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This research examined the performance of a machine learning algorithm when predicting the surface roughness of tempered steel AISI 1060. Different machine learning algorithms, such as decision tree (DT), random forest (RF), adaptive boosting (ADB), gradient boosting (GB), and extreme gradient boosting (XGB), were optimized by using 10-fold cross-validation and the grid search method. From these optimized models, the decision tree, adaptive boosting, gradient boosting, and extreme gradient boosting were used as base models to develop a more powerful machine learning model called super learner machine learning. The linear regression (LR) was used as a meta-model in developing super learner machine learning. The developed super learner model performance was then validated against all machine learning models used in this research. For performance measurement metrics such as mean absolute error (MAE), root mean square error (RMSE), mean absolute percentage error (MAPE), and coefficient of determination (R²) has been used. The developed super learner model achieved the highest R² of 99.2% and the lowest MAPE of 2.6% on the test data set when compared with other machine learning models. Further, the SHAP method shows that hardness has the highest effect, followed by feed rate and cutting speed, respectively. Most machine learning approaches are not used practically for user applications, but in this research, a graphic user interface framework called fast, accurate, and intelligent (FAI) frame was developed to predict the surface roughness of tempered steel AISI 1060. This research is used for practical application for any user in industry and for research purposes.

To review the literature on psychosocial care and experiences of young adults with early-onset type 2 diabetes (EOT2D), to identify what is known, current gaps and to develop recommendations to help advance psychosocial care and support for the population. We searched Medline (Ovid), Google Scholar and diabetes-specific journals for English-language articles focused on psychosocial aspects in young adults (aged 18-45 years) with EOT2D. Two people with lived experience reviewed and commented on the review findings. Growing evidence indicates that a diagnosis of EOT2D is associated with an increased risk of developing diabetes-related psychological comorbidities. Experiences of diabetes-related stigma, compounded by age-related negative preconceptions, contribute to heightening the psychosocial impact of EOT2D. Some population sub-groups appear to be more likely to experience adverse psychological effects. However, the evidence base is limited by a dearth of diverse research specifically focused on the psychosocial experiences and needs of this population (e.g., longitudinal and qualitative studies). Adults with EOT2D also experience unmet education, care and support needs relevant to optimising their psychosocial well-being and diabetes management. Overall, they require enhanced, tailored care and support that is age-appropriate, person-centred and responsive to their psychosocial needs. Digital technology and support-based strategies may help to address current gaps and improve the psychological well-being of this group, but these require further exploration. Despite the importance of psychosocial factors in young adults' diabetes management and outcomes, there remain gaps in research and practice and the need for further research, alongside changes in practice.

Selenoproteins represent a structurally and functionally distinct class of proteins that contribute to cellular antioxidant defense and a wide range of other essential biological processes in specific organisms. They contain the 21st amino acid selenocysteine (Sec) in their active sites, which is encoded by an in-frame UGA stop codon through a translational reprogramming mechanism. Due to the dual functionality of the UGA codon, selenoprotein genes are frequently misidentified and misannotated in genomic databases, especially in bacteria where selenoproteins exhibit greater complexity and diversity compared to their eukaryotic counterparts. Thus, a comprehensive resource is urgently required to enable accurate identification of selenoprotein genes across diverse bacterial genomes. We have developed BSepDB, a specialized database dedicated to systematic curation of bacterial selenoprotein genes and proteins, providing an exhaustive resource for the research community. The current version (BSepDB v. 1.0) encompasses over 57,000 selenoprotein entries derived from 16,621 bacterial species, representing the largest and most taxonomically diverse repository of bacterial selenoproteins to date. To facilitate intuitive data exploration, BSepDB offers multiple user-friendly interfaces, such as interactive browsing and search tools, an integrated BLAST search function, and options for bulk data download. Additionally, the curated entries in BSepDB are cross-referenced with established genomic databases (e.g., GenBank and RefSeq) to improve the accuracy of selenoprotein annotations in large-scale genomic projects. BSepDB serves as a valuable resource for researchers investigating selenium utilization and the functional diversity of selenoproteins in bacteria. The database is freely available at https://bsepdb.metalbioinfolab.net.

The integration of neurocognitive challenges into biomechanical movement tasks has gained attention due to its potential relevance for assessments of physical function, injury risk, and performance. However, a comprehensive mapping of the chosen methodological approaches, targeted populations, and applied outcome measures is still lacking. This scoping review hence aimed to synthesize the current literature on unplanned movement tasks combining cognitive decision-making and biomechanical outcome measurements. A systematic literature search following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses-extension for scoping reviews) guidelines was performed in Web of Science (Core Collection), MEDLINE (PubMed), Cochrane Library, and Google Scholar. Included studies combined unplanned movement tasks (e.g., change-of-direction or stopping) with biomechanical assessments. Eligible articles were analysed in terms of participant characteristics, movement type, unplanned task type, reactive stimulus, and biomechanical outcome variables. From the total of 167 studies, the majority focused on change-of-direction tasks (82%), mostly using standardized angles of 45° and moderate approach speeds (3.9 ± 0.9 m/s). Jump (7%), land (12%), and/or stop tasks (3%) were less frequent. Most studies (83%) relied on simple visual cues (e.g., lights or symbols), whereas more ecologically valid stimuli (e.g., videos or real opponents) were rarely applied. Biomechanical analyses predominantly focused on knee angles and moments as well as ground reaction forces, while only 23% of studies included electromyography measurements. Older adults (50+ years) were not represented. Although research on unplanned biomechanical tasks is growing, significant methodological heterogeneity and limited ecological validity may constrain the interpretability and applicability of findings. Future research should aim for task designs that better reflect real-world conditions and include diverse populations and comprehensive neuromuscular assessments.

Timely palliative care can reduce the disease burden and improve quality of life in patients with cancer. Although several studies have developed assessment models for palliative care needs in cancer patients, the quality and clinical applicability of these models remain unclear. To systematically review existing assessment models for palliative care needs in patients with cancer, with a focus on their characteristics, predictors, risk of bias, and applicability. A systematic search was conducted in PubMed, Cochrane Library, Embase, Web of Science, CINAHL, Scopus, China National Knowledge Infrastructure (CNKI) through September 12, 2025. Data extraction and evaluation were rigorously performed by two researchers based on the Prediction Model Risk of Bias Assessment Tool (PROBAST). A total of 5714 articles were identified, and eight studies were included, which covered 24 models for assessing palliative care needs. The sample size of the included studies ranged from 179 to 54,628, with areas under the curve ranging from 0.724 to 0.998. The models in all the included studies encompassed four categories of predictive factors: general demographic data, symptom/functional assessments, laboratory indicators, and treatment status. Five studies were rated as having a high risk of bias, primarily due to high risks associated with participants and conclusions, with generally low applicability. Existing models demonstrate potential for identifying patients with cancer who have increased palliative care needs using routinely collected clinical data. Commonly included predictors were symptom burden, functional status, laboratory parameters, treatment-related factors, and demographic characteristics. However, the overall body of evidence is constrained by a substantial risk of bias, particularly arising from inappropriate data sources, limited sample sizes, suboptimal handling of continuous variables, insufficient reporting of missing data, and the lack of robust internal or external validation. In addition, many models adopted mortality-based surrogate outcomes rather than clinically meaningful indicators of palliative care needs. Therefore, the currently available models should be interpreted with caution, and further high-quality model development and external validation are required before they can support broader routine clinical implementation. Future research should prioritize clinically actionable outcomes and incorporate patient-, caregiver-, and family-level factors to improve the relevance of these models for referral decisions and care planning.

Methotrexate (MTX) is a long-standing drug used to treat leukemia (at high doses to inhibit DNA/RNA synthesis) and rheumatoid arthritis (at low doses for anti-inflammatory effects). Its characteristic narrow therapeutic range, in terms of efficacy and safety associated with MTX, are important factors to consider when deciding whether to prescribe it. A major challenge in its use is interindividual variability which is largely attributed to germline genetic polymorphisms in genes encoding proteins that control the pharmacokinetics or pharmacodynamics of MTX. This study updates a previous 2018 review using a systematic literature search in PubMed/MEDLINE, Scopus, and SciELO. The search, conducted according to the PRISMA protocol, employed predefined keywords to identify studies published up to June 2025. This systematic review identified that, to date, only a few genetic polymorphisms influence clinical decision-making. Specifically, the MTHFR 677T allele and the MTHFR 677T-1298 A haplotype (rs1801133- rs1801131) have been associated with toxicity in both adults and children. Furthermore, the 677T-1298 A haplotype has been linked with reduced event-free survival in Caucasian patients with either adult RA or pediatric ALL. Regarding other markers, the TYMS rs34743033 3R allele has been implicated with reduced efficacy in adult patients receiving low-dose MTX, while the FPGS rs1544105 T allele has shown an association with diverse toxicities in ALL pediatric patients. Although considerable research has been conducted and numerous results have been obtained, the available evidence remains predominantly of moderate quality. Consequently, current guidelines from CPIC and the DPWG do not recommend routine MTX dose adjustments based solely on single gene variants. It is, therefore, imperative to develop and validate multifactorial risk prediction tools that integrate a range of other clinical factors. Accordingly, the establishment of a comprehensive pharmacogenetics-guided dosing guideline for MTX remains an elusive goal.

The purpose of this systematic review was to analyze whether breathing therapy is effective in reducing pain, improving health-related quality of life, improving physical functioning/activity, and improving sleep quality in patients suffering from complex chronic non-cancer pain conditions (CNCP). An electronic literature search was conducted in MEDLINE, CINAHL, EMBASE, Cochrane Library, PEDro, and PsycINFO from inception to October 2024. The inclusion criteria were randomized clinical trials (RCT) examining breathing therapy as a sole or central intervention component in adult patients with CNCP. From 2,369 abstracts, a total of 10 RCTs (n=638) met the inclusion criteria. The population in the selected studies were patients with chronic neck pain, chronic low back pain, fibromyalgia, or tension-typed headache. Breathing therapy significantly improved pain and/or health-related quality of life in six studies. However, the quality of the included RCTs ranged from high to critically low, and substantial heterogeneity in participants, intervention, and methods prevented synthesis of results across studies. This systematic review highlights breathing therapy as a promising pain management strategy in patients suffering from CNCP. We evaluated two RCTs examining similar daily slow diaphragmatic breathing for 15 min to have a low risk of bias; both demonstrating statistically significant relevant pain reduction up to 37 %. However, the strength of recommendations for clinical practice depends on the level of evidence as indicated by a risk of bias assessment (internal validity), consistency of results between studies, and generalizability (external validity). Based on the findings of this systematic review evidence of breathing therapy invention in patients suffering from CNCP conditions remains sparse. Striving to eliminate or minimize opioid management for complex CNCP, high-quality research is needed to reinforce the evidence base for non-pharmacological interventions such as breathing therapy to support modern pain management rather than former traditional pharmacological treatment. Trial registry number: PROSPERO #CRD42023460181.

Background: To evaluate temporal trends in public interest regarding surgical treatments for benign prostatic hyperplasia (BPH) in the United States using Google Trends (GT) data from 2010-2025. Relative search volume (RSV) data for Holmium Laser Enucleation of the Prostate (HoLEP), Rez&#x16b;m&#xae;, UroLift, Aquablation, and Prostatic Arterial Embolization (PAE) were extracted from GT between January 2010 and August 2025. Annual mean RSV values were analyzed using descriptive statistics, linear regression, and Pearson correlation. Statistical significance was defined as p < 0.05. HoLEP demonstrated a robust and statistically significant upward trajectory throughout the study period (R2 = 0.762; &#x3b2; = 0.873; p < 0.001), reflecting sustained growth in public interest. Rez&#x16b;m&#xae; similarly exhibited a strong and consistent increasing trend (R2 = 0.799; &#x3b2; = 0.894; p < 0.001), indicating a notable expansion in online engagement over time. Aquablation showed a moderate but significant rise in search activity (R2 = 0.549; &#x3b2; = 0.741; p < 0.001), although its overall magnitude of interest remained comparatively lower than other modalities. UroLift demonstrated a significant temporal association (R2 = 0.637; &#x3b2; = 0.798; p = 0.001), despite fluctuations in interest during later years of the study. PAE demonstrated a strong but non-significant upward trend (R2 = 0.788; &#x3b2; = 0.888; p = 0.051), suggesting a more variable pattern of public attention. Correlation analyses further revealed strong inter-modality relationships, particularly between HoLEP and Aquablation (r = 0.948) and between HoLEP and PAE (r = 0.916). Rez&#x16b;m&#xae; and Aquablation have experienced rapid growth in recent years, while HoLEP has consistently maintained its importance. UroLift and PAE have exhibited more variable trends. Digital trend analysis is a valuable tool for understanding evolving patient preferences and informing clinical and policy decisions.

To map how simulation-based education supports the development of critical thinking skills required for nurses to recognize delirium in clinical practice. A scoping review guided by the Joanna Briggs Institute methodology and the framework developed by Arksey and O'Malley, refined by Levac and colleagues. Two reviewers independently screened and extracted data to identify studies evaluating simulation-based education designed to strengthen nurses' delirium recognition and associated critical thinking processes. A narrative approach was used to chart and synthesize findings across varied simulation modalities and clinical contexts. The search was conducted on 4 September 2025, using MEDLINE, CINAHL and PsycINFO. No timeframe was applied to the search. Fourteen studies met inclusion criteria. Simulation-based education consistently enhanced skills aligned with critical thinking, including observational accuracy, recognition of fluctuating cognitive cues, clinical reasoning, reflective awareness, empathy and communication within interprofessional teams. Structured debriefing played a central role in helping nurses analyse decision-making processes and integrate experiential learning into clinical judgement. Several studies reported changes in practice, including more consistent use of delirium identification tools and improved clarity of clinical documentation. Simulation-based education strengthens interconnected domains of critical thinking that underpin nurses' capacity to recognize delirium early and respond effectively to its fluctuating presentation. These findings highlight the educational value of immersive, theory-informed simulation for developing the clinical judgement required in cognitively complex patient situations. Integrating structured simulation into nursing education and professional development may enhance timely delirium recognition, foster more effective interprofessional communication and support safer, higher-quality care for hospitalized adults. Simulation-based education offers a practical and scalable strategy for improving delirium recognition across care settings. By supporting nurses in noticing subtle cognitive changes, interpreting clinical patterns and communicating concerns with clarity and confidence, simulation contributes to stronger workforce preparedness and patient safety. This review adhered to PRISMA-ScR reporting guidance. This study did not include patient or public involvement in its design, conduct or reporting.

Growth differentiation factor-15 (GDF15), a stress-responsive cytokine of the transforming growth factor-&#x3b2; superfamily, is elevated in cancer cachexia, chemotherapy-induced nausea, and hyperemesis gravidarum, making it both a biomarker and a therapeutic target. Here, we developed high-affinity GDF15 binders using an artificial intelligence-driven protein design framework. To achieve this, we systematically explored three complementary scaffold-generation strategies: scaffold grafting, diffusion-based de novo design, and scaffold-search and grafting, identifying distinct advantages - scaffold grafting rapidly optimized receptor-derived motifs to sub-nanomolar affinity; de novo diffusion produced topologically novel binders; and scaffold-search and grafting enabled access to concave site B of GDF15 by repurposing evolutionary structural analogs from natural complexes. The designed GDF15 binders were translated into two functional modalities. First, a one-step, wash-free luminescent biosensor was created by coupling a de novo binder to split-luciferase fragments, enabling the rapid and sensitive quantification of GDF15. Second, the highest-affinity binder was engineered as an Fc-fusion decoy receptor, thereby effectively neutralizing GDF15 signaling in cell-based assays (IC50&#x2009;=&#x2009;7.2&#x2009;nM), demonstrating comparable in vitro potency to ponsegromab, a monoclonal antibody currently undergoing phase II clinical trials. Together, this work establishes a versatile artificial intelligence-driven binder design pipeline with broad potential for next-generation diagnostics and therapeutics in cancer cachexia and other GDF15-mediated diseases.

This study reviews the evidence for point-of-care ultrasound (POCUS) for the detection of hip effusion in children presenting to the emergency department with atraumatic limp or hip pain. A scoping review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review (PRISMA-ScR) guideline. PubMed, EMBASE, and the Cochrane Library databases were searched from January 2000 to October 2025. All study designs were considered. The primary outcome was diagnostic accuracy of POCUS for hip effusion, and key secondary outcomes included provider characteristics and clinical integration. Data were also charted across study, participant, and ultrasound characteristics. Thirteen studies met inclusion criteria: 3 prospective studies, 9 retrospective cohorts, and 1 case report. Studies predominately evaluated diagnostic accuracy of POCUS performed by emergency medicine physicians with variable training compared with radiology performed ultrasound, feasibility of POCUS guided hip arthrocentesis, and explored its integration into clinical decision rules. Diagnostic accuracy was high, with reported sensitivity ranging from 80% to 98% and specificity from 91% to 98%. This scoping review demonstrates that there is growing evidence that hip POCUS is a useful clinical tool for evaluation of pediatric patients presenting to the emergency department with atraumatic limp or hip pain. It has been shown to be accurate when performed by emergency physicians after variable training. Further research is required with large prospective multicenter studies to explore patient-centered outcomes and validate diagnostic pathways that incorporate POCUS.

Parkinsonian disorders, including Parkinson's disease, Lewy body dementia, multiple system atrophy, and progressive supranuclear palsy, are progressive neurodegenerative conditions with no treatment options to slow disease progression. This systematic review provides an overview of evidence of disease-modifying therapies that have been evaluated in clinical studies across these disorders, based on a comprehensive literature search up to May 2025. Eligible studies included clinical trials investigating pharmacological interventions aimed at slowing disease progression. Most clinical development has focused on Parkinson's disease, with limited progress in other Parkinsonian disorders. Therapies targeting alpha-synuclein, such as monoclonal antibodies and small molecules, have shown target engagement but limited clinical efficacy. Glucocerebrosidase-enhancing agents, particularly ambroxol, demonstrated promising biomarker and clinical signals in early-phase trials. Glucagon-like peptide-1 receptor agonists and kinase inhibitors have yielded mixed results, with some agents progressing to phase 3 trials. Neurotrophic factors, cell survival and neuroprotective therapies, stem cell therapies, and anti-inflammatory agents remain largely investigational, with limited evidence of efficacy. Repurposed drugs, including memantine and riluzole, have shown preliminary signals of benefit, though confirmatory trials are lacking. Despite substantial research efforts, no disease-modifying therapy has been approved for any Parkinsonian disorder. The heterogeneity of disease mechanisms and the limitations of current clinical endpoints, such as the Unified Parkinson's Disease Rating Scale, underscore the need for biomarker-driven approaches and stratified trial designs. Future success will likely depend on improved patient selection, mechanistic targeting, and the integration of fluid and imaging biomarkers to demonstrate disease modification.

This study aimed to standardize the global prevalence of metabolic syndrome (MetS) in patients with epilepsy. Several databases including PubMed, Scopus, Web of Science, Embase, Science Direct, and Google Scholar were thoroughly searched. Studies up to 2025 on MetS prevalence in people with epilepsy were included. The search covered cross-sectional, cohort, and case-control studies in English that reported MetS prevalence in this group. Statistical analysis was performed using Comprehensive Meta-Analysis software (Version 2). The I&#xb2; statistic was used to assess heterogeneity across studies, and the random-effects model was applied for data analysis. Analysis of 24 findings from 18 studies estimated that the overall prevalence of (MetS) in people with epilepsy was 29.6% (95% CI: 25.7%-33.9%). Further analysis showed that the highest prevalence of MetS in epilepsy patients was in studies conducted in South America, with a prevalence of 42.4% (95% CI: 37.8%-47.0%). The only study that used the Harmonized Criteria diagnostic tool reported the prevalence equal to 49.4% (95% CI: 39.2%-59.7%). Furthermore, a meta-regression analysis found no significant association between the year of publication or the number of participants and the prevalence of MetS in epilepsy patients (P&#x2009;>&#x2009;0.01). The results highlighted a high prevalence of MetS among patients with epilepsy. Therefore, healthcare professionals should not only focus on epilepsy but also regularly monitor risk factors associated with MetS and identify them early in patients with epilepsy.

Physician associations play a significant role in shaping health policy at national and sub-national levels. However, the influence of such associations in low- and middle-income countries has not been synthesized or assessed. The Indian Medical Association (IMA), one of the largest physician associations in the world, has a long history of policy engagement at national and state levels across multiple issues. This review aims to assess - for the first time - the empirical literature available on the IMA as a political actor. Adopting a scoping review methodology, the paper sought to identify the policy stances, strategies and influence of the IMA over India's health policy. Nine health, social science, and policy research databases were searched for English-language studies published between 1974 and 2024. Reviewing 37 papers, it finds that the IMA has been active in seven main policy domains: violence against doctors; regulation of the private healthcare sector; restriction of traditional medicine; professional authority or autonomy for physicians; publicly funded health insurance; medical ethics; and partnership in public health programs. It has been reactive against new legislation, reform or regulation in all domains except for violence against doctors. Through interrelated interior and exterior strategies, the organization has been successful in influencing, stalling or limiting legislation. While the IMA holds influence through the size of its membership and its embeddedness in health administration and corporate interests, the tactics of the organization often lack coherence and consistency. Situating these findings in the broader landscape of health governance, our review contributes further evidence for the need to develop more inclusive and transparent pathways for participation in decision-making.

Epilepsy is one of the most prevalent chronic neurological disorders worldwide, affecting approximately 70 million people globally and imposing substantial burdens on patients, families, and healthcare systems. Its multifaceted treatment landscape spanning antiepileptic drug (AED) therapy, epilepsy surgery, ketogenic dietary therapy, and neuromodulation makes accurate health information critical for patient decision-making and treatment adherence. Short-video platforms such as TikTok (Douyin) and Bilibili have emerged as primary channels through which the public accesses health-related content, yet the quality and reliability of epilepsy-related content on these platforms remain largely unexamined. A cross-sectional content analysis was conducted. We systematically retrieved videos via keyword search on TikTok (Douyin) and Bilibili, using the terms "dianxian" (epilepsy) and "jingfeng" (seizure/convulsion). For each platform, we collected the top 100 unique videos ranked by the platform's default relevance algorithm, with duplicate results from the two search terms removed. After applying pre-specified inclusion and exclusion criteria, 182 videos were included in the final analysis. Two physicians independently assessed the videos using a multi-instrument framework with clear applicable boundaries: Global Quality Score (GQS, for overall educational quality across all content types), modified DISCERN (mDISCERN, exclusively for treatment information reliability), JAMA benchmark criteria (for source transparency, not direct clinical accuracy), and a novel Treatment Misinformation Risk Scale (TMRS, specifically for epilepsy treatment-related content). Inter-rater reliability was assessed using the intraclass correlation coefficient (ICC). Engagement metrics and uploader characteristics were also recorded, with sensitivity analyses performed to control for confounding from uneven content theme distribution between platforms. A total of 182 videos were analyzed (96 from TikTok, 86 from Bilibili). The overall educational quality was suboptimal (mean GQS: 2.65&#x2009;&#xb1;&#x2009;0.93; mDISCERN: 2.12&#x2009;&#xb1;&#x2009;0.89 for treatment-containing videos). Bilibili videos demonstrated significantly higher performance across all instruments: overall educational quality (GQS: 3.11&#x2009;&#xb1;&#x2009;0.87 vs. 2.24&#x2009;&#xb1;&#x2009;0.84, P&#x2009;<&#x2009;0.001), treatment information reliability (mDISCERN: 2.56&#x2009;&#xb1;&#x2009;0.81 vs. 1.74&#x2009;&#xb1;&#x2009;0.76, P&#x2009;<&#x2009;0.001), and source transparency (JAMA: 2.18&#x2009;&#xb1;&#x2009;0.72 vs. 1.42&#x2009;&#xb1;&#x2009;0.68, P&#x2009;<&#x2009;0.001). The mean normalized TMRS score was 1.15&#x2009;&#xb1;&#x2009;0.62, with TikTok showing significantly higher treatment misinformation risk (1.41&#x2009;&#xb1;&#x2009;0.54) than Bilibili (0.86&#x2009;&#xb1;&#x2009;0.53, P&#x2009;<&#x2009;0.001). TMRS scores were positively correlated with likes (rho&#x2009;=&#x2009;0.46, P&#x2009;<&#x2009;0.001), shares (rho&#x2009;=&#x2009;0.43, P&#x2009;<&#x2009;0.001), and comments (rho&#x2009;=&#x2009;0.39, P&#x2009;<&#x2009;0.001), while quality scores showed no significant correlation with engagement. Sensitivity analyses confirmed that the observed platform differences were not confounded by differences in content theme distribution. Epilepsy-related content on China's major short-video platforms is of concerningly poor quality, with treatment misinformation receiving disproportionately higher user engagement. These findings highlight the urgent need for collaborative efforts among neurologists, platform operators, and health authorities to improve the quality of epilepsy health information in the digital environment.

Self-harm in young people is a pressing public health issue, with family support playing a crucial role in the young person's prognosis. Concurrently, the impact extends to families themselves, who must navigate caregiving responsibilities while also requiring support. Understanding these experiences is key to providing more effective assistance in their caregiving roles. With this mixed-methods systematic review we investigated the experiences, barriers, and needs of families of young people who self-harm. Following PRISMA guidelines, a search was conducted within PsycINFO, PubMed, Web of Science, and Scopus databases in July 2024 and April 2025. Thirty-one studies were included in this review, and quality was assessed with the Mixed Methods Appraisal Tool (MMAT). A narrative synthesis was employed for the quantitative data, while qualitative data were analysed with thematic synthesis. The quantitative findings revealed two themes: (1) the repercussions of self-harm in the family and (2) family support needs. Qualitative analysis identified four themes: (1) parents' emotional and psychological impact; (2) impact on parenting and the bond with the young person; (3) disruption of family dynamics; and (4) barriers to and pathways for family support. We discuss the implications of these findings, offering recommendations for future research and improvements in family support services to alleviate caregiver burden and foster supportive environments for recovery. Siblings&#x2019; experiences can vary with age, and many of their needs remain unaddressedAccessible care, family involvement, trained staff, and follow-up are neededFindings call for a systemic, family-centered approach to self-harm recovery.