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Psychotropics are increasingly prescribed in paediatrics despite limited evidence regarding their benefits and effectiveness. Although deprescribing approaches are established in adults, structured paediatric strategies remain poorly defined. To identify and evaluate clinical practice guidelines (CPGs) on psychotropic deprescribing in youth, to describe and discuss recommendations regarding when and how to deprescribe in practice. We systematically searched PubMed, Embase, PsycInfo, Scopus, Web of Science and grey literature (2015-2025). Two reviewers independently screened and evaluated the quality of the guidelines (AGREE II). We derived from this a psychotropic deprescribing algorithm in youth, supplemented with clinical expertise. Among the 1390 records identified, none strictly met the methodological criteria for formal CPGs. Nevertheless, we assessed two papers that provided practical deprescribing recommendations and shared several characteristics with CPGs. One systematic review focused on antidepressant discontinuation, recommending tapering after remission with gradual dose reduction and monitoring to distinguish withdrawal from relapse. One narrative review provided child-specific guidance for stimulants, recommending reassessment and possible discontinuation after 1 year of stability. Both were rated as 'moderate' using the AGREE II tool and provided limited practical detail on stepwise deprescribing procedures. Critical gap and urgent need for paediatric-specific deprescribing guidelines. We propose an expert-informed stepwise deprescribing algorithm. Psychotropic medications are increasingly prescribed to children and adolescents, even though their long‐term benefits and harms are still uncertain. We searched major medical databases (2015–2025) for clear, practical guidance on how to safely reduce or stop these medicines in young people. Out of 1390 records, none strictly met the methodological criteria for formal clinical practice guidelines (CPGs). Nevertheless, two papers provided practical deprescribing recommendations and shared several characteristics with CPGs. One addressed antidepressant withdrawal, the other mainly concerned stimulants. Both offered only limited, sometimes vague advice on when and how to taper, and little help for everyday clinical decisions. No guidance was found for other drug classes, revealing a major gap in paediatric care.

Background: Aging involves several social, psychological, and biological changes, including changes in perceived energy. Within Self-Determination Theory, Subjective Vitality refers to the experience of having energy available to the self. Despite its relevance for older adults, no review has mapped how Subjective Vitality has been studied in this population. This scoping review aimed to map the literature on Subjective Vitality in older adults and identify gaps in the evidence base. Method: Following Joanna Briggs Institute guidance, five electronic databases were searched for peer-reviewed quantitative articles published between 1997 and 2026 in which Subjective Vitality was assessed in samples with a mean age of 65 years or older. Of the 1915 records identified, 11 reports were included, corresponding to eight independent samples. Results: Studies were conducted in a limited number of countries, predominantly Western, and showed substantial heterogeneity across research domains. Subjective Vitality was most often assessed using the Subjective Vitality Scale, although different versions and response formats were used, and psychometric or adaptation evidence specific to older adults was limited. Potential antecedents and mechanisms included basic psychological need satisfaction, autonomy support, autonomous regulation, intrinsic goals, flow, social contacts, ego integrity, and meaning in life. Intervention studies suggested that leisure education and endurance training may support Subjective Vitality, although evidence remains limited. Conclusions: Future studies should use clearer sampling procedures, validated and well-reported measures, and stronger longitudinal and intervention designs capable of testing temporal and causal relationships.

To map and synthesize how spirituality is defined in the oncology literature, identifying the key domains associated with the concept. A scoping review was conducted following PRISMA-ScR guidance. PubMed, Scopus, Web of Science, Embase, and LILACS were searched, along with gray literature. Definitions and conceptual domains were synthesized using inductive thematic analysis, descriptive domain analysis, and a complementary content-analytic step. A total of 104 studies were included in the review. Six core themes were identified: search for meaning and purpose, transcendence and connection to something greater, relational connectedness, inner peace and well-being, faith and belief in the sacred, and coping and existential resources. Definitions of spirituality varied widely, with earlier studies emphasizing religious frameworks and later ones adopting broader existential and psychosocial interpretations. Geographic trends highlighted cultural influences on the conceptualization of spirituality. The theme of meaning and purpose was the most consistently represented across geographic and temporal contexts. Spirituality in oncology is a multidimensional construct shaped by cultural, temporal, and contextual factors. Although the theme of search for meaning and purpose was represented across the largest number of definitions in the complementary content analysis, establishing a common definition of spirituality remains elusive. These findings underscore the importance of culturally sensitive approaches to spiritual care in oncology, recognizing how spirituality is conceptualized in relation to patient resilience and well-being.

IntroductionUnderstanding the modifiable risk factors for Graves' orbitopathy (GO) is crucial for its prevention.MethodsWe searched PubMed, Embase, and Web of Science databases following PRISMA guidelines. Studies reporting the presence of GO compared to patients with Graves' disease (GD) without orbitopathy or healthy controls were included. Statistical analysis was performed using Review Manager 5.4.1.ResultsTwenty-two studies met the inclusion criteria. Smoking increased the risk of GO, with odds ratios (ORs) of 2.00 (95% CI [1.47, 2.72]; p&#x2009;<&#x2009;0.0001) for current smokers and 1.77 (95% CI [1.33, 2.37]; p&#x2009;=&#x2009;0.0001) for former smokers, compared with GD patients without orbitopathy. Thyroidectomy was associated with a higher OR of Graves' disease without orbitopathy, supporting a protective effect against orbitopathy (OR 2.53; 95% CI [1.03, 6.22]; p&#x2009;=&#x2009;0.04). However, radioiodine therapy did not show a significant association (OR 0.89; 95% CI [0.42, 1.91];p&#x2009;=&#x2009;0.77). Biomarkers, including vitamin D (p&#x2009;=&#x2009;0.63), FT3 (p&#x2009;=&#x2009;0.89), FT4 (p&#x2009;=&#x2009;0.59), and TSH (p&#x2009;=&#x2009;0.40), showed no significant differences. In comparison to healthy controls, smoking remained a major risk factor for GO (OR 4.81; 95% CI [1.39, 16.70]; p&#x2009;=&#x2009;0.01), while elevated FT4 (MD 8.87; 95% CI [1.64, 16.10]; p&#x2009;=&#x2009;0.02) and decreased TSH (MD -1.23; 95% CI [-2.25, -0.20]; p&#x2009;=&#x2009;0.02) levels were found in the GO groups.ConclusionOur analysis provides a comprehensive understanding of clinical and biomarker-based risk factors to guide targeted prevention strategies.

Evidence on the relationship between smoking and postoperative surgical site infection (SSI) after spinal fusion is inconsistent. This systematic review and meta-analysis assessed whether smoking is associated with an increased risk of SSI following spinal fusion surgery. PubMed, Embase and the Cochrane Library were searched for observational studies published from 2010 to October 2025 comparing postoperative SSI between smokers and non-smokers undergoing spinal fusion; included studies used cohort or case-control designs. Risk ratios were pooled using a random effects model. Prespecified subgroup analyses were performed by spinal region, SSI definition, surgical indication, infection type, follow-up duration and smoking category. Meta-regression, leave-one-out analyses and the Peters test explored effect modifiers, robustness and small-study effects. The review was registered in PROSPERO (CRD420251181545). Twenty-six studies including 16,385 patients met the inclusion criteria. Smoking was associated with an increased risk of postoperative SSI (RR 1.28; 95% CI 1.08-1.53; p = 0.005). Significant associations were also seen with CDC criteria (RR 1.24; 95% CI 1.02-1.51; p = 0.03), in degenerative spine surgery (RR 1.76; 95% CI 1.17-2.67; p = 0.007), and in cohorts with at least 1 year of follow-up (RR 1.36; 95% CI 1.07-1.73; p = 0.01). Stratification by infection depth showed no significant differences. Sensitivity analyses supported the stability of the pooled effect. Smoking is associated with a higher risk of SSI after spinal fusion. Because all included studies were observational, these findings indicate association rather than causation, and support incorporating smoking status into perioperative risk assessment and counseling.

Preoperative and postoperative anxiety adversely affect pain, recovery, and patient experience. Nurse-led interventions are well-placed to address these outcomes, yet their effectiveness across the perioperative arc has not been synthesized with a specific focus on nurses. Hence, this review was done to determine the effectiveness of perioperative nurse-led interventions for psychological problems among patients undergoing surgery. Systematic review and meta-analysis. Following PRISMA 2020, we searched major databases and trial registries from 2000 to the latest search date, including randomized and comparative nonrandomized studies of adult surgical patients receiving nurse-led psychological interventions versus usual care. Two reviewers screened, extracted, and assessed risk of bias (RoB 2/ROBINS-I). Random-effects meta-analyses used standardized mean differences with DerSimonian-Laird estimation; heterogeneity (Q, I&#xb2;, &#x3c4;&#xb2;), small-study effects (Egger's test when &#x2265;10 studies), and leave-one-out analyses were performed. Fifteen studies (n = 1,827) were included. For preoperative anxiety (10 studies; n = 1,059), nurse-led interventions produced a significant reduction (SMD = -1.13; 95% CI: -1.65 to -0.60), with high heterogeneity; Egger's test suggested no significant small-study effects (P = .064). For postoperative anxiety (8 studies; n = 784), effects also favored interventions (SMD = -0.87; 95% CI: -1.33 to -0.41), with high heterogeneity. Patient satisfaction improved (5 studies; n = 543; SMD = 1.22; 95% CI: 0.17 to 2.27), with substantial heterogeneity. Leave-one-out analyses showed robust findings across outcomes. Perioperative nurse-led psychological interventions meaningfully reduce preoperative and postoperative anxiety and improve patient satisfaction. Despite heterogeneity and limited long-term data, the consistency and robustness of effects support integrating brief, structured, nurse-delivered psychological care as a routine component of perioperative pathways.

Background: Atrial fibrillation (AF) is a common but frequently undiagnosed cause of ischemic stroke, particularly among patients with cryptogenic stroke and embolic stroke of undetermined source (ESUS). Implantable cardiac monitors (ICMs) enable prolonged continuous rhythm monitoring and may improve AF detection following ischemic stroke or transient ischemic attack (TIA). This systematic review and meta-analysis aimed to evaluate the diagnostic yield, clinical impact, and safety of prolonged ICM monitoring in patients with ischemic stroke or TIA. Methods: This systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 guidelines and registered with PROSPERO (CRD42024573913). PubMed, Google Scholar, and the Cochrane Library were systematically searched. Randomized controlled trials and observational studies evaluating the use of ICMs after ischemic stroke or TIA were included. Randomized evidence was synthesized narratively, whereas single-arm random-effects meta-analyses of observational studies were performed to estimate pooled proportions for AF detection, oral anticoagulation initiation, recurrent ischemic stroke or TIA, and device-related adverse events. Results: Twelve completed studies involving 4563 participants met the inclusion criteria, including two randomized controlled trials and ten observational studies. One additional ongoing randomized controlled trial (Find-AF 2) involving a planned enrollment of 5200 participants was identified and is described narratively. Across the observational studies, the pooled AF detection rate during prolonged ICM monitoring was 25.9% (95% CI, 18.9-33.5%), although substantial heterogeneity was observed (I2 = 95%). Oral anticoagulation was initiated in 94.2% (95% CI, 79.4-100.0%) of patients diagnosed with AF. Device-related complications were uncommon, with a pooled incidence of 3.7% (95% CI, 2.0-6.0%; I2 = 0%), while the pooled rate of recurrent ischemic stroke or TIA during follow-up was 6.2% (95% CI, 3.9-9.2%). Narrative synthesis of the randomized evidence demonstrated that ICMs significantly increased AF detection compared with conventional monitoring but did not demonstrate a significant reduction in recurrent stroke during the available follow-up period. Conclusions: Prolonged implantable cardiac monitoring identifies AF in approximately one-quarter of patients following ischemic stroke or TIA and frequently leads to the initiation of oral anticoagulation, with a favorable safety profile. Although ICMs substantially improve AF detection, current evidence remains insufficient to confirm that increased detection translates into a reduction in recurrent stroke. Large, adequately powered randomized controlled trials are needed to determine the long-term clinical benefits of ICM-guided management and to define the optimal monitoring strategy for patients following ischemic stroke.

Background: Artificial intelligence (AI)-driven markerless motion capture (MMC) technologies are increasingly being integrated into pediatric healthcare to improve the assessment and management of movement disorders. These video-based systems enable non-invasive motion analysis without wearable sensors, facilitating more natural movement assessment in children, particularly those with neurological or developmental conditions. Objectives: We evaluated the clinical applicability of AI-based MMC tools in pediatric settings for diagnosis, monitoring of motor development, and rehabilitation. Methods: This systematic review was registered in PROSPERO (CRD42024511787) and conducted by two independent reviewers, with a third reviewer resolving disagreements. The literature published between 2018 and 2025 was systematically searched. Studies involving pediatric populations or clinically relevant pediatric applications of MMC were included. Results: Of 1521 identified studies, 52 were finally selected. The included studies evaluated populations across a wide age range. However, seven of the included articles were specifically focused on underage populations. Infant studies primarily analyzed whole-body movements, emphasizing the relevance of global motor patterns in early development. OpenPose and AlphaPose were the most frequently used frameworks in pediatric research because of their automatic full-body key point detection, whereas DeepLabCut was commonly selected for its customizable labeling capabilities. Theia3D emerged as a promising clinically applicable solution with high accuracy. Most studies evaluated kinematic parameters as objective markers of motor performance and development. However, methodological heterogeneity and limited pediatric-specific validation remain important limitations. Conclusions: AI-driven MMC technologies show considerable potential to support objective, accessible, and child-friendly movement assessment in pediatric clinical practice.

Background: Physical exercise is strongly recommended for breast cancer survivors due to its beneficial effects on physical function, metabolic health, and quality of life. Lactate, traditionally considered a metabolic byproduct of glycolysis, is increasingly recognized as a signaling molecule involved in metabolic regulation and exercise adaptation. However, exercise-induced circulating lactate responses in breast cancer survivors remain poorly characterized. The aim of this systematic review and exploratory meta-analysis was to synthesize and critically appraise current evidence on exercise-induced circulating lactate responses in breast cancer survivors Methods: A systematic review and exploratory meta-analysis were conducted according to PRISMA guidelines and prospectively registered in PROSPERO (CRD42024504288). PubMed, Scopus, and Web of Science were searched to identify controlled trials investigating exercise-induced changes in circulating lactate concentrations in breast cancer survivors. Random-effects meta-analysis was performed using pooled mean differences. Results: Among 173 screened records, four studies met eligibility criteria for qualitative synthesis and three contributed to quantitative analysis. Pooled results demonstrated no statistically significant effect of exercise on circulating lactate concentrations (weighted mean difference: 0.03 mmol/L; 95% CI: -0.24 to 0.31; p = 0.81), with low heterogeneity (I2 = 31.1%). Considerable variation was observed across exercise protocols, intervention duration, and lactate assessment timing. Conclusions: Exercise-induced circulating lactate responses in breast cancer survivors appear modest and inconsistently reported across available studies. Current evidence remains limited by small sample sizes and methodological heterogeneity. These findings provide a physiological overview of lactate responses to exercise in breast cancer survivorship and highlight the need for standardized exercise interventions and metabolic outcome assessment in future research.

Antimicrobial resistance (AMR) is a major global public health threat, compromising prevention and treatment of infectious diseases. This narrative review examines AMR as a multifactorial and transnational crisis through epidemiological, One Health, social and bioethical perspectives, and discusses emerging non-antibiotic preventive and therapeutic strategies. PubMed and Scopus were searched using terms related to AMR, epidemiology, public health, surveillance, One Health, bioethics, equity and alternative therapies. Peer-reviewed medical and public health articles were considered, together with selected reports from international organizations and public health agencies. AMR is driven by inappropriate antibiotic use in human medicine, livestock, aquaculture and agriculture, combined with weaknesses in infection prevention, stewardship, environmental control and surveillance. Epidemiological evidence shows a substantial global burden, marked regional inequalities in resistance patterns, surveillance capacity and policy response, and major consequences, including increased mortality, prolonged hospitalization, rising healthcare costs and disproportionate effects on vulnerable populations. Key bioethical concerns include collective responsibility, equitable access to effective treatment, stewardship, global justice and intergenerational accountability. Emerging non-antibiotic strategies vary in translational maturity: vaccines and selected microbiome-based interventions have preventive or supportive roles in defined settings, bacteriophage therapy is used mainly in compassionate or specialized contexts, and many antimicrobial peptides and nanotechnology-based platforms remain experimental or early translational. AMR requires coordinated global action grounded in One Health, strong public health systems, integrated surveillance, responsible antimicrobial use and sustained innovation. Effective containment must also address social inequalities, ethical stewardship, equitable access to diagnostics and treatment, and responsibility toward future generations.

IntroductionBrain-computer interfaces (BCIs) have shown meaningful functional benefits for patients with severe neurologic and neuromuscular disabilities. Pediatric populations with similar conditions may likewise benefit, yet the scope and characteristics of pediatric BCI (pBCI) research remain unclear. We systematically characterize the global clinical trial landscape of pBCI studies to inform clinical and regulatory strategies.MethodsWe conducted a registry-based cross-sectional descriptive analysis of recruiting, ongoing, and planned pBCI clinical trials. ClinicalTrials.gov and 3 international registries were searched using "brain-computer interface," "BCI," "brain-machine interface," "neural interface," "neuroprosthetics," and "EEG-based assistive technology" and limited to participants aged 0-17 years. Two independent reviewers screened records and extracted key study variables, including device type (implanted vs non-implanted), enrollment, duration, phase, and condition studied; discrepancies were resolved by consensus.ResultsEleven studies met the inclusion criteria. Trials encompassed 7 countries. Eight studies evaluated non-implanted devices and 3 for implanted systems. Duration and enrollment differed descriptively between groups. Non-implanted trials had a median duration of 56.0 days (IQR: 42.0-182.6), whereas implanted trials had a median duration of 365.3 days (IQR: 91.3-1826.4 days). Non-implanted trials had a median enrollment of 29 participants (IQR: 19-51.5; range: 8-400), whereas implanted trials had a median enrollment of 8 participants (IQR: 3-30; range: 3-30). Only 4 studies exclusively enrolled pediatric participants; the others recruited both pediatric and adult participants.ConclusionsCurrent pBCI clinical research remains limited in scope, and children may be inadequately prioritized in BCI research.

Nurse practitioner (NP) students have distinct needs transitioning from experienced nurses to NPs; yet, faculty-led mentorship remains poorly defined. This scoping review examined faculty-led mentorship for NP students and its impact on clinical competency. Guided by Joanna Briggs Institute methodology and the the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), MEDLINE (Ovid), PubMed, Embase (Ovid), and Cumulative Index to Nursing and Allied Health Literature were searched. Twenty-six articles were included. Mentorship definitions varied widely, and reported outcomes were sparse but included increased student self-efficacy, perceived support, and improved retention. Empirical outcome data and structured NP-specific mentorship models remain limited, highlighting a critical gap within competency-based education. However, faculty mentorship programs show potential to support academic progression, professional growth, and transition to advanced practice.

General practitioners manage most opioid tapering. This process requires time-consuming, individualised planning accounting for patient preferences, dose options and costs. Consequently, clinicians need tools to support tapering. This review explores existing international digital decision support systems for opioid tapering. We conducted a scoping review following the JBI methodology. Five databases (PubMed, Embase, CINAHL, Cochrane and Web of Science) were searched in January 2026. Title/abstract and full-text screening were performed independently by two reviewers based on predefined eligibility criteria. Disagreements were resolved by a third reviewer. Data were extracted and summarised both descriptively and narratively. The search identified 2340 studies, of which four met the eligibility criteria. The studies included described four different technology-driven decision support tools for opioid tapering. The tools varied in format and clinical context (primary and secondary care), but they all aimed to support clinicians in planning and managing opioid tapering. Evidence on clinical effectiveness and real-world implementation was limited across the studies. Only few studies have investigated technology-driven decision support for opioid tapering, and only one is set within a European context. While tools exist in different formats and clinical settings, evidence on their effectiveness and real-world implementation remains limited, highlighting a need for further development and evaluation. General practitioners manage most opioid tapering, which requires individualised plans based on patient preferences, doses, and costs. To identify digital decision support systems assisting clinicians, we conducted a scoping review in January 2026. After screening 2340 studies across five databases, we identified four relevant studies. These described four distinct technological tools used in primary and secondary care to plan opioid tapering. However, we found limited evidence regarding their clinical effectiveness or real&#x2010;world implementation, and only one study was European. While tapering tools exist, researchers must further evaluate their effectiveness and practical use in clinical settings.

Craniomaxillofacial trauma (CMFt) poses a significant burden, yet in many countries the evidence base is fragmented across single-center hospital series without specialized registry. Using Chile as a case study, we demonstrate a dual-synthesis approach to construct a national CMFt profile. Six databases were searched through February 2026 (PROSPERO: CRD420261290860). Two reviewers independently screened studies. Risk of bias was assessed with the JBI critical appraisal tool. Fracture-site proportions were pooled via random-effects meta-analysis and synthesized using GRADE. DEIS trauma discharges (2001-2024) were analyzed with negative binomial interrupted time-series. Nineteen studies were included. CMFt represented 2.6-6.1% of emergency consultations. CMFt admissions were 54.2/1000 trauma discharges; this rate dropped during 2020-2021 and rebounded post-2022. Pooled fracture-site distributions were highest for mandibular (45.3%) and zygomatic (24.2%) fractures. CMFt disproportionately affected males across both hospital series and national discharge data. According to DEIS, low-energy accidental injuries were the predominant etiology, followed by transport-related high-energy injuries and interpersonal violence, contrasting with hospital series where interpersonal violence predominated among adult surgical cohorts. Fracture admissions had longer length of stay (LOS) than soft-tissue CMFt (+0.94 days), with mean LOS ranging from 2.08 (nasal) to 8.35 days (multiple skull/facial fractures). These findings support prioritizing surgical preparedness and training in common fracture patterns, while strengthening trauma surveillance, referral pathways, and service planning in health systems without dedicated CMFt registries.

Accurate prognostication after aneurysmal subarachnoid hemorrhage (aSAH) remains challenging. Conventional clinical and radiological grading systems, including the World Federation of Neurosurgical Societies (WFNS), Hunt-Hess, and Fisher scales, are widely used but have limited discriminative capacity. This study aimed to systematically compare machine learning (ML)-based prognostic models with conventional grading systems for predicting functional outcomes and mortality after aSAH, and to evaluate factors influencing ML performance. A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines. PubMed, Embase, Scopus, Web of Science, and the Cochrane Library were searched for studies published between 2010 and 2025. Eligible studies evaluated ML-based models for outcome prediction in adult aSAH patients and reported performance of conventional grading systems. Prognostic discrimination was pooled using random-effects meta-analysis of the area under the receiver operating characteristic curve (AUC), with predefined subgroup analyses. Fourteen studies including 6,247 patients were analyzed. ML models demonstrated good to excellent discrimination, with AUCs ranging from 0.81 to 0.97. The pooled ML AUC for predicting unfavourable neurological outcome was 0.86 (95% CI 0.83-0.89; p&#x2009;<&#x2009;0.0001), with substantial heterogeneity (I&#xb2; = 96.1%). ML models outperformed conventional grading systems in most studies and showed comparable performance in the remainder. Subgroup analyses confirmed statistically significant prognostic accuracy across clinical-only, imaging-based, and multimodal ML models. Machine learning-based prognostic models demonstrate statistically significant and clinically meaningful performance for outcome prediction after aSAH, exceeding conventional grading systems and supporting their role as complementary risk stratification tools.

Proprioception is traditionally defined as the perception of joint position and movement, yet contemporary evidence supports a broader view: a multimodal sensorimotor system integrating peripheral afferent input with central motor commands. Despite its recognised importance in rehabilitation and sport, conceptual and methodological inconsistencies persist regarding its definition, assessment and training, and interventions labelled proprioceptive are frequently indistinguishable from general neuromuscular or balance-based exercise. This narrative review, reported in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA), critically analyses the current state of knowledge on proprioception and clarifies the concept of proprioceptive training. PubMed, Scopus, Web of Science and SPORTDiscus were searched from January 2000 to May 2025, combining "proprioception", "kinaesthesia", "joint position sense" and "force sense" with "definition", "assessment", "training" and "rehabilitation". Sources addressing conceptual foundations, assessment instruments, interventions explicitly labelled proprioceptive, or critical reviews were eligible, with no restriction of body region; studies on balance alone without proprioceptive measurement and non-peer-reviewed material were excluded. Of 1412 records screened, 119 informed the synthesis. Proprioception comprises distinct submodalities-joint position sense, kinaesthesia and force sense-mediated by specific receptors and pathways. Current tools isolate these under artificial conditions with limited ecological validity, and most interventions labelled proprioceptive induce general motor adaptations rather than genuine sensory ones. Submodality-specific operational definitions and ecologically valid assessment tools are required.

Background: In older adults, multimorbidity and polypharmacy complicate medication regimens and often lead to poor adherence. Mobile health (mHealth) has been suggested as a solution to enhance medication adherence in chronic conditions. Despite the increase in smartphone usage among people aged 65 and over, there is still a lack of evidence of mHealth in this age group. Objectives: To evaluate the impact of mHealth interventions on medication adherence in older adults (&#x2265;65 years) with chronic diseases, compared with standard care or other interventions. Methods: The review was conducted in accordance with PRISMA 2020 guidelines and the Cochrane Handbook for Systematic Reviews. Randomized controlled trials published from 2000 onwards were considered with no linguistic or geographical restrictions. The databases searched included PubMed, Scopus, Cochrane Library, and CINAHL. Methodological quality was assessed using the Revised Cochrane Risk of Bias Tool for Randomized Trials. Results: 551 records were initially identified, from which 8 randomized controlled trials published between 2014 and 2025 were included. Six of eight studies showed that medication adherence in mHealth groups was significantly higher than in controls. However, one study found benefits only in specific drug classes rather than a general improvement. Conclusions: The results of this review suggest that mHealth has the potential to improve medication adherence among older adults with chronic diseases, especially when interventions go beyond simple reminders and incorporate educational and relational components. Nevertheless, higher quality studies with larger samples and longer follow-up are needed to clarify mHealth's role in the care of this population.

Although Clostridioides difficile infection (CDI) is a key cause of global morbidity and mortality, the burden of CDI in mainland China is not well-defined. The objective of this systematic literature review was to summarize the available epidemiologic evidence on the CDI disease burden (cases, hospitalizations, and deaths) in mainland China. Six databases (three global [PubMed, Embase, Cochrane] and three Chinese [Chinese National Knowledge Infrastructure, Chinese Science Citation, Wanfang]) were searched on 5 August 2025 using CDI-related and epidemiological search terms. No date or language limits were applied. Real-world epidemiologic studies of adults and/or children with laboratory-confirmed CDI in mainland China reporting population-based CDI incidence, hospital-based CDI incidence, and/or CDI admission rates were included. All studies not meeting these criteria were excluded. Risk-of-bias (RoB) assessment was performed using the Newcastle-Ottawa Scale. Results were summarized descriptively. In total, 11 articles formed the evidence base for this review; each was a single-center, hospital-based study conducted in one of six cities in mainland China and published between 2014 and 2023. RoB assessment indicated that the evidence base was appropriate for this study. No study reported population-based CDI incidence. In total, 10 studies reported hospital-based CDI incidence (0 to 82.0/10,000 patient-days), and four reported CDI admission rates (0 to 23.1/1000 admissions). Eight studies reported mortality rates, which varied across studies. Several single-center, hospital-based studies demonstrate that CDI is present in hospitals in mainland China, but there are no published population-based CDI incidence estimates. These results should be interpreted considering this study's limitations, including potential publication and selection bias, heterogeneity, and limited generalizability. Overall, the burden of CDI is poorly understood in mainland China. Thus, prospective epidemiological studies, including those with sensitive detection methods, are needed to examine CDI burden across multiple cities in mainland China. These efforts would help illuminate the CDI burden and guide prevention efforts. (PROSPERO ID 1140152; registered 17 March 2026; funding by Pfizer Inc.).

Background: Non-contact anterior cruciate ligament (ACL) injury is common and disabling, often requiring reconstruction and predisposing individuals to early post-traumatic osteoarthritis, making scalable, exercise-based prevention a clinical and public health priority. Excessive peak vertical ground reaction force (vGRF) during landing is a modifiable biomechanical risk marker for ACL injury, although whether reducing it lowers injury incidence is unproven. We evaluated the effect of movement retraining on peak vGRF during landing in pivot-sport athletes and general athletic populations. Methods: MEDLINE (PubMed), Embase, and the Cochrane Central Register of Controlled Trials were searched from inception through to 25 May 2026. Two reviewers independently screened records and extracted data. Random-effects meta-analyses (DerSimonian-Laird) used Hedges' g; risk of bias was assessed with RoB 2 and certainty with GRADE. The protocol was registered in PROSPERO (CRD42025116119). Results: Nine comparisons from eight randomised controlled trials (292 participants) were included. Movement retraining significantly reduced peak vGRF (Hedges' g = -0.94, 95% CI -1.34 to -0.54; I2 = 63%), with larger effects in general athletic populations (g = -1.50) than in pivot-sport athletes (g = -0.66; subgroup difference p = 0.005). Knee flexion angle at initial contact showed a non-significant increasing trend (g = 0.48; p = 0.18). Certainty of evidence (GRADE) was low. Conclusions: Movement retraining was associated with a reduction in peak vGRF during landing, a surrogate biomechanical marker for ACL injury, on the basis of low-certainty evidence with substantial heterogeneity (I2 = 63%). A subgroup difference favouring general over pivot-sport athletes was observed but is exploratory, resting on only three general-athletic comparisons. Because no included trial measured injury incidence, whether these biomechanical changes reduce ACL injury is unknown, and the findings should be regarded as hypothesis-generating.