搜索结果：Strategy and Management

Dysphagia is a prevalent disorder that compromises the safety and efficiency of swallowing, increasing the risk of complications such as aspiration, malnutrition, and dehydration. Swallowing is a complex process involving both motor and sensory mechanisms, with sensory input playing a crucial role in bolus perception and control. In this context, modifying food texture and liquid viscosity has become a key strategy to promote safe oral intake. In addition, the experience of eating is related to the sensory perception of food, including characteristics such as taste, aroma, texture, and temperature, which influence the acceptance, enjoyment, and effectiveness of the eating process. Historically, the lack of standardized terminology has hindered clinical practice and communication among professionals, the International Dysphagia Diet Standardisation Initiative (IDDSI) framework was developed to address this gap, providing an internationally standardized system with defined levels to classify food textures and liquid consistencies. The framework includes simple, practical testing methods suitable for clinical use. Implementation of IDDSI has been associated with improved consistency in dietary adaptations and enhanced interdisciplinary communication, however, its effectiveness relies on adequate professional training, teamwork, and institutional support. IDDSI is a support tool that does not replace screenign, clinical assessment or individualized management of patients with dysphagia.

This review synthesizes current evidence on the psychological and neurological benefits of physical activity, with emphasis on mental health, Parkinson's disease (PD), and Alzheimer's disease (AD). Physical inactivity is increasingly recognized as a modifiable risk factor that may exacerbate neuroinflammatory and metabolic dysfunctions associated with these conditions. Structured exercise has been shown to activate muscle-brain signaling pathways, including neurotrophic factors (BDNF, IGF-1, VEGF), immune modulation (IL-6, IL-10), metabolic regulators (PGC-1α, SIRT1), and peripheral mediators such as myokines and gut-brain axis components. For mental health, exercise is associated with reductions in depressive, anxiety, and stress-related symptoms, potentially through HPA-axis recalibration, neurotransmitter remodeling (serotonin, dopamine), and enhanced endocannabinoid signaling. These changes are supported by fMRI and EEG studies showing improved prefrontal-limbic connectivity and cognitive resilience. In PD, exercise interventions are linked to improvements in motor control, balance, and mood, likely mediated by dopaminergic integrity, neurotrophic support, and anti-inflammatory effects, with multimodal programs (aerobic, resistance, and dance-based) often demonstrating superior outcomes. In AD, mid-life physical activity has been associated with reduced dementia risk in epidemiological studies; proposed mechanisms include enhanced amyloid/tau clearance, glymphatic function, and synaptic adaptation, with some RCTs reporting hippocampal volume preservation and improved network connectivity. Shared mechanisms across conditions include neurotrophic upregulation and anti-inflammatory effects, whereas distinct pathways involve dopaminergic circuit remodeling in PD and glymphatic facilitation in AD. Clinical translation through FITT principles (frequency, intensity, time, type) requires personalized prescriptions, strong adherence strategies, and multidisciplinary integration. Despite methodological heterogeneity and limitations in the existing trials, structured physical activity emerges as a scalable, non-pharmacological intervention with potential for prevention, symptom management, and neuroprotection. Larger, well-designed studies are needed to optimize its application and clarify long-term disease-modifying effects.

Continued cannabis use among young people with first-episode psychosis (FEP) has been linked to poorer clinical and functional outcomes (eg, increased symptom severity and higher relapse rates). Digital harm-reduction interventions may represent a promising, person-centered approach to reduce at-risk cannabis use behaviors in this population. However, evidence remains limited regarding which subgroups are more likely to engage with these interventions and whether specific levels of engagement are required to achieve more favorable cannabis-related outcomes. This exploratory, hypothesis-generating analysis of the CHAMPS (Cannabis Harm-Reducing App to Manage Practices Safely) pilot randomized controlled trial (RCT) evaluated a cannabis harm-reduction mobile app for youth with FEP in early intervention services (EIS). The objectives of this study were to assess engagement by examining associations between selected sociodemographic factors and module completion and to determine whether achieving specific completion thresholds was associated with improvements in cannabis-related outcomes. Cannabis-related outcomes (Marijuana Problems Scale [MPS], Protective Behavioral Strategies for Marijuana [PBSM] scores, and days of cannabis use) were self-assessed at baseline and at week 6 (primary end point), week 12, and week 18 (postrandomization). Participants were categorized into low to moderate (0-4 modules) and high (5-6 modules) completion groups, and selected sociodemographic factors were compared between groups using bivariate analyses. Mixed-effects models, adjusted for baseline values and the covariates sex and cannabis use disorder (CUD) status, were fitted to evaluate whether module thresholds were associated with improvements in cannabis-related outcomes. Data from 96 participants, including 46 in the CHAMPS+EIS arm and 50 in the EIS-only arm (1:1 ratio), were analyzed under a modified intention-to-treat principle. Individuals in the high-engagement group reported higher baseline social support and higher educational level (P=.005 and P=.01). No statistically significant associations were observed between specific module completion thresholds and cannabis-related outcomes in adjusted mixed-effects models. Participants with higher social support and higher education were more likely to engage with CHAMPS. Although descriptive analyses suggested a potential gradient of improvement with increasing module completion, no specific completion threshold was robustly associated with improvements in outcomes. Given the multifactorial nature of engagement, supporting subgroups at risk of lower app use and examining metrics beyond module completion may enhance the impact of CHAMPS. These findings are hypothesis-generating, given their exploratory nature, and require replication in a future efficacy trial.

Prolonged air leak (PAL) remains one of the most frequent and clinically consequential complications after lung resection, prolonging chest tube duration, delaying recovery, increasing postoperative morbidity, and expanding healthcare resource utilization. Although traditionally approached as a mechanical failure of alveolar-pleural sealing or surgical technique, PAL is increasingly understood as a heterogeneous postoperative syndrome in which persistent air leak dynamics intersect with impaired inflammatory and reparative biology. Surgical manipulation, one-lung ventilation, parenchymal injury, and patient-specific vulnerability may activate cytokine signaling, epithelial barrier disruption, oxidative stress, extracellular matrix remodeling, glycocalyx degradation, and delayed wound repair. This narrative review synthesizes clinical, translational, and experimental evidence on the pathogenesis of PAL, with particular emphasis on inflammatory mediators and biomarker-defined mechanisms relevant to failed closure of alveolar-pleural fistulas (APFs). Candidate biomarkers are discussed according to the biological domains they reflect, including systemic inflammatory burden and poor healing reserve (C-reactive protein [CRP], IL-6, and serum albumin), epithelial injury and damage-associated signaling (high-mobility group box 1 [HMGB1]/receptor for advanced glycation end products [RAGE] and sRAGE), oxidative epithelial stress (4-hydroxynonenal [4-HNE] and malondialdehyde [MDA]), protease-mediated matrix and junctional remodeling (matrix metalloproteinase [MMP]-9), glycocalyx and barrier disruption (syndecan [SDC]-1), and upstream inflammatory regulation (histone deacetylase 6 [HDAC6]-related pathways). The review also considers how quantitative digital chest drainage parameters may complement molecular biomarkers by capturing the physiologic expression of persistent air leak. By integrating these mechanistic and technological signals, this review proposes a conceptual framework for biomarker-informed perioperative risk stratification, PAL phenotyping, and individualized prevention and management. Because most biomarker-driven strategies remain investigational, prospective validation is required before routine clinical implementation.

Obesity is a major public health challenge worldwide, driving chronic disease and health care costs. Primary health care (PHC) is a key setting for prevention, early identification, and management of obesity, yet implementation of evidence-based interventions remains limited. Identifying the barriers and enablers that influence adoption of obesity care in PHC is critical to strengthen delivery. This scoping review will systematically map and synthesize barriers and enablers to implementing obesity interventions in PHC, considering behavioral, nutritional, pharmacological, digital, and organizational approaches, across both adult and pediatric populations. The review will follow the Joanna Briggs Institute (JBI) methodology and be reported according to PRISMA-ScR guidelines. Searches will be conducted in PubMed, Cochrane Library, Scopus, Web of Science, and ScienceDirect, complemented by gray literature from OpenGrey, ResearchGate, Google Scholar, and organizational websites. Eligible sources will include peer-reviewed and gray literature published between 2019 and 2025 in English, French, German, Italian, Portuguese, Spanish, or Turkish. Two reviewers will independently screen, extract, and analyze data, with discrepancies resolved by consensus. Data will be synthesized descriptively and thematically, supported by NVivo, and results presented in tables, thematic maps, and conceptual diagrams. Expected Results Anticipated barriers include time constraints, limited provider training, stigma, scarce resources, and inadequate reimbursement models. Enablers are expected to include supportive health policies, training, patient engagement strategies, and team-based care models. This review will synthesize implementation factors affecting obesity care in PHC, informing scalable strategies and policy to improve obesity management worldwide.

Bradykinin-mediated angioedema, particularly hereditary angioedema due to C1 esterase inhibitor deficiency or dysfunction (HAE-C1INH), is caused by dysregulation of the kallikrein-kinin system with excessive bradykinin generation and subsequent increased vascular permeability. Modern HAE management is based on three major therapeutic strategies: on-demand treatment, short-term prophylaxis (STP), and long-term prophylaxis (LTP). On-demand treatment options include plasma-derived and recombinant C1 inhibitor (C1INH) concentrates, the bradykinin B2 receptor antagonist icatibant, and, more recently, the first orally available plasma kallikrein inhibitor, sebetralstat. Short-term prophylaxis prior to invasive medical procedures is performed as replacement therapy by intravenous administration of C1INH concentrates. The goal of long-term prophylaxis is complete disease control with reduction of attack frequency and/or severity and improvement of quality of life. LTP therapies include subcutaneous and intravenous C1INH preparations, the oral kallikrein inhibitor berotralstat, the anti-kallikrein monoclonal antibody lanadelumab, the factor XIIa inhibitor garadacimab, and the antisense oligonucleotide donidalorsen. Currently under development are the oral bradykinin B2 receptor antagonist deucrictibant, which is intended for both on-demand treatment and long-term prophylaxis in different formulations, long-acting antibodies, such as navenibart, and CRISPR/Cas9-based gene-editing therapies, such as NTLA-2002 with potential functional curative properties. In particular, orally available and long-acting therapies are expected to improve adherence, self-management, and quality of life in affected patients. Bradykininvermittelte Angioödeme, insbesondere das hereditäre Angioödem mit C1-Esterase-Inhibitor-Mangel oder -Dysfunktion (HAE-C1INH), entstehen durch eine Dysregulation des Kallikrein-Kinin-Systems mit überschießender Bradykininbildung und daraus folgender erhöhter Gefäßpermeabilität. Die moderne HAE-Therapie basiert auf drei zentralen Behandlungsstrategien: Akuttherapie („on-demand treatment“), Kurzzeitprophylaxe („short term prophylaxis“ [STP]) und Langzeitprophylaxe („long term prophylaxis“ [LTP]). In der Akuttherapie stehen plasmagewonnene und rekombinante C1-Inhibitor-Konzentrate, der Bradykinin-B2-Rezeptorantagonist Icatibant sowie erstmals der oral verfügbare Plasmakallikreininhibitor Sebetralstat zur Verfügung. Die Kurzzeitprophylaxe vor invasiven Eingriffen erfolgt als Substitutionstherapie durch intravenöse Gabe von C1INH-Konzentraten. Ziel der Langzeitprophylaxe ist eine vollständige Krankheitskontrolle mit Reduktion der Attackenfrequenz und Verbesserung der Lebensqualität. Hierfür stehen subkutane und intravenöse C1INH-Präparate, der orale Kallikreininhibitor Berotralstat, der gegen Kallikrein gerichtete monoklonale Antikörper Lanadelumab, der Faktor-XIIa-Inhibitor Garadacimab sowie das Antisense-Oligonukleotid Donidalorsen zur Verfügung. Aktuell in Entwicklung befindet sich der orale Bradykinin-B2-Rezeptorantagonist Deucrictibant, der in unterschiedlichen Formulierungen sowohl für die Akuttherapie als auch für die Langzeitprophylaxe eingesetzt werden soll, und lang wirksame Antikörper wie Navenibart sowie CRISPR/Cas9-basierte geneditierende Therapien wie NTLA-2002 mit potenziell funktionell kurativem Ansatz. Insbesondere oral verfügbare und lang wirksame Therapieformen sollen Adhärenz, Selbstmanagement und Lebensqualität Betroffener verbessern.

Distal radius fractures and distal ulna fractures are common orthopedic injuries treated in emergency departments (ED). Our goal in this narrative review was to present emergency physicians with a single source that covers the evaluation and treatment of distal radius fractures and distal ulna fractures across the lifetime of our patients. There are differences in the treatment algorithms for distal radius fractures between pediatric, young adult, and geriatric patients. Pediatric distal radius fractures are defined by their relation to the growth plate and are influenced by the gradual calcification of the developing bone. Some pediatric distal radius fractures can heal through significant displacement, while others require anatomical reduction to limit the risk of growth arrest. For adult patients with a distal radius fracture, there are established guidelines for both appropriate reduction goals and for when operative treatment is indicated. For geriatric patients, management strategies have evolved over the last decade after multiple studies demonstrated no functional difference between operative and nonoperative management. Given this, most geriatric distal radius fractures are managed nonsurgically, which makes effective reduction in the ED important to optimize long-term wrist function. Emergency physicians need to be well versed at both identifying fracture patterns and be knowledgeable about radiographic fracture-reduction goals. This emergency medicine-focused and illustrated narrative review will assist physicians, nurse practitioners, and physician assistants in meeting those goals. We also summarize pain management, splint molding, possible complications and follow-up considerations for emergency physicians treating patients with distal radius fractures.

Aflatoxin (AF) contamination in tree nuts poses a serious threat to global food safety, public health, and international trade due to the potent carcinogenicity of aflatoxin B1 (AFB1). Although traditional mitigation strategies exist, their industrial implementation is constrained by a strict "technological filter," in which high detoxification efficacy must be carefully balanced against the preservation of the nutritional, structural, and sensory quality of the food matrix. This scoping review systematically mapped and critically synthesized recent scientific advances (2005-2025) in physical, chemical, and biological decontamination methods, evaluating their operational effectiveness, underlying mechanisms, and qualitative impacts on tree nuts. Guided by the question, "What physical, chemical, and biological methods are most effective for AF decontamination in tree nuts, and to what extent are they feasible regarding quality preservation and industrial applicability?", the study strictly followed the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and was reported according to PRISMA-ScR guidelines. A total of 41 eligible original studies were selected after comprehensive screening of the PubMed, Scopus, Web of Science, and ScienceDirect databases. Physical approaches, particularly cold atmospheric plasma and UV-C radiation, achieved robust reduction rates ranging from 70% to 95%; however, these highly energetic treatments often induced lipid oxidation, evidenced by linear increases in malondialdehyde (MDA) levels in matrices such as pistachios. Among chemical methods, ozonation and the use of organic acids achieved degradation rates close to 100% for the most toxic forms, but significant technological trade-offs were identified, including up to a 29% loss of α-tocopherol in hazelnuts. Inorganic selenium emerged as a promising alternative by combining efficacy with matrix preservation. Biological strategies using microorganisms such as Bacillus subtilis, Bifidobacterium lactis, and Lactobacillus kefiri demonstrated substantial sustainable potential, with detoxification efficiencies exceeding 80% through dual mechanisms of active biosuppression and physical adsorption. No single universal method is currently sufficient to handle contamination safely. The future of commercial AF management depends on the development of "hurdle technology," integrating multi-stage synergistic interventions with automated optical sorting and intelligent packaging, supported by further technical advances, studies of practical applicability, and industrial-scale validation to ensure absolute consumer safety and commercial viability.

The TriService Nursing Research Program (TSNRP) has been a cornerstone of military nursing science for over three decades. Established in 1992, TSNRP has evolved from a visionary pilot project to the Gold Standard for the Joint Force, providing the empirical foundation for clinical practice guidelines used globally. With a focus on operational readiness, high-velocity science, and advanced professional development, TSNRP aims to bridge the cognitive and clinical strain on military nurses operating in contested environments. TSNRP's strategic trajectory has shifted towards addressing the complex physiological and environmental stressors inherent to modern warfare. Research initiatives have focused on warfighter health and performance, mental health and resilience, development of military nursing, and forward-looking broad research. The program has also expanded its reach through international collaboration, with the inaugural Global Tactical Nursing Research Symposium convening nursing professionals from across the globe. TSNRP's commitment to operational readiness is reflected in its strategic alignment with the National Defense Strategy and the Department of War. The program's funding priorities have shifted towards military operational research problems, recognizing that a sophisticated defense strategy requires a highly skilled and resilient nursing corps. TSNRP has also developed innovative training programs, such as the eCornell Leadership Certificate Program, to cultivate epistemic curiosity and critical thinking among nurses. With over $200 million in research funding and a legacy of publishing numerous studies and guidelines, TSNRP remains poised to meet the challenges of Large-Scale Combat Operations (LSCO). The program's dedication to evidence-based practice, international collaboration, and professional development ensures that military nurses are equipped with the most powerful weapon in medical science: rigorous, actionable, and life-saving knowledge. As the Military Health System confronts the daunting reality of LSCO, TSNRP stands ready to meet these challenges head-on, cementing its position as the leading authority on military nursing science.

Neuromuscular fatigue (NMF) is an inherent consequence of strenuous training and competition. It arises from complex interactions between the central nervous system and peripheral skeletal muscle. Despite decades of research, the interaction between central and peripheral mechanisms of neuromuscular fatigue and their influence on sports performance remains a contentious topic. In addition, translating mechanistic insights into practical strategies for monitoring, training, and recovery in athletes is an ongoing challenge. This review synthesizes contemporary literature to build a central-peripheral integrative model of NMF and proposes an applied framework for athlete monitoring and training design. The review first summarizes central and peripheral fatigue mechanisms, highlighting the bidirectional influence of descending motor drive and afferent feedback, and discusses controversies such as the central-governor theory. It then assesses monitoring tools (subjective ratings, neuromuscular tests, electromyography, heart-rate variability, biochemical and neurochemical markers) and recovery strategies. Finally, the review translates mechanistic knowledge into evidence-based training and recovery recommendations. A conceptual model illustrating the interactions between central and peripheral mechanisms and their monitoring is included. The aim is to inform sports scientists and practitioners about the physiological bases of fatigue and provide guidance for individualized athlete management.

Animal-vehicle collisions (AVCs) are a growing global problem with significant implications for human, animal, and ecosystem health. In the United States, approximately one million vertebrates are killed by vehicles each day. Research on roadkilled animals has increased over time, especially regarding wildlife and ecosystem impacts, economic costs, and human physical health risks. However, less is known about how involvement with AVCs or encounters with roadkilled animals influences human health more broadly, including psychological, emotional, psychosocial, and community-level outcomes. Guided by the One Health framework, this study protocol presents the methodological plan to identify and synthesize current evidence on how AVCs and exposure to roadkilled animals affect human health. The scoping review has not yet been conducted. The methodological approach follows PRISMA-ScR guidelines and Arksey and O'Malley's five stage framework. A comprehensive, librarian‑assisted search will be conducted across six databases-Scopus, CABI Digital Library, Web of Science, Wildlife & Ecology Studies Worldwide, TRID, and PubMed-without restrictions on publication year or peer‑review status. Reference lists of included records will also be screened. Three reviewers will independently screen the titles, abstracts, and full texts, with each record reviewed by a combination of two reviewers. Records will be included if they examine how AVCs or roadkilled animals affect any dimension of human physical, mental, or social well‑being and are available in English. Data will be extracted using a standardized form and analyzed through content analysis to describe the distribution of evidence and organize findings into themes. By consolidating dispersed knowledge across disciplines, this review will provide the first comprehensive overview of how AVCs and roadkilled animal exposure affect human health. Findings will inform public policy, transportation planning, wildlife management, and future interdisciplinary research aimed at integrated One Health solutions.

 With the increasing burden of non-communicable chronic diseases, it is important to empower people to self-manage their conditions. This study aimed to explore the support that persons living with chronic disease require to self-manage their conditions at a Primary Health Care (PHC) facility in the Victor-Khanye subdistrict, Delmas, Mpumalanga.  Individual in-depth interviews were conducted with 14 adult participants who collected their monthly medication for diabetes, human immunodeficiency virus or hypertension. Data were analysed manually using thematic analysis.  Three themes were identified: (1) individual self-management; (2) support enhancing for self-management; and (3) barriers to self-management. The study highlights that self-management requires a combination of individual beliefs, capabilities, education, access to healthcare resources, financial assistance, emotional support from family and friends, and community support. While knowledge is crucial for empowering individuals to manage their diseases effectively, challenges such as financial constraints and a lack of specific self-management support provided by healthcare workers hinder many from fully implementing self-management strategies.  Persons living with chronic disease require comprehensive care that extends beyond healthcare and includes emotional, social and financial support. Effective self-management requires access to tailored education and community support networks that allow people to take an active role in their health.Contribution: Understanding the support persons living with chronic diseases require for effective self-management is critical for improving health outcomes, enhancing quality of life and promoting sustainable healthcare systems.

BackgroundBrazil has recognized the need to investigate the health context of Indigenous Peoples by (a) collecting data on service coverage, barriers, needs, and gaps in access to health care; (b) developing, funding, and implementing plans and strategies for multilingual service delivery (c) reducing gender, social, and cultural inequalities as well as geographical barriers that hinder equitable access to quality health services; and, (d) incorporating an intercultural-intersectoral approach in the development of policies and inclusive-participatory research.PurposePropose an original conceptual framework for action research on the socio-cultural aspects of pregnancy, childbirth, and the postpartum cycle among Brazilian Indigenous women.ResultsAn online consultation with healthcare professionals was conducted (April-June 2024) using audio recorded narratives to gather information about the health of pregnant and postpartum Indigenous women. The Canadian model of population health promotion guided information analysis. Fourteen healthcare professionals with experience working in four Brazilian states and with 11 ethnic groups were consulted. A total of 23 modifiable situations were identified, and an original conceptual framework was developed that encompasses the following health promotion areas as modifiable situations: structure of the healthcare network; administrative barriers in healthcare management; operationalization of care delivery; and clinical and social contexts.ConclusionThis article conceptualizes areas for innovative and socially responsive solutions to amend vulnerabilities in Brazilian Indigenous maternal health. The conceptual framework proposed offers a useful operational foundation for designing future interventions in Indigenous maternal health and for strengthening action research as a transformative methodological strategy in contexts marked by persistent historical and social inequalities.

Depression and anxiety are a major contributor to the global burden of mental disorders, disproportionately affecting women of reproductive age (15-49 years). This study examined the global trends for depression and anxiety in women of reproductive age, allowing for the variation in social development, profiles of risk factors, and public policies. We analyzed Global Burden of Disease Study (1990-2021) data, estimating age-standardized rates (ASRs) and applying age-period-cohort (APC) analysis to assess trends in depressive and anxiety disorders by sociodemographic index (SDI). We also calculated the slope index of inequality (SII) to measure disparities in disability-adjusted life years (DALYs) and examined correlations with policy performance indicators. From 1990 to 2021, the global age-standardized prevalence of depressive and anxiety disorders rose from 55.98 (95% UI: 55.96-55.99) to 62.21 (62.20-62.22) and 58.66 (58.65-58.67) to 70.97 (70.96-70.98) per 1,000 reproductive-aged women, respectively, with the steepest increase in high SDI regions. Socioeconomic disparities in depression shifted from lower SDI regions in 1990 to near convergence by 2021, while anxiety disparities persisted in higher SDI regions. Intimate partner violence and bullying victimization drove a high burden of depression and anxiety among younger women in Eastern Europe and Sub-Saharan Africa. Migration and financial policies correlated strongly with rising depressive disorder burdens (r = 0.40-0.41). The global burden of depression and anxiety in women of reproductive age necessitates the concerted action targeting their social lives and mental wellness. Integration of mental health services into broader development strategies is encouraged to build sustainable and inclusive societies.

Serious reportable and sentinel events are preventable events that cause death or serious injuries to patients. Such events within the field of psychiatry include abscondment, inpatient suicide, unexpected deaths, sexual assaults, and serious physical assaults. This review aimed to examine the contributing risk factors and preventive strategies of serious reportable or sentinel events. PRISMA for scoping reviews and the updated Arksey and O'Malley methodological framework for conducting scoping reviews guided the methodology of the review. Databases (CINAHL, Embase, PsycINFO, PubMed, ScienceDirect, and Scopus) were searched. Twenty-nine articles were included. The articles explored (1) inpatient suicide [n=18 (62.07%)]; (2) general adverse events [n=5 (17.24%)]; (3) serious assaults [n=2 (6.90%)]; (4) abscondment [n=2 (6.90%)]; and (5) inpatient sexual events [n=2 (6.90%)]. Preventive strategies were as follows: (1) suicide (means restriction, allocation of high‑risk patients to higher‑dependency wards, safe prescribing, psychiatrist review of high-risk patients around the clock); (2) unexpected death (routine medical review, prompt activation of the code blue team); and (3) sexual incidents (segregation of genders). Consistent preventive strategies common to all adverse events, including establishment and continual review of guidelines, optimal staffing, and training, a secured ward with surveillance and no blind spots, rigorous observation, individualized risk assessments, and supportive counseling to patients. Consistent factors were associated with varying serious reportable or sentinel events. These factors were associated with patient and ward profiles, management, staffing, training, observation, risk assessments, and treatment. Bolstering factors related to the prevention of these events can enhance patient safety and the provision of quality care for psychiatric inpatients.

We aimed to review the current evidence on kidney transplant in patients with posterior urethral valves, focusing on transplant-specific lower urinary tract assessment, bladder optimization, graft outcomes, infection burden, and long-term follow-up. We searched peer-reviewed literature indexed in PubMed and major guideline sources through March 2026, focusing on studies that addressed posterior urethral valves, valve bladder dysfunction, and kidney transplantation. Contemporary cohort studies, critical reviews, pediatric urology and transplant literature, and guideline-based statements were prioritized. In accordance with journal policy, donors considered in the reviewed transplant literature were either deceased donors or living related donors. Available evidence indicated that posterior urethral valves are not a contraindication to kidney transplant when the lower urinary tract is systematically evaluated and optimized. Low-pressure urine storage and reliable bladder emptying are central determinants of graft protection. Vesicoureteral reflux should be actively assessed and, when clinically significant, treated in the context of native kidney function, infection burden, and bladder strategy; in poorly functioning refluxing native kidneys, native nephroureterectomy may be more appropriate than anti-reflux correction. Clean intermittent catheterization, with or without a catheterizable channel, is often graft-protective, whereas augmentation cystoplasty should be reserved for selected hostile bladders refractory to conservative treatment. The timing of reconstruction and native upper-tract surgery should be individualized according to bladder phenotype, residual urine output, donor type, and anticipated wait time. Kidney transplant in patients with posterior urethral valves can achieve durable allograft function when bladder phenotyping, stepwise optimization, reflux management, infection prevention, donor-specific surgical planning, and lifelong follow-up are integrated into care. Clinically significant vesicoureteral reflux should prompt consideration of anti-reflux surgery or native nephroureterectomy according to kidney function, residual diuresis, and reconstructive timing. A multidisciplinary strategy extending through transition to adult services offers the best opportunity to protect the allograft.

Degenerative spine conditions and physical inactivity are major public health concerns. Engaging in physical activity before spine surgery may improve postoperative outcomes experienced by patients with lumbar stenosis or lumbar disc herniation. This study aims to identify barriers and facilitators to physical activity among patients with degenerative lumbar spine conditions awaiting surgery. In this qualitative patient-oriented study, guided by a patient partner who contributed to the development of the interview guide and interpretation of findings, we conducted data-prompted semi-structured interviews (a method in which personalised physical activity information is used to stimulate reflection and discussion), with patients diagnosed with lumbar spinal stenosis or lumbar disc herniation on a surgical waiting list. Interviews were structured around the Theoretical Domains Framework (TDF). Patient responses were deductively coded to TDF domains and inductively analyzed to identify subthemes. Key domains were determined through researcher consensus based on the frequency and clarity of specific beliefs within each domain. We interviewed 18 patients (8 female), 11 with lumbar spinal stenosis and 7 with lumbar disc herniation, with a mean (SD) age of 54.7 (17.3) years. Five key TDF domains were identified: skills, beliefs about capabilities, beliefs about consequences, environmental context and resources, and emotion. Barriers to physical activity included a lack of physical capacity, pain and other adverse symptoms, potential for negative consequences, inappropriate environment, and negative emotions. Facilitators to physical activity were motivation, appropriate environment, supportive social influences, positive emotions, alternate strategies, and daily physical activity habits. Physical activity behaviour in patients awaiting spine surgery is shaped by an interplay of physical, emotional and contextual factors. These findings can inform the design of tailored, theory-driven preoperative physical activity interventions, targeting key barriers such as pain, fear of harm, and limited access to resources, while leveraging factors including motivation, professional guidance, social support, and habit formation.

To reduce perinatal deaths, identification of their causes is paramount. 'The WHO application of ICD-10 to deaths during the perinatal period' (ICD-PM) was developed to improve the quality of perinatal death data. To determine stillbirth and very early neonatal death rates across 16 hospitals in Benin, Malawi, Tanzania, and Uganda, examine causes of death and associated maternal conditions applying the ICD-PM, and assess how a clinical perinatal e-registry performed when applying the ICD-PM. We used cross-sectional data collected between 1st July 2021 and 29th February 2024 of babies weighing ≥1000 g or ≥28 weeks of gestational age, born to women aged 13-50 years in the participating hospitals. After analyzing 143,105 births, the stillbirth rate was 36.9 per 1,000 births and very early neonatal death rate was 7.7 per 1,000 live births. Nine in ten antepartum stillbirths could not be assigned a cause of death. Among intrapartum stillbirths, the most common cause of death was 'disorders of fetal growth' and for very early neonatal death it was 'complications of intrapartum events'. The e-registry provided information to report on 17 out of the 24 ICD-PM categories. Collecting high-quality clinical data through an e-registry allowed the identification of a cause of death for most intrapartum stillbirths and very early neonatal deaths. A specifically designed clinical questionnaire and simple diagnostic procedures could enable the application of the ICD-PM in settings with limited diagnostic resources and high mortality rates. Main findings: After applying the International Classification of Diseases to Perinatal Mortality classification system to a clinical dataset, a cause of death or an associated maternal condition was established for the majority of perinatal deaths, while most intrapartum stillbirths were a consequence of disorders of fetal growth, complications of intrapartum events were the main cause of very early neonatal deaths.Added knowledge: This study reveals that collecting basic clinical information through a structured questionnaire in high-burden and resource-limited settings can support the application of the International Classification of Diseases to Perinatal Mortality.Global health impact for policy and action: This study highlights that despite revisions and updates are needed, the International Classification of Diseases to Perinatal Mortality is still a valuable instrument that could help better understand the pathways to perinatal death, thus contributing to the development of targeted prevention strategies.

Cyclodialysis cleft (CDC) is an uncommon but potentially vision-threatening condition characterized by separation of the ciliary body from the scleral spur, often causing hypotony and maculopathy. While small clefts may resolve with conservative or minor treatment, large traumatic CDCs in phakic eyes remain challenging due to limited evidence on optimal management. This systematic review aims to evaluate current surgical approaches for repairing large traumatic CDCs in phakic eyes, focusing on success rates, complication profiles, and the impact of treatment timing on outcomes. A systematic search of three databases was conducted in November 2023, following PRISMA guidelines, to identify peer-reviewed studies and case reports published since 2000. Eligible cases included patients older than 14 years with phakic eyes who underwent treatment for traumatic CDCs involving ≥ 180°. The risk of bias was evaluated using the JBI Critical Appraisal Checklist for Case Reports. Cases were categorized based on primary repair method and compared according to outcomes and complications. Registration was not applicable. We retrieved 284 publications, out of which 23 met the inclusion criteria, representing 43 eligible cases. No randomized controlled or interventional studies were identified. Mean age was 39 years, average baseline intraocular pressure (IOP) was 3.82 ± 2.31 mmHg, and mean cleft size was 8.6 ± 2.61 clock-hours. The two most common treatment approaches were direct cyclopexy and vitrectomy with or without additions. Successful cleft closure after a single intervention was achieved in 32 cases (74.4%). Vitrectomy-based procedures and direct cyclopexy produced similar postoperative IOP levels, although IOP spikes were more common after direct cyclopexy. Cataract alone did not influence treatment selection, whereas lens instability often necessitated an internal approach. Delayed intervention in eyes with intermediate baseline visual acuity did not appear to worsen outcomes, though late-treated eyes underwent more interventions. Large traumatic CDCs in phakic eyes were usually managed either externally by cyclopexy or internally with vitrectomy-based procedures, with favorable outcomes in both approaches. The available evidence on treatment approaches is limited by publication bias and inconsistent reporting. Future standardized, structured case reporting is essential to improve comparative evaluation and guide future management strategies.