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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.

To map the barriers identified by healthcare professionals to the prevention of violence against children. This scoping review was conducted in accordance with the JBI methodology for scoping reviews. The search was conducted using the MedLine, CINAHL, Psychology and Behavioral Sciences Collection, ERIC, Cochrane, MedicLatina, Scopus, Web of Science, RCAAP, and MedNar databases. A total of 1,674 publications were identified, with 45 studies included in the review. Barriers were most frequently reported in relation to the identification and reporting of violence against children. Recurrent challenges included deficits in knowledge and training, professional insecurity, excessive workload, and limited time availability. Cultural, social, and organizational factors also emerged as significant cross-cutting obstacles. The need for targeted training, improved working conditions, and strengthened inter-institutional collaboration is highlighted as a priority area identified in the literature to address the complex and interconnected barriers faced by healthcare professionals in the prevention and combat of violence against children. Mapear as barreiras identificadas por profissionais de saúde para a prevenção da violência contra crianças. Esta revisão de escopo foi conduzida de acordo com a metodologia JBI para revisões de escopo. A pesquisa foi realizada nas bases de dados MedLine, CINAHL, Psychology and Behavioral Sciences Collection, ERIC, Cochrane, Medicaid Latin, Scopus, Web of Science, RCAAP e MedNar. Identificaram-se 1.674 publicações, das quais 45 estudos foram incluídos na revisão. As barreiras mais frequentemente identificadas estavam relacionadas com a identificação e notificação de situações de violência contra crianças. Os desafios recorrentes incluíram lacunas no conhecimento e na formação, insegurança profissional, sobrecarga de trabalho e disponibilidade limitada de tempo. Fatores culturais, sociais e organizacionais também emergiram como obstáculos transversais significativos. A necessidade de formação específica, melhores condições de trabalho e reforço da colaboração interinstitucional emerge na literatura como uma área prioritária para ultrapassar as barreiras complexas e interrelacionadas que os profissionais de saúde vivenciam na prevenção e no combate à violência contra crianças.

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.

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.

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.

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.

This Integrative review aimed to identify the interprofessional education opportunities for undergraduate nursing students on clinical placement and to understand their experiences of undertaking them. This study used an Integrative Review design following the process outlined by Whittemore and Knafl (2005). Five electronic databases were searched: CINAHL Complete, MEDLINE Complete, ERIC, Web of Science Core Collection and ProQuest Health and Medicine Collection. The PRISMA principles were used for reporting the review. Quality assessment was undertaken using an adapted version of the Mixed Methods Appraisal Tool (MMAT). Braun and Clarke's (2020) six-step reflexive thematic analysis approach was adopted to interpret the study characteristics and main themes. A total of 32 articles were included in the review. Interprofessional education in clinical placement has variability in lengths of placement, placement settings, and interprofessional education activities. The length of placement and activities were linked to a lack of placement availability and the financial impact on a facility. The three main settings for interprofessional placements were primary health care, residential aged care and rehabilitation wards. Most articles reported the creation of temporary multidisciplinary placements for interprofessional education research. Five main themes were classified during data analysis including: 'authentic and valuable learning experience'; 'communication and collaboration'; 'constraints and challenges'; 'professional hierarchies'; and 'professional identity'. Student nurses value interprofessional education opportunities and believe they support the development of communication and collaboration skills, their own role perceptions and perceptions of other professions, although professional hierarchies remain a concern. Opportunities for interprofessional education are mainly artificially created for research projects. Research is lacking on actual opportunities or experiences for nursing students in standard clinical placements. Further research is needed on Interprofessional education focusing on the acute setting and the length of time required to support interprofessional education in practice.

Telehealth was essential for maintaining care continuity during the COVID-19 pandemic, leading to its rapid adoption across the United States. Telehealth has been heralded as a strategy for improving health care access and reducing health disparities, especially for community-dwelling older adults who face significant barriers to in-person care. However, data on telehealth use among socially and financially vulnerable older adults are limited, and little is known about characteristics associated with telehealth use in this population. Guided by the Systems Engineering Initiative for Patient Safety (SEIPS) 3.0 framework, this study examined factors associated with postpandemic telehealth use among older adults living at home and receiving publicly funded home- and community-based services (HCBS), considering HCBS receipt as an indicator of social and financial vulnerability. This cross-sectional study included older adults aged 65 years or older living at home with available telehealth use data who participated in the 2021-2022 survey wave of the National Core Indicators-Aging and Disabilities Adult Consumer Survey. We used complete-case multivariable logistic regression, adjusting for sociodemographic and health-related factors with state-level random intercepts, to examine associations between telehealth use and covariates of interest (age, sex, race/ethnicity, zip code, rural-urban commuting area code, internet access, self-perceived overall health, medical transportation access, living alone, number of known non-Alzheimer disease and related dementias [ADRD] diagnoses, known ADRD diagnosis, and HCBS program/payer type). Based on the regression results, we estimated bivariate associations between internet access and key sociodemographic variables (age, sex, race/ethnicity, and zip code rural-urban commuting area) using the Pearson chi-square test. Findings were organized and interpreted through the SEIPS 3.0 framework. Of the 3680 participants, 1467 (40%) were telehealth users and 2213 (60%) were nonusers. Significantly lower odds of telehealth were observed for older adults in older age groups, males, Black individuals, those living in nonmetropolitan areas, and recipients of Older Americans Act services (odds ratios [OR] between 0.66 and 0.80). Individuals with more than one known non-ADRD diagnosis (OR 1.49, 95% CI 1.02-2.17) and those with an ADRD diagnosis (OR 1.33, 95% CI 1.07-1.66) had higher odds of telehealth use. Internet access was strongly associated with telehealth use (OR 2.51, 95% CI 2.15-2.92). Follow-up bivariate analyses between internet access and sociodemographic characteristics revealed that those of younger age, females, and White individuals had higher levels of internet access. Differences in telehealth use among older HCBS recipients are associated with multiple individual, technological, and organizational factors. Interpreted through the SEIPS 3.0 framework, these findings underscore the importance of viewing telehealth use as the outcome of multiple features of the health care system. Future research should clarify the mechanisms driving variation in telehealth use to identify and address barriers to telehealth adoption among vulnerable older adults.

Child sexual abuse (CSA) is a critical human rights violation. Children with disabilities (CWD) face a 4 to 10 times higher risk due to dependency and communication barriers, yet evidence from Asian sociocultural contexts remains fragmented. This scoping review aims to map the prevalence, risk factors, and impacts of CSA among CWD in Asia. Guided by PRISMA-ScR, a systematic search was conducted across PubMed, Scopus, Web of Science, ScienceDirect, ERIC, and Medline (1995-2025). Quantitative and qualitative studies involving children aged ≤18 were analyzed, identifying 2015 records, with 27 studies meeting the inclusion criteria. Prevalence ranges from 1.5% to 40%, among the broader CWD population, while evidence derived specifically from studies on individuals with intellectual disabilities (ID) reveals they face up to 14 times higher risk of sexual assault. Evidence is geographically skewed toward Turkey, Israel, and Taiwan. Critical findings reveal that trauma symptoms are frequently missed due to diagnostic overshadowing, where behavioral regression is misattributed to disability. Emerging risks include Online Child Sexual Abuse (OCSA) targeting socially isolated children, and severe rights violations such as forced contraception administered by families as a preventive measure. The lack of disability identifiers in national registries creates statistical invisibility, hindering resource allocation. Urgent actions include prohibiting coercive medical interventions and training professionals to recognize non-verbal trauma indicators. Future research should address the data gap in Southeast Asia and employ participatory design approaches to enhance the understanding of the region's health issues.

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.

The WW-FINGERS network has demonstrated the efficacy of multidomain non-pharmaceutical interventions (NPIs) but left their real-world implementation largely unexplored, prompting this study in Changxing County to identify key determinants and develop actionable strategies for community-based delivery. An embedded mixed-methods retrospective evaluation using the Consolidated Framework for Implementation Research (CFIR) was conducted. Data from 42 stakeholders across six communities were analyzed via a hybrid deductive-inductive approach and coincidence analysis (CNA). Strategies were matched using the ERIC compendium and refined by a stakeholder panel. We identified 202 determinants, revealing six core facilitator themes (e.g., policy-academia-community synergy) and six barrier themes(e.g., unsustainable funding). CNA delineated potential pathways. Three strategy bundles were finalized: Capacity Building, Collaborative Network Building, and an AI-enabled digital platform. This study provides a practical, theory-informed framework for implementing complex NPIs, bridging the science-to-practice gap in dementia prevention. The AI-enabled platform offers a forward-looking approach for sustained delivery.

Metacognition, defined as "thinking about thinking," is an essential skill that enables medical students to navigate the cognitive complexity of anatomy curricula. By fostering learners' abilities to monitor comprehension, recognise knowledge gaps, and strategically regulate their learning approaches, metacognition supports both academic achievement and lifelong learning. This narrative review provides a comprehensive overview of the role of metacognitive skills in anatomy education. It examines existing literature and educational interventions to provide insights into developing and applying these skills for students and educators. A targeted literature search was conducted across major electronic databases, including PubMed, Scopus, and ERIC. The search used a Boolean string combining terms related to metacognition with those for anatomy and health professions education. The review included a broad range of article types to synthesise diverse applications and theoretical underpinnings. Multiple studies show that explicit, integrated metacognitive interventions-such as structured training, reflective writing, and flipped classroom methodologies-are associated with improvements in metacognitive awareness. These approaches appear most effective when incorporated as ongoing, course-specific activities rather than as isolated sessions. Notably, while metacognitive knowledge improves readily, the development of self-regulatory learning behaviours requires sustained scaffolding and practice. The literature suggests metacognition as a crucial skill for academic success in anatomy and for a successful career as a health professional. An integrated pedagogical approach that combines strategies such as retrieval practice, peer teaching, and reflective writing appears essential. This approach fosters deep, lasting learning and empowers students to become self-directed, resilient learners who can continually adapt to new challenges throughout their careers.

Constructed-response situational judgement tests (CR-SJTs) are used internationally to assess personal and professional attributes in health professions admissions, with over one million applicants to more than 500 programs having used them in the last decade. Despite this, a synthesis of their validity is lacking. This study aimed to quantify the association between CR-SJT scores and measures of personal, interpersonal and professional performance in health professions education and to determine how moderating factors influence this relationship. MEDLINE, EMBASE, CINAHL, ERIC, SCOPUS, Web of Science and grey literature sources (ProQuest Dissertations & Theses, EThOS and OpenGrey) were searched from inception to 7 April 2025. Search was supplemented by contacting experts and admissions directors to include unpublished quality assurance studies. Eligible studies evaluated a CR-SJT for applicants or trainees in health professions programmes and reported a quantitative relationship with a non-academic outcome (e.g., professionalism and communication). Of 463 full-texts reviewed, 27 met inclusion criteria. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, two reviewers independently extracted data and assessed risk of bias using the Quality In Prognosis Studies (QUIPS) tool. A multilevel random-effects meta-analysis was used to pool Fisher z-transformed correlation coefficients. Meta-regressions tested moderator effects, and sensitivity analyses examined bias impact. The primary outcome was the correlation between CR-SJT scores and measures of interpersonal or professional skills. Moderators included the construct congruence between the CR-SJT and the outcome measure, outcome type, publication type, and outcome assessment stage. The 27 studies yielded 100 unique effect sizes and were judged, in total, to be at moderate risk of bias. The pooled correlation between CR-SJT scores and outcomes was z&#x2009;=&#x2009;0.22 (95% CI, 0.16-0.28; p&#x2009;<&#x2009;0.001). Construct congruence was the only significant moderator; more congruent outcomes showed z&#x2009;=&#x2009;0.32 (95% CI, 0.25-0.37), compared to that of less congruent outcomes (z&#x2009;=&#x2009;0.17; 95% CI, 0.12-0.18). Publication bias was insignificant (Egger's test, p&#x2009;=&#x2009;0.73). The use of CR-SJTs in health professions selection is supported by the evidence. Validity depends substantially on construct congruence between the CR-SJT and the outcome measure. Programs should consider CR-SJTs within their operational context and with deliberate attention to downstream evaluation alignment.

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.

Clinical learning environments (CLEs) are critical components of nursing education, as they influence skill acquisition, professional identity development, and learning outcomes. The aim was to systematically map the evidence regarding (1) factors of CLE that affect learning outcomes in higher nursing education, (2) the barriers and facilitators to implementing favourable CLEs, and (3) the outcomes, outcome measurement instruments, and possible effects of the CLE. A scoping review was conducted, including evidence published between 2001 and 2024, using seven databases via EBSCOhost (CINAHL, ERIC, MEDLINE, APA PsycArticles, APA PsycInfo, and Teacher Reference Centre). The reference lists of all included articles were searched manually. Data were independently extracted using a predefined table and synthesized by thematic analysis. One hundred studies were included: 80 descriptive studies, 11 intervention studies and nine reviews. Four overarching factors were identified, influencing the CLE of nursing students: (1) physical learning environment, (2) guidance and education, (3) cooperation between university and hospital, and (4) interprofessional relationships. We identified outcomes in 16 different areas, most often measured by unstandardized instruments. Barriers and facilitators were categorized into four categories: 1) university-clinical cooperation, (2) placement design, (3) roles and responsibilities, and (4) educational mentorship concepts. The findings indicate that many studies were conducted addressing various aspects of the CLE in nursing education. However, the majority of studies were descriptive, and there is an urgent need to investigate the effects of interventions to enhance the CLE to improve nursing students' learning outcomes. Most studies look at student perception; few focus on assessing clinical skills. Further research is needed to examine the interplay of clinical skills, CLEs and student perception.

Immigrant parents in the US face unique challenges related to immigration policy and structural inequities. Although stress interventions exist for parents in general, little is known about those targeting US immigrant parents. This scoping review aimed to map the intervention and participant characteristics of stress intervention trials targeting US immigrant parents. The JBI conduct standards, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, and the Population, Concept, and Context framework guided the review. A comprehensive literature search was conducted across APA PsycINFO, PsycARTICLES, CINAHL Plus, ERIC, Embase, MEDLINE, the International Bibliography of Social Sciences, and the Cochrane Library. Peer-reviewed, English-language articles were included without date limits. Five independent reviewers screened studies and extracted data. Of 7,989 records screened, 13 trials were included. Most trials were pilot or feasibility studies (62%) and employed randomized controlled trial designs (62%), with 69% published in the past decade. Interventions primarily focused on stress management or reduction (85%) and were largely adapted from existing programs (92%); all (100%) utilized language adaptations, but only half (50%) incorporated immigrant-specific experiences. Target populations were predominantly Latino/Hispanic parents (69%). Interventions were most often delivered in community (46%) or home (31%) settings, using in-person group formats (69%), commonly combining social support (92%) with parenting skill development (85%). Stress outcomes most frequently assessed parenting stress (69%) or general stress (31%), while immigration-related stress was infrequently measured (15%). Although most trials (77%) used stress measures validated in populations sharing the same racial, cultural, or ethnic background, only four studies (31%) employed tools validated in US immigrant samples. Among the 11 trials reporting group-level outcomes, six (55%) reported improvements. Slightly more than half of the trials enrolled 50 or fewer participants (61%) and primarily involved parents with a mean age between 30 and 39 years (62%). Many trials involved parents of children with a mean age in the preschool-kindergarten (23%) and elementary school (46%) ranges. Over two-thirds of trials (77%) reported participation of parents with low education. While female parents were reported in all trials, fathers' participation was reported in fewer than half of studies (46%). Among these, no trials reported samples with &#x2265;&#x2009;50% fathers, and only two reported&#x2009;&#x2265;&#x2009;25% fathers. No trials reported participation of non-biological or non-residential parents. Despite the heightened stress faced by US immigrant parents, few targeted intervention trials have been published. Key gaps in the existing literature include reliance on adapted interventions that emphasize social support and parenting skills, limited use of stress measures validated for US immigrant parent populations, and underrepresentation of diverse immigrant groups. Future research should broaden populations and settings, diversify intervention strategies, and assess immigration-related stress and stressors using validated measures.

Clinical skills deficits are a patient-safety concern, yet remediation remains underexamined, particularly in low- and middle-income countries, where faculty shortages, uneven access to simulation and supervised practice, inconsistent assessment, and stigma can hinder timely and effective support. The effects of trainee underperformance extend beyond the individual, with implications for patient care, supervisory workload, and team functioning. Although interest in remediation is increasing, the evidence base remains fragmented, dominated by high-income settings, and largely descriptive. A theory-driven review is therefore needed to explain how remediation works, for whom, and under what conditions. This realist review protocol aims to identify the main challenges and strategies reported in clinical skills remediation in undergraduate and postgraduate medical training, explain for whom these strategies work, in what contexts, and through which mechanisms, and develop an evidence-informed initial program theory for low- and middle-income country settings. Following the RAMESES (Realist and Meta-narrative Evidence Syntheses: Evolving Standards) for realist synthesis, this review will draw on a broad range of sources, including MEDLINE or PubMed, CINAHL, PsycINFO, ERIC, and Scopus, alongside gray literature such as dissertations, World Health Organization resources, medical education policy documents, and institutional reports. Sources published from January 2000 onward will be considered eligible, spanning empirical studies, program evaluations, and theory-informing documents focused on the remediation of clinical or procedural underperformance among medical learners at any training stage. Screening, extraction, and appraisal will be performed in duplicate. Extracted data will include learner characteristics, remediation triggers, intervention features, contextual conditions, candidate mechanisms, and outcomes related to competence, progression, and patient safety. Synthesis will apply retroductive reasoning to develop and refine context-mechanism-outcome configurations and a middle-range program theory. Funding was secured through Badan Riset dan Inovasi Nasional (National Research and Innovation Agency of Indonesia; 2023). The protocol was registered in PROSPERO (International Prospective Register of Systematic Reviews) (CRD42023447029). Protocol development, stakeholder-informed scoping, preliminary literature familiarization, and initial program theory construction were completed by April 2026. Formal database and gray-literature searching is planned for mid-2026, followed by duplicate screening, relevance and rigor appraisal, data extraction, and iterative realist synthesis through 2026-2027. The primary review manuscript is targeted for submission in 2027. This review aims to move remediation scholarship beyond description, toward a clearer understanding of what works, for whom, and why. By bridging evidence, theory, and real-world practice, it hopes to guide the design of remediation systems that are contextually grounded, educationally sound, and ultimately capable of restoring safe clinical performance across both undergraduate and postgraduate medical training.