搜索结果：evidence-based

Military veterans are at an elevated risk of developing posttraumatic stress disorder (PTSD), while first-line trauma-focused treatments are less effective in this population. This highlights the need for novel, evidence-based complementary interventions for military veterans with treatment-resistant PTSD. Although equine-assisted interventions (EAIs) are increasingly popular and appear promising, many studies suffer from methodological issues. Therefore, further research incorporating both psychometric and physiological parameters is warranted. Nine consecutive groups of eight veterans (n = 72; 58 men and 14 women) participated in this study. Due to a dropout rate of 8.33% and the exclusion of 11.11% of participants for missing more than two sessions, 58 veterans were included in the dataset. All participants had a prior PTSD diagnosis and/or a score >31 on the PTSD Checklist for DSM-5 (PCL-5) questionnaire at intake and had previous evidence-based treatment but continued to experience symptoms. The program consisted of 12 weekly non-trauma-focused group sessions and one follow-up session (week 24), all lasting from 10:00 to 15:00. Measurements were performed during baseline conditions (B), a 20-min free activity (F) focused on relaxation and social affiliative contact with the horse, and a 30-min directed activity (D) involving caretaking, groundwork, and riding. Psychometric questionnaires demonstrated a significant decrease in PTSD symptoms (PCL-5), an improvement in sleep quality (Pittsburgh Sleep Quality Index [PSQI]), and an improvement in quality of life (EuroQol 5-Dimension 5-Level questionnaire [EQ-5D-5L]), with effects persisting at least until the 3-month follow-up session. No significant differences in heart rate (HR) or heart rate variability (HRV) were observed between pre- and post-intervention. However, during EAI sessions, patterns consistent with physiological adaptation were observed, as HR decreased and HRV increased after the first week during free interactions with the horse. In conclusion, the EAI program was associated with long-term effects on PTSD, sleep quality, and quality of life in veterans with treatment-resistant PTSD. No structural changes in physiological parameters were found, only evidence for successful adaptation to acute stress during EAI sessions. We hypothesize that adaptation to physiological arousal during acute stress may represent a possible working mechanism of EAI.

Heat stress (HS) is at the top of the challenges facing modern dairy production, with annual losses according to global projections, under high-emission scenarios, reaching US$14.7-40.0 billion by the end of the century. This review emphasizes three interconnected topics that account for most of the proportion of the productive and reproductive losses during HS. First, the physiological consequences of HS are reviewed, with emphasis on the pair-fed thermal neutral (PFTN) paradigm, which established that reduced dry matter intake (DMI) accounts for only 35-50% of the observed milk yield decline, with the remainder arising from tissue-level effects of hyperthermia on mammary function, metabolism, and reproductive performance. Second, HS-induced microbiome disruption is examined as an active pathophysiological amplifier, whereby rumen dysbiosis compromises intestinal barrier integrity and drives systemic endotoxaemia, chronically amplifying the immune suppression already imposed by the thermal insult. Third, we focus on the integration of multi-omics platforms as a management approach, since single-omics analyses capture only a fraction of the biological complexity underlying the HS response. As the available datasets expand in coverage and scale, their integration through AI-driven analytical frameworks has the potential to substantially advance beyond the current fragmented picture, progressively building toward a systems-level model of thermal stress. Evidence-based mitigation strategies spanning environmental cooling, targeted nutritional supplementation, and genomic selection are critically evaluated within this framework, with emphasis on equity of access to evidence-based solutions across global dairy production systems.

Emergency contraception (EC) is a time-sensitive pharmacy service in which consistent, patient-centred counselling is important but can be challenging to deliver in routine practice. This prospective implementation study evaluated the feasibility and real-world use of a digital counselling support tool for pharmacist-led EC consultations in Swiss community pharmacies. The tool combines patient self-reporting with structured, evidence-based support for pharmacist counselling. All EC consultations between 1 November 2023 and 14 February 2026 using the tool in 10 Swiss community pharmacies were analysed descriptively (n = 3428), alongside a voluntary anonymous post-consultation survey (n = 148) assessing patient-reported experience and acceptance. Median total consultation duration was 11:32 min, including 4:27 min of direct pharmacist counselling, indicating partial transfer of assessment to the digital pre-consultation phase. Ulipristal acetate was dispensed in 71% and levonorgestrel in 26% of consultations. Prior to counselling, 80% of patients reported uncertainty regarding the optimal active ingredient, underscoring the relevance of pharmacist involvement. Survey respondents rated the tool as easy to use (97%), discreet (99%), and trustworthy (98%); 85% preferred it over standard paper-based procedures. These findings demonstrate the feasibility and patient acceptance of integrating a digital tool into routine EC services and suggest that such tools may support structured, evidence-based counselling within community pharmacy practice.

Anxiety and depressive disorders remain highly prevalent and insufficiently treated, with many individuals experiencing persistent or untreated symptoms, limited access to evidence-based care, or insufficient support between clinical encounters. Adults with disabilities represent a particularly underserved subpopulation, often facing compounded barriers to mental health care and higher rates of anxiety and depression. Digital therapeutics offer a scalable opportunity to address these gaps by extending structured, evidence-based interventions beyond traditional care settings. This pilot study evaluated Rauha, a novel digital therapeutic created by Toivoa Inc, that integrates cognitive behavioral therapy (CBT)-based modules with live weekly sessions led by a National Board-Certified Health and Wellness Coach (NBC-HWC), delivering structured, smartphone-based psychoeducation and interactive therapeutic exercises combined with personalized mental health coaching to support behavior change. Thirteen adults with mobility and/or hearing disabilities and clinically elevated anxiety and/or depression were enrolled in a single-arm, within-participants design. Participants completed 8 weeks of CBT modules delivered via smartphone, accompanied by synchronous virtual mental health coaching. Anxiety and depression were assessed using the Hamilton Anxiety and Hamilton Depression Rating Scales, respectively, at baseline, post treatment, and at the 4-week follow-up. Mean reductions were significant for both anxiety (-13.05, SD 2.51; P<.001) and depression (-12.83, SD 1.55; P<.001), exceeding thresholds for clinical significance and sustained through follow-up. Post treatment, 84.6% (11/13) of participants showed clinically significant improvement in both anxiety and depression. At follow-up, 76.9% (10/13) and 92.3% (12/13) of participants showed clinically significant improvement in anxiety and depression, respectively. Between baseline and follow-up time points, these reductions corresponded to mean shifts from moderate to mild anxiety on the Hamilton Anxiety Rating Scale and from moderate to mild/nondepressed on the Hamilton Depression Rating Scale. Participants reported strongly favorable acceptability, experience, and usability ratings for the Rauha treatment program, demonstrating 100% treatment retention and an average replay rate of 5.5 for personalized smartphone content. The findings suggest that a combined digital CBT and NBC-HWC approach can yield clinically meaningful and durable symptom reductions in depression and anxiety, coupled with high user acceptability and engagement, for adults with disabilities. These findings provide preliminary evidence supporting Rauha as a scalable, evidence-informed mental health intervention with the strong potential to improve access and address key barriers to care.

Interpretation of postmortem (PM) gamma-hydroxybutyric acid (GHB) remains challenging due to endogenous production and postmortem increases in concentration associated with decomposition. Existing interpretation guidelines primarily rely on a single criterion, such as concentration thresholds or urine-to-blood ratios. In San Francisco, routine and unbiased implementation of GHB testing across all casework generated a large dataset including 1865 GHB detections in PM blood or urine, of which 552 were paired peripheral blood and urine samples. Cases were categorized as acute exogenous use, confirmed exogenous use, or no indication of use based on toxicological and investigative findings. Peripheral blood concentrations in cases with no indication of use did not vary significantly by age, gender, race, or manner of death, but were significantly higher in decomposed cases. While existing guidelines effectively identify endogenous levels, the proposed hybrid model, combining peripheral blood concentration (B) with urine-to-blood ratio (U/B), enables further classification into no exogenous use, possible exogenous use (B&#x2009;>&#x2009;5&#x2009;mg/L and U/B > -0.05&#x2009;&#xd7;&#x2009;B&#x2009;+&#x2009;4), and acute exogenous use (B&#x2009;>&#x2009;50&#x2009;mg/L and U/B > -0.05&#x2009;&#xd7;&#x2009;B&#x2009;+&#x2009;10). The model was evaluated and compared to existing guidelines. Internal applicability was assessed using recent casework, and external applicability was evaluated using an independent dataset from Qu&#xe9;bec, Canada. The hybrid model demonstrated improved performance, achieving substantially higher positive predictive value when compared to existing guidelines, while maintaining equal or improved performance measures across other metrics. This approach provides a conservative, evidence-based framework for distinguishing acute exogenous GHB use in PM casework.

Lactose intolerance is a common digestive disorder found in many people around the world. It occurs when the body does not produce enough of the enzyme lactase needed to break down lactose, a type of sugar. Lactose is present in almost all mammal milk products, and for infants, this sugar is important for providing energy during their growth. There are many variations of adults with lactase persistence around the world; for example, in Nordic countries, more than 90% of adults produce lactase into adulthood, but in Southeast Asia, only around 10% of adults do so. Overall, about one-third of all adults can digest dairy products; however, many people believe that there will be negative side effects if they eat or drink dairy products. This leads to a restriction of dairy products that can hurt the body's ability to grow and get enough nutrients because dairy products contain many essential nutrient sources (protein, vitamins, minerals). About 68% of the world population is affected by lactose intolerance, but that figure has not changed much in the past decade. However, there are vast regional variations (5-28% in Europe and 70-98% in Asia and Africa). The therapeutic market, including enzyme supplements, probiotics, and dietary aids applicable in all of the severity stages of the condition, is estimated to be valued at $ 36.96 billion in 2026, which represents a 7.4% compound annual growth rate; to reach $ 49.13 billion in 2030 due to the creation of personalized interventions and dairy substitutes. Lactose intolerance results from reduced lactase enzyme activity, leading to lactose malabsorption and gastrointestinal symptoms such as bloating, abdominal pain, flatulence, and diarrhea.The prevalence of lactose intolerance varies widely across populations due to genetic differences in lactase persistence, with the highest rates reported in Asia and Africa and the lowest in Northern Europe.Hydrogen breath testing remains the most widely accepted and accurate noninvasive diagnostic method for confirming lactose malabsorption and lactose intolerance.Complete avoidance of dairy products is generally unnecessary; most individuals with lactose intolerance can tolerate small amounts of lactose, particularly when consumed with meals or in fermented dairy products such as yogurt and aged cheese.Lactase enzyme supplementation, dietary modification, and selected probiotic interventions represent the current evidence-based approaches for symptom management.Emergving microbiome-based therapies, precision nutrition strategies, synbiotics, and engineered probiotics may provide future personalized treatment options for lactose intolerance.Long-term unnecessary dairy restriction may increase the risk of calcium and vitamin D deficiencies; therefore, nutritional counseling is important to maintain adequate nutrient intake while managing symptoms.

This communication provides a multidisciplinary perspective on the contribution of nuclear medicine, liquid biopsy-derived molecular markers, and AI/ML-based approaches to evolve a stepped-care model in precision oncology. The subject is of significance, particularly in the current era of precision medicine, where individualized treatment strategies increasingly require the integration of molecular imaging, molecular profiling, and multidisciplinary decision-making. The authors also emphasize the growing role of nuclear medicine in personalized treatment selection and theranostic decision-making, highlighting the next steps in molecular PET-CT imaging for further evolution of Theranostics. The past decade and a half have witnessed an exponential growth in Theranostic applications of Nuclear Medicine and its evolution as a powerful scientific precision approach, blending&#xa0;"diagnostics" and "therapeutics" in a simple workflow platform. One can foresee an evolution of a number of therapeutic radiopharmaceuticals in the coming years directed towards various targets on cancer cells & associated tumor microenvironment (TME) (e.g. cancer associated fibroblasts, neovascularization) and are likely to develop as preferred substitutes to systemic therapies or "sandwich" combinatorial regimens in metastatic/advanced disease, in view of their well-tolerability and relatively low toxicity. The systemic targeted treatment approaches-such as targeted chemotherapy, immune-directed treatments, and radiopharmaceutical agents-have enhanced in recent years, with a number of eligible targets traceable for the same cancer. Developing a "stepped care" precision theranostic approach-by selecting the most appropriate tumor target(s) and planning an evidence-based individualized drug-sequencing priority list on a scientific basis-is a critical need to enhance clinical outcomes by optimizing treatment efficacy with minimal toxicity. This perspective primarily emphasizes on the personalized therapy choices amongst the targeted radioligand therapy, chemotherapy, and/or immune-targeted treatments through the current and emerging molecular profiling technologies to evolve a stepped care precision theranostic model of cancer care, in an era of AI/ML.

Background/Objectives: Childhood vaccine refusal may negatively affect immunization programs in T&#xfc;rkiye, where regional clusters of hesitancy have emerged despite high national coverage. This study aimed to identify sociodemographic, behavioral, and vaccine confidence-related factors independently associated with childhood vaccine refusal in Konya, T&#xfc;rkiye. Methods: An unmatched case-control study was conducted between July and October 2025 in family health centers across Konya. Cases were parents who had refused at least one routine childhood vaccine (n = 406); controls were parents whose children had completed all routine vaccinations (n = 412). Data were collected through face-to-face interviews using a 47-item structured questionnaire and the Turkish version of the Vaccine Hesitancy Scale (VHS). Independent associations were assessed using multivariable logistic regression, with multicollinearity evaluated by variance inflation factors. Results: Maternal employment (aOR = 0.371, 95% CI: 0.218-0.633), parental COVID-19 vaccination (aOR = 0.131, 95% CI: 0.086-0.200), mother's complete childhood immunization (aOR = 0.418, 95% CI: 0.262-0.667), tetanus vaccination during pregnancy (aOR = 0.259, 95% CI: 0.159-0.421), and neonatal vitamin K administration (aOR = 0.256, 95% CI: 0.132-0.497) were independently associated with lower refusal odds. Higher number of children (aOR = 1.281) and perceived vaccine-related adverse events in the social environment (aOR = 16.982, 95% CI: 9.914-29.089) increased refusal odds. VHS scores were significantly lower in the refusal group (22.2 &#xb1; 6.4 vs. 39.8 &#xb1; 6.5; p < 0.001), indicating greater hesitancy. Notably, 21.9% of refusing parents reported being advised by a healthcare professional not to vaccinate. Conclusions: Childhood vaccine refusal in Konya was associated with sociodemographic, behavioral, preventive health-related, and vaccine confidence-related factors. The findings suggest relatively reduced engagement with selected preventive health practices, greater reliance on non-professional information sources, and lower vaccine confidence among refusing parents. Interventions should focus on strengthening healthcare-professional communication, trust-building, transparent risk communication, and evidence-based social media strategies.

Pelvic venous disease (PeVD) and lymphedema are traditionally regarded as distinct clinical entities and are usually investigated and managed within separate clinical frameworks. However, both conditions may coexist in patients with chronic edema, raising the question of whether a venous-lymphatic interaction contributes to chronic edema and whether such a relationship is supported by current evidence. A systematic-style review was performed of published literature on pelvic venous disorders, chronic venous disease, and lymphatic dysfunction. Evidence relating to pelvic venous reflux, central venous obstruction, lymphatic pathophysiology, imaging, and treatment outcomes was critically evaluated, with explicit distinction between established evidence, indirect associations, and hypotheses. The evidence base consists predominantly of observational studies and systematic or narrative reviews. Across published cohorts and reviews, the predominant reported outcome measure for reflux-dominant pelvic venous disease is pelvic pain, with pain improvement reported in approximately 70-80% of patients following embolization. In contrast, the predominant reported outcome measure for obstruction-dominant pelvic venous disease is edema, with subjective improvement reported in approximately 60% of patients following iliocaval with or without caval venous stenting, although edema outcomes are rarely quantified and are not distinguished from lymphedema in the available literature. Objective lymphatic dysfunction is frequently reported in advanced chronic venous disease, but pelvic venous pathology has not been systematically evaluated in relation to lymphatic dysfunction or lymphatic assessment. Current evidence does not establish a causal relationship between pelvic venous disease and lymphedema. While venous-lymphatic interaction is biologically plausible, the proposed surgical continuum should be regarded as hypothesis-driven rather than evidence-based. Routine pelvic venous intervention for lymphedema cannot be justified based on existing data, highlighting the need for integrated prospective studies combining venous and lymphatic assessment.

In this study, we develop a data-driven susceptible-exposed-infectious-treatment tuberculosis transmission model. The model incorporates a Holling type-II saturated incidence rate to capture behavioral and contact saturation effects, along with a Verhulst-type treatment function to reflect constraints in treatment capacity. Model parameters are estimated using India's tuberculosis (TB) incidence data from 2000 to 2020, yielding R0&#x2009;=&#x2009;1.4507, which indicates persistent disease transmission in the absence of effective interventions. To identify efficient control strategies, an optimal control problem is formulated by introducing three time-dependent interventions: preventive measures (u1), tuberculosis preventive treatment (u2), and active case finding (u3). The necessary optimality conditions are obtained using Pontryagin's maximum principle, and the resulting system is solved numerically. Two intervention scenarios are examined: a baseline scenario with limited intervention efficacy (&#x3c4;&#x2009;=&#x2009;0.15, &#x3b8;&#x2009;=&#x2009;0.05) and an enhanced scenario with improved efficacy parameters (&#x3c4;&#x2009;=&#x2009;0.60, &#x3b8;&#x2009;=&#x2009;0.67). A comprehensive cost-effectiveness analysis is conducted using incremental averted ratio, Average Cost-Effectiveness Ratio (ACER), and Incremental Cost-Effectiveness Ratio (ICER) to compare competing intervention strategies. The analysis shows that, under the baseline efficacy, strategy E (u1 only) emerges as the most impactful intervention for reducing transmission. Under the with-improvement scenario, strategy C (u1&#x2009;+&#x2009;u3) demonstrates the most economically efficient, achieving the lowest ACER and most favorable ICER among all strategies considered. These findings provide evidence-based, cost-effective intervention strategies to guide policy formulation and accelerate India's progress toward the WHO End TB strategy milestones, including a 95% reduction in TB deaths and 90% reduction in incidence by 2035 relative to 2015 levels.

The temporomandibular joint (TMJ) is a uniquely complex, bi-articular joint that enables both rotational and translational mandibular movement. Joint sounds, such as clicking and crepitation, are among the most common clinical findings associated with temporomandibular disorders (TMDs) and frequently cause patient concern. Understanding the underlying anatomy of the TMJ, its fibrocartilaginous surfaces, articular disc morphology, and complex muscular attachments is essential to diagnosing the origin of these joint sounds. This article outlines the anatomy and clinical relevance of the TMJ to help clinicians adopt a conservative, evidence-based approach to the assessment of joint sounds, recognising that most are benign and self-limiting, while ensuring accurate diagnosis of sounds suggestive of internal derangement or degenerative change.

Newborn screening in England is a national program with laboratories adhering to common screening algorithms. Until recently, screening for inherited metabolic disorders was provided by ten laboratories using laboratory-developed tests (LDTs) and three using commercial assays: harmonization of results proved challenging. Introduction of hereditary tyrosinemia type 1 screening meant LDTs required modification to include the measurement of succinylacetone, and subsequent re-validation. This provided an opportunity to implement a single commercial reagent kit in all laboratories. It was anticipated that this would improve analytical performance and harmonization. This study aimed to determine whether these goals were achieved. Verification across the 13 laboratories revealed that the commercial kit reduced inter-laboratory variation for all analytes demonstrating improved harmonization. However, this was achieved by applying instrument-specific correction factors to all analytes, the magnitude of which were significant, indicating a lack of standardization. Performance of succinylacetone was limited by instrument-dependent background interference from the methionine stable isotope label, underscoring the need to establish evidence-based screening cut-off values (COV) rather than adopting published thresholds. This study emphasizes the need for traceable reference materials to improve laboratory quality and the value of screening outcome data.

The phenomenon of "choking" under pressure remains a significant challenge in elite sports, where traditional psychological skills training (PST) often yields limited efficacy and transferability due to its subjective nature. This study investigated the efficacy of "Cognitive Armor," a novel neurofeedback protocol designed to enhance performance under pressure by training athletes to self-regulate neural activity associated with an optimal performance state. Forty-five elite athletes from precision-based sports were randomly assigned to one of three groups: a Neurofeedback Group (NG) receiving the Cognitive Armor protocol, an Active Control Group (ACG) receiving sham neurofeedback, and a traditional PST Group (PSTG). Over a 12-week intervention, participants underwent baseline and post-intervention assessments, including quantitative EEG (qEEG), sport-specific performance tests under normal and induced pressure conditions, and psychological questionnaires. A follow-up assessment was conducted after 3 months. Results indicated that the NG demonstrated a significantly greater ability to increase the sensorimotor rhythm (SMR)/high-beta ratio compared to both control groups (F(2, 42)&#x2009;=&#x2009;21.34, p < .001, &#x3b7;p2 = 0.50). Crucially, the NG showed significantly smaller performance degradation under high-pressure conditions than the ACG and PSTG (F(2, 42)&#x2009;=&#x2009;8.91, p < .01, &#x3b7;p2 = 0.30), and these gains were maintained at follow-up. These findings provide promising evidence that objective, EEG-based neurofeedback can be a superior intervention for building mental resilience and preventing performance decrements in elite athletes, offering an evidence-based tool for mental conditioning in competitive sports.

In recent decades, clinical practice has been founded on the principles of evidence-based medicine, where therapeutic decisions arise from the integration of clinical expertise, patient preferences, and scientific evidence derived from controlled studies and meta-analyses. The advent of artificial intelligence (AI) in health care, however, is driving a significant evolution in clinical research, owing to its ability to analyze large volumes of heterogeneous data and overcome the limitations of traditional statistical approaches. The availability of large-scale datasets, increasing computational capability, and reduced storage costs have supported the transition towards a "data-intensive" research model, progressively integrated with conventional methods. Within cardiology, arrhythmology represents one of the fields in which AI finds extensive application. The analysis of complex electrophysiological signals, data from implantable devices, advanced cardiac imaging, and clinical parameters enables the development of algorithms capable of identifying patterns not detectable by human interpretation. These tools have already demonstrated practical utility in the early diagnosis of arrhythmias, risk stratification, procedural planning and guidance for catheter ablation, prediction of response to cardiac stimulation therapies, and optimization of remote device monitoring. Among the key emerging benefits, AI promises increasingly personalized care, enabling more targeted interventions while reducing overtreatment. Furthermore, the development of "digital twins" opens the possibility of simulating patient-specific therapeutic scenarios to support complex clinical decision-making. This manuscript provides an overview of current evidence, emerging applications, and remaining challenges related to the integration of AI in arrhythmology, highlighting its potential to drive a transition towards predictive, preventive, and personalized cardiovascular medicine.

The present integrative umbrella review aims to provide a comprehensive overview of the evidence and practices related to mental health and career transitions in elite sport toward the implementation of service provision through digital interventions. Following PRIO guidelines, an extensive search across five databases (2015-2025) identified 52 eligible manuscripts (e.g., conceptual, review, and position studies). Data extraction focused on mental health, dual-career pathways, career transition challenges and needs, and identity-related issues among high-performance athletes. The findings revealed a strong consensus that athlete well-being is shaped by the dynamic interaction of mental health symptoms, sport-specific stressors, identity processes, and structural conditions across the athletic lifespan. Mental health vulnerabilities (e.g., anxiety, depression, disordered eating, and distress) were consistently reported, particularly during injury, deselection, and retirement. Dual-career engagement, diversified identities, and proactive career planning emerged as key protective factors, while stigma, limited literacy, and uneven access to psychological services remained persistent barriers. Five main thematic areas (Matrix 1) operationalized in ten higher-order intervention domains (e.g., Matrix 2, screening, monitoring, literacy, and others) and 14 potential online implementation strategies (Matrix 3) were identified. However, the evidence highlights fragmented implementation and a lack of scalable, cross-national tools to support athletes during and beyond their competitive careers. Therefore, a harmonized, evidence-based, multidimensional framework for the development and implementation of digital support resources has been proposed. This integrative review underscores the need for integrated, culturally sensitive, and digitally enabled support systems to promote sustainable transitions and long-term athlete well-being.

Background: Nurse Practitioners (NPs) are increasingly integrated into pediatric inpatient teams in response to evolving healthcare needs and workforce challenges. However, evidence describing how NP roles are operationalized, implemented, and sustained in general pediatric ward settings remain fragmented. Objective: This scoping review will synthesize international literature on NP roles in general pediatric inpatient settings, with a focus on determinants of role implementation. Guided by the Participatory, Evidence-based, Patient-focused Process for Advanced Practice Nursing (PEPPA) framework, this review will examine implementation strategies, outcomes, timelines, facilitators, barriers, and required resources to inform future integration and evaluation. Methods: This scoping review will be conducted in accordance with Joanna Briggs Institute (JBI) methodology and reported following PRISMA-ScR guidelines. A PRESS-reviewed search strategy will be applied to Scopus, MEDLINE, PsycInfo, CINAHL, Cochrane Central, ProQuest, grey literature, and reference lists for English and French language studies published from 2016 onward. Studies relating to NP roles in general pediatric wards internationally will be included. Data extraction and synthesis will be structured using the PEPPA framework's implementation domain. Findings will be summarized descriptively and presented in tables and narrative synthesis. Conclusions: A targeted synthesis focused on determinants of NP role implementation in this context is needed. This review will clarify how NPs roles have been integrated in general pediatric wards, highlight enabling and constraining factors, and will identify gaps to guide future research, practice redesign, and policy development.

Background/Objectives: Bronchopulmonary dysplasia (BPD) remains a major morbidity among extremely premature infants, with variability in the application of evidence-based interventions between and within neonatal intensive care units (NICUs). We evaluated a multi-component, risk-guided personalized implementation strategy for BPD prevention in a real-world setting. Methods: We conducted a prospective observational study of infants <29 weeks' gestation at birth admitted to a quaternary NICU. The intervention combined risk stratification and structured longitudinal care planning rounds (LCPRs) that included standardized documentation, multidisciplinary facilitation, and associated continuous quality improvement strategies. Implementation outcomes were assessed using the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. Secondary outcomes included care processes, provider-reported measures, and exploratory clinical outcomes. Results: Over six months, 41 infants were included. Risk stratification was consistently applied and all fifteen high-risk infants received LCPR, demonstrating targeted reach. Multidisciplinary participation was broad, with implementation fidelity reflected by consistent screening, structured documentation, and timely care plan execution. Practice standardization was observed, including consistent corticosteroid use (100%), earlier initiation of systemic postnatal steroids (median 16 days), and selective adjunctive therapy use. Providers reported improved teamwork, care coordination, and confidence. Rates of BPD or mortality were comparable between higher-risk infants receiving LCPR and lower-risk infants, despite greater illness severity in the LCPR group. Respiratory severity scores showed a downward trend after implementation, though this did not reach statistical significance (p = 0.07). Strategy use continued beyond the study period indicating early sustainability. Conclusions: A multi-component, risk-guided implementation strategy can be effectively integrated into routine NICU practice, improving care processes while maintaining clinical outcomes in high-risk infants compared with lower-risk infants.