecosocial perspective, these inequities reflect the embodiment of intersecting forms of oppression structured through racialized, gendered, and socioeconomic relations. Critical racial literacy (CRL) has emerged as a promising framework for recognizing and addressing structural racism in ways that foster critical reflection and support justice-oriented action in health contexts. However, evidence on how CRL is conceptualized and operationalized in health research, policy, and practice concerning ACB communities remains fragmented and limited. This scoping review aims to map how CRL is conceptualized and operationalized in HICs and examine its potential to advance health equity for ACB populations. This scoping review will be conducted in accordance with the Joanna Briggs Institute guidance. Comprehensive searches will be conducted in MEDLINE (Ovid), Embase, CINAHL, PsycInfo, ERIC, Scopus, and ProQuest Dissertations and Theses Global from inception to March 31, 2026. Peer-reviewed articles and theses or dissertations will be included, with no restrictions on study design or publication type. At least 2 independent reviewers will conduct screening, charting, and analysis of the data. A 3-phase thematic mapping process guided by critical race theory, intersectionality, and ecosocial theory will be used to analyze and interpret the findings. Searching, screening, data charting, and analysis will be undertaken between April 2026 and July 2026. Manuscript preparation will be completed by July 31, 2026, and dissemination will occur between August 2026 and October 2026. The findings will identify key CRL components, applications, strategies, barriers, and equity pathways across clinical, policy, and community contexts. This scoping review will provide a comprehensive overview of how CRL is conceptualized and applied in health contexts involving ACB populations in HICs. By clarifying current conceptualizations, applications, and gaps in the literature, the review will identify priorities for future theoretical, methodological, and practice-based development. In doing so, the findings will inform more critically grounded, praxis-oriented, and structurally focused antiracism efforts across health systems. Results will be disseminated through open access publications, conference presentations, and stakeholder engagement activities to advance evidence-informed health equity action. PROSPERO CRD42024623132; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024623132. PRR1-10.2196/79361.

Nursing professionals require practical clinical skills to ensure patient-centered and safe care. Traditional teaching methods face challenges, such as limited student engagement and resource intensity, prompting a shift toward integrating technology into clinical nursing education. This scoping review aims to explore and categorize technological innovations used in teaching clinical nursing skills, thereby supporting nursing educators and policymakers. Following Arksey and O'Malley's five-stage scoping review methodology and PRISMA-ScR guidelines, we conducted a systematic literature search across MEDLINE, EMBASE, Scopus, WoS, CINAHL, ERIC, and PsycINFO databases. Inclusion criteria encompassed studies from 1995 to 2023 focusing on technology used to teach clinical nursing skills to students or nurses. The data from 58 studies were charted and synthesized through template analysis to identify key technological features. The review identified seven primary categories of technological features: Content, accessibility, learning environment, usability, pedagogical approach, security, and ethical issues. Mobile applications, virtual simulations, and educational videos were the most frequently employed technologies. Findings highlight how these tools enhance skills acquisition, accessibility, and user engagement while raising ethical considerations, particularly around privacy and data security. Integrating educational technologies into nursing curricula has demonstrated significant potential to enhance clinical skill development. However, successful adoption necessitates addressing ethical issues and balancing technology with traditional teaching methods. Future research should examine the long-term impact of these innovations on clinical competence and explore strategies to mitigate ethical concerns.

Pelvic examination is a core, yet anxiety-provoking, clinical skill in undergraduate medical education. Traditional teaching approaches-often opportunistic or reliant on simulation-have been criticised for disembodying technical skill from relational and ethical practice. Gynaecology Teaching Associates (GTAs), trained educators who use their own bodies to teach and provide embodied feedback, have emerged as an alternative model. This scoping review aimed to map what is known about GTAs, whose perspectives are represented, and what factors influence implementation. A scoping review was conducted in accordance with Arksey and O'Malley's framework and prospectively registered. Searches of MEDLINE, Embase, PsycINFO, ERIC and Scopus (June 2025) were supplemented by citation tracking and grey literature searches. English-language sources focused on GTAs were included, with no date restriction. Screening and data extraction were undertaken by two reviewers, with thematic synthesis conducted inductively. Eighty-three sources were included. Four interrelated domains were identified: educational outcomes, finance, ethics and representation/standardisation. GTA programmes are consistently associated with reduced student anxiety, improved confidence and enhanced communication skills, though evidence is frequently short-term and self-reported. Financial constraints and logistical complexity present ongoing barriers. Ethically, GTAs are positioned as an advance on historical practices, yet concerns regarding GTA well-being and labour persist. Standardisation improves programme quality but may inadvertently narrow representations of bodily diversity. GTAs represent a pedagogically and ethically significant approach to pelvic examination teaching. Future research should prioritise longitudinal, multi-institutional evaluation, clearer definitions of effectiveness, patient-centred outcomes and co-produced standards to support sustainable, equitable implementation.

The primary aim of our systematic review and meta-analysis was to investigate the effects of school-based interventions on motor performance in children and adolescents with developmental coordination disorder (DCD). Our secondary aim was to explore potential moderators of effects. We conducted a search of seven databases (PubMed, Web of Science, SCOPUS, SPORTDiscus, ERIC, PsychINFO, CINAHL, and Google Scholar). The date was restricted from 1999 to 2025. Eligible studies included school-aged children or adolescents (5-19 years) with DCD or probable DCD (pDCD), were conducted in school settings, included motor skill training, and assessed motor performance. Only studies with a DCD/pDCD non-training control group were eligible for meta-analysis. Methodology, participant and study characteristics, motor performance outcomes and main results on motor performance were extracted. A total of 35 studies were included in the systematic review, with 18 studies (47 effect sizes) eligible for meta-analysis. We found a large effect on motor performance (Hedges' g=1.06, 95% CI 0.60 to 1.53). Intervention frequency and total intervention dose had a substantial moderating effect on motor performance, with training frequency of at least three times a week and total dose of at least 500 minutes yielding the largest effects. Both teacher- and external facilitator-led interventions were effective in improving motor performance, with teacher-led interventions showing larger effects. Our findings indicate positive effects of school-based motor skill interventions in children and adolescents with DCD/pDCD, with teacher delivered interventions appearing more effective than those delivered by external facilitators.

Implementation Science (IS) is the study of methods and strategies that facilitate the uptake of evidence-based practice and research into regular use. The use of IS in graduate surgical education has not been well characterized. This scoping review aims to identify key barriers, facilitators, and best practices for integrating IS into surgical education. Embase, PubMed, Scopus, Cochrane Library, and ERIC were searched in accordance with PRISMA guidelines. Included studies utilized a validated IS strategy to implement an educational or curricular intervention for surgical residents. Qualitative analysis was used to map the IS theories, models, and frameworks used in the included studies to existing IS frameworks, as well as characterize barriers and facilitators to implementation via the Theoretical Domains Framework (TDF). Six studies were identified with surgical residents from general surgery, urology, obstetrics-gynecology, vascular surgery, and cardiothoracic surgery programs. Each study used a different approach informed by IS to successfully implement an educational intervention (e.g., quality improvement research curriculum, faculty-resident coaching program, or surgical skills simulation course). IS theories, models, and frameworks included: the Replicating Effectiveness Programs Framework, Fixsen's 6-stage Implementation Framework, Expert Recommendations for Implementing Change, RE-AIM Framework, Normalization Process Theory, and Theory of Change Methodology. Barriers to implementation included variability in resident schedules and competing demands of clinical responsibilities. Facilitators to implementation included protected didactic time, endorsement from program leadership, and incorporation into established educational programming. The studies identified in this review utilized a variety of IS theories, models, and frameworks to successfully implement new educational practices. The majority of barriers and facilitators identified fit into the "Environmental Context and Resources" and "Social Influences" domains of the TDF. Key facilitators to implementation shared across the six studies included protected didactic time, buy-in from leadership, and integration into established resident education time. IS represents a promising field for enhancing graduate surgical education.

The Department of Neurosurgery at the University of Illinois Chicago (UIC) traces its origins to 1882 with the founding of the College of Physicians and Surgeons (P&S) of Chicago. Formally established in 1936, the Department of Neurosurgery developed in parallel with the emergence of modern neurosurgery in the United States. Eric Oldberg, the final direct trainee of Harvey Cushing and a founding member of the American Board of Neurological Surgery, served as its inaugural chairman. A historical review was conducted using institutional archives, published literature, departmental records, and faculty interviews to chronicle the historical trajectory of neurosurgery at UIC across the 20th and 21st centuries. From its inception until present day, the leaders of this institution have represented an unwavering commitment to technical excellence, innovation, and education in the field of neurosurgery. Successive departmental leadership included Oscar Sugar (1971-1981), Robert M. Crowell (1982-1989), James L. Stone (1989-1991), James I. Ausman (1991-2001), and Fady T. Charbel (2001-present). Across these successive eras, the department expanded its clinical and academic footprint through the development of subspecialty programs, expansion of research and surgical practice, and contributions to advances in neurosurgery. This article carefully details the evolution of neurosurgery at UIC, as it paralleled the progression of modern-day neurosurgery, and highlights many of the instrumental figures, contributions, and landmark moments that have resulted in what it has become today. We conclude this historical recount by highlighting the department's contemporary structure, including its faculty, facilities, and future directions.

This scoping review examined research applying digital twins in nursing practice and education and summarized their application domains, methods, outcomes, and implications. A human digital twin is a virtual health replica modeled from real-world data. This study followed the 5-stage scoping review process proposed by Arksey and O'Malley. Two researchers independently conducted the literature search without restrictions on publication year. From April 1 to 15, 2026, the Cochrane Library, PubMed, Embase, CINAHL, ERIC, and RISS databases were searched, and 15 studies were ultimately included. Digital twin applications were identified in 3 major domains: clinical practice and patient-centered care, education and training, and decision-making and workflow management. Application methods and outcomes varied according to technological implementation and included (1) modeling and data-driven prediction, (2) development of immersive learning and practice-training environments, and (3) system integration and decision-support frameworks. In clinical settings, multimodal patient data can be analyzed using artificial intelligence and machine learning to generate a virtual persona resembling the patient, thereby facilitating real-time personalized nursing care and self-management. In educational settings, digital twins can provide realistic and safe learning environments that enhance training effectiveness. Digital twins show substantial potential to advance predictive and personalized nursing in both clinical practice and education. Their data-driven capabilities are expected to contribute to innovative applications in future nursing practice and educational environments.

Medical schools worldwide have struggled for decades to determine the most effective strategy for selecting students to meet the needs of their healthcare systems. Despite recent changes in the direction of medical education, most medical schools have been slow to respond and adapt their selection. Applying a standard admission strategy across dissimilar contexts, such as the Asia-Pacific region, is challenging due to differing school missions, contexts and health priorities. In addition to academic achievements, several selection approaches have been implemented across the globe, with the hope of selecting those who are 'best' suited to be doctors. An equitable and fit-for-purpose selection approach is crucial for meeting priority community needs and ensuring institutional accountability. This scoping review aims to explore the selection strategies used by medical schools in low-and middle-income countries (LMICs) within the Asia-Pacific region to contribute to a fit-for-purpose workforce. This scoping review was conducted between July 2024 and December 2024 using the methodology outlined by Arksey and O'Malley. Inclusion and exclusion criteria were developed to meet the objectives of this review. SCOPUS, EMCARE, OVID Medline, ERIC and CINAHL databases were searched. Only documents in the English language were considered eligible for inclusion. There was no date restriction applied for the reviewed documents. Grey literature was searched, and unpublished theses, policy documents, abstracts of conference materials, technical reports and guidelines were extracted using the inclusion criteria. The study population consisted of medical students and graduates from LMICs within the Asia-Pacific region. Key concepts searched included selection, recruitment, admission and matriculation. The outcomes of interest were health workforce, medical workforce, fit-for-purpose, medical graduates, doctors and physicians. Five other team members worked independently and collaboratively to assess the elligibility of relevant studies. Three were very senior medical education experts, one senior dental educator and a senior research fellow whose expertise is in health systems and medical education. The Quality Assessment Tool for Studies with Diverse Designs was used to assess the quality of selected studies. The information extracted from each study was deductively coded using a framework that captured selection approaches, factors informing the selection strategy, and fit-for-purpose workforce considerations. This was followed by inductive coding to extract major themes. A total of 5045 studies were retrieved from the five databases. Ten (62%) studies from the five databases and 6 (38%) from other sources were included. Five major themes emerged from the inductive analysis of the included studies: engagement of key stakeholders in the selection approach (political validity), prioritizing the health needs of the communities that medical schools serve (social accountability), responding to the needs of communities in which schools are located (responding to context), ensuring a sustainable selection approach, and a purposive and mission-driven strategy. This review highlights the different selection approaches that medical schools use within LMICs in the Asia-Pacific region. The engagement of stakeholders in the selection process, premised on a clear mission and purpose, is imperative within each context. A proposed selection framework aimed at contributing to a fit-for-purpose workforce could guide selection approaches in LMICs in the Asia-Pacific region and similar contexts.

Food insecurity has increasingly been recognised as a significant challenge among university student populations in Australia. This systematic review aimed to synthesise existing evidence on the prevalence, predictors, and outcomes of food insecurity among university students in Australia. A comprehensive search was conducted (May 2025), following PRISMA guidelines, across eight databases (Scopus, Web of Science, Google Scholar, ERIC, MEDLINE, CINAHL, Informit, and PsycINFO). Studies were included if peer reviewed, published in English since 2000, and food insecurity was assessed among students attending tertiary institutions in Australia. Two authors independently screened search results against the inclusion criteria. From 1450 records, 23 met the inclusion criteria: 20 quantitative (n = 105-3077) and 3 qualitative or mixed methods (n = 14-64). 17 studies assessed the prevalence of food insecurity, reporting rates between 9.0% and 77.9%. Fifteen studies examined predictors of food insecurity. Key risk factors included being an international student (n = 2), low income/limited financial resources (n = 3), unstable employment (n = 3), younger age (n = 5), and living alone (n = 9). 6 studies found associations between food insecurity and poor dietary patterns; 5 studies reported associations with poorer physical health. 6 studies identified associations with increased anxiety, depression, and stress, and 2 of 4 studies reported associations with poorer academic performance. Qualitative findings suggested that food insecurity exacerbated existing health conditions and weight management. Studies evaluating interventions to improve student food insecurity were not identified. Food insecurity is highly prevalent among Australian university students and was associated with poorer diet and health, and to reduced academic performance. Despite evidence of widespread impact, no evaluated interventions were identified, underscoring the need for coordinated research and policy action in higher education.

The clinical learning environment (CLE) is a crucial component of health professions education, providing the foundation for developing profession-specific clinical skills. This systematic review aimed to identify evaluated assessment tools for the CLE in health professions education and to report their measurement properties. This systematic review was preregistered (IDESR000098), and its protocol was published previously. Eligible studies were peer-reviewed articles in English that developed and validated tools for assessing the CLE among undergraduate health professions students and followed the COSMIN guidelines for systematic reviews of patient-reported outcome measures. Multiple electronic databases, including MEDLINE, the Cochrane Library, ERIC, Education Research Complete, and CINAHL, were searched; studies were independently screened, and data were extracted. Data were synthesized using best-evidence synthesis according to COSMIN guidelines. Of the 6,236 articles included in title and abstract screening, 55 were eligible for full-text screening. A supplementary search identified 13 additional articles, resulting in 40 included articles. Overall, 28 tools were identified, with 4 tools (PET, PET-Midwifery, DECLEI, and MidSTEP) demonstrating sufficient content validity. Only MidSTEP demonstrated sufficient structural validity. Only a minority of the included tools provided sufficient evidence of content and structural validity according to the COSMIN criteria. This finding indicates a systemic need for higher standards in monitoring clinical placements and identifies tools that should be re-evaluated and supported by additional research. Limitations include the exclusion of EMBASE and gray literature and the reliance on studies that predominantly used psychometric-first rather than content-validity-first designs.

This study aimed to assess the risk factors, associations and outcomes of stroke at an academic tertiary medical center in Trinidad and Tobago. This cross-sectional observational study with longitudinal follow-up evaluated 546 patients admitted with stroke at the Eric Williams Medical Sciences Complex (EWMSC) from January 2023 to January 2024. Patients' comorbidities, medications, and neuroimaging findings were recorded. Disability and survival outcomes utilizing the modified Rankin Scale (mRS) were assessed during their inpatient status and at three months post-hospitalization. The average age represented was 65 years, with 56% males. Of a total of 546 patients who presented with acute neurologic deficits, 410 were diagnosed with a stroke, with the remaining 136 (25%) with a transient ischemic attack (TIA). Of the stroke cases, 328 (80%) were ischemic, 78 (19%) were hemorrhagic, and 5 (1%) were with ischemic lesions complicated by hemorrhagic transformation. The overall inpatient mortality rate was 16%, and the 3-month mortality rate was 26%. Gender was associated with an increased odds of having a stroke compared to a transient ischemic attack (p-value 0.036). Chronic kidney disease (CKD) was associated with an increased odds ratio (OR) of hemorrhagic stroke (OR&#x2009;=&#x2009;11.10; 95% confidence interval (CI) 3.39-36.36, p-value 0.020). Diabetes mellitus (DM) (OR 1.72, 95% CI 1.08-2.73, p-value 0.02; OR 1.51, 95% CI 1.03-2.21; p-value 0.037), subarachnoid hemorrhage (SAH) (OR 5.45, 95% CI 1.72-17.32, p-value 0.004; OR 4.14, 95% CI 1.29-13.25, p-value 0.017), intraparenchymal hemorrhage (IPH) (OR 4.83, 95% CI 2.76-8.48, p-value&#x2009;<&#x2009;0.001; OR 3.17, 95% CI 1.87-5.37, p-value&#x2009;<&#x2009;0.001) and middle cerebral artery (MCA) infarct (OR 3.02, 95% CI 1.87-4.89, p-value&#x2009;<&#x2009;0.001; OR 2.34, 95% CI 1.54-3.57, p-value&#x2009;<&#x2009;0.001) were associated with in-hospital and 3-month mortality respectively. Atrial fibrillation (AF) (OR 2.47, 95% CI 1.08-5.64, p-value 0.031) was associated with in-hospital mortality. Age (OR 1.02, 95% CI 1.01-1.04, p-value 0.004), heart failure with reduced ejection fraction (HFrEF) (OR 4.88, 95% CI 1.15-20.68, p-value 0.032) and anterior cerebral artery (ACA) infarct (OR 2.27, 95% CI 1.13-4.56, p-value 0.022) were associated with 3-month mortality. Age was positively correlated with mRS (p-value 0.013). Ischemic stroke had a median mRS of 3, while hemorrhagic stroke had a median mRS of 5 (p-value&#x2009;<&#x2009;0.001). This study demonstrated high-risk subgroups, disability and mortality outcomes in patients with stroke in Trinidad. Conventional risk factors such as age, CKD, DM, AF, and HFrEF with specific neuroradiologic findings (SAH, IPH, MCA and ACA infarcts) were all negatively associated with adverse outcomes in stroke patients in Trinidad. This information may be clinically pertinent in devising comprehensive strategies to attenuate stroke burden. Further, large-scale prospective studies are required to confirm these epidemiologic results. NCT05256550. This study was prospectively registered on 02/15/2022 on clinicaltrials.gov.

Placenta accreta spectrum (PAS) is a serious pregnancy complication caused by abnormal placental attachment to the uterus. In this Perspective, Eric Jauniaux and colleagues discuss emerging evidence that challenges our long-held pathophysiological understanding of PAS, and argue that a critical reassessment of definition, diagnosis, and management is overdue.

Adverse childhood experiences (ACEs) affect nearly two-thirds of the US population and have long-lasting consequences on health and well-being. Integrating ACEs education into medical curricula is vital to equip future physicians to address these effects. This systematic review evaluates the effectiveness of ACEs educational interventions in US medical education on student and resident knowledge, attitudes, or practice. We conducted a comprehensive literature search in January 2025 using MEDLINE (PubMed), ERIC, and PsycInfo databases for studies published between 2013 and 2025, reported using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were empirical studies evaluating ACEs training in US medical schools and residency programs in the English language. Study selection, data extraction, and quality assessment were performed independently by two authors, with discrepancies resolved by coauthor consensus. A total of 608 unique studies were identified from our search and screened, with 15 studies meeting the inclusion criteria. Most interventions relied on lecture-based formats, though 46.7% included interactive components such as small-group discussions and standardized patient interactions. While most studies reported significant increases in ACEs knowledge postintervention, only 20% evaluated objective knowledge changes, with the majority relying on self-assessment. Confidence in addressing ACEs improved in 46.7% of studies, but only 6.7% objectively measured behavioral changes. ACEs education in medical training is expanding, but current interventions vary and often lack methodological rigor. Most studies show short-term knowledge gains, though few assess lasting behavior change. Future research should prioritize objective and longitudinal outcomes to better prepare physicians to address ACEs in clinical practice.