Safewards is a nursing model of care designed for acute mental health inpatient units. Since inception, the model has gained popularity in many countries and has been implemented in settings other than mental health. A version for bed-based mental health units within prisons has also been developed to assist nurses working in this complex setting called Safewards Secure-Custodial Mental Health. A previous study identified that modifiers (things staff can do to prevent conflict and containment) were needed for custodial staff to finalise the prison model. The aim of this study was to develop custodial staff modifiers for the adapted model known as Safewards Secure-Custodial Mental Health. To inform the modifiers a literature review was first conducted. A Nominal Group Technique was then used to seek feedback and reach consensus on the proposed custodial staff modifiers. Participants (n = 15) included custodial officers, forensic mental health nurses, allied health and lived experience workers. Consensus was reached on the custodial staff modifiers after suggestions from the NGT were incorporated. Data were thematically analysed and three themes were interpreted: (1) Complexity with clashes in paradigms (custodial versus clinical); (2) You are a 'Care Bear': Ostracised for demonstrating care and concern; (3) Meeting in the middle (to work collaboratively). There was support for the implementation of Safewards Secure-Custodial Mental Health. Future research should consider the interventions for the custodial model with reference to contextual factors in a prison setting.

To investigate urinary metabolite differences between subgroups stratified by anhedonia severity in patients with major depressive disorder (MDD) and identify potential biomarkers associated with anhedonia using untargeted metabolomic profiling.

Fifty-five MDD patients were recruited and stratified by median Snaith-Hamilton Pleasure Scale (SHAPS) total score into Low-SHAPS (n=32) and High-SHAPS (n=23) groups, along with 35 healthy controls (HC). Urinary metabolomic profiling was performed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Differential metabolites were identified using one-way ANOVA for multi-group comparisons and independent-sample t-tests for pairwise comparisons, followed by multivariate statistical analyses and pathway enrichment analysis.

Three-group ANOVA identified 706 nominally differential metabolites (P < 0.05), of which 115 reached P < 0.01. The contrast between Low-SHAPS and High-SHAPS groups showed the most pronounced differences, with 1608 metabolites reaching nominal significance (P < 0.05). OPLS-DA models demonstrated significant discriminative ability across all pairwise comparisons after permutation testing (Low vs High: cross-validated AUC = 0.726, P = 0.010; Low vs HC: cross-validated AUC = 0.886, P = 0.010; High vs HC: cross-validated AUC = 0.901, P = 0.010). Pathway enrichment analysis revealed significant alterations in tryptophan metabolism and phenylalanine metabolism.

MDD patients with differing degrees of anhedonia exhibit widespread urinary metabolic differences. The greater metabolic divergence between High-SHAPS and Low-SHAPS subgroups compared with patient-control comparisons suggests that anhedonia contributes substantially to metabolic heterogeneity in depression. SHAPS-based stratification offers novel metabolomic evidence for precision subtyping and biomarker discovery.

The therapeutic use of phytocannabinoids has expanded considerably over the past decade because of their potential application across a wide range of clinical conditions. However, their concomitant use with conventional medications raises important concerns regarding drug interactions and patient safety. This narrative review provides a critical overview of current evidence on the pharmacokinetic (PK), pharmacodynamic, and toxicological interactions of major phytocannabinoids, with particular emphasis on cannabidiol (CBD) and Δ⁹-tetrahydrocannabinol (THC), while also discussing emerging evidence related to minor phytocannabinoids and the potential contribution of terpenes. Phytocannabinoids modulate the activity of drug-metabolizing enzymes, particularly cytochrome P450 isoenzymes, and may affect selected drug transporters, thereby altering the systemic exposure and clinical effects of co-administered medications. Conversely, conventional medications that inhibit or induce cannabinoid-metabolizing enzymes may modify phytocannabinoid exposure, efficacy, and tolerability. Documented or potentially clinically relevant interactions have been reported for antiseizure medications, anticoagulants, antidepressants, opioids, alcohol, and other central nervous system depressants. However, the strength of the supporting evidence varies considerably, ranging from in vitro predictions and case reports to controlled PK and clinical studies. The magnitude and clinical relevance of these interactions are influenced by multiple factors, including cannabinoids formulation, dose, route of administration, treatment duration, pharmacogenetic variability, patient-specific characteristics, and polypharmacy. Particular attention should be given to vulnerable populations, such as pregnant women, children, older adults, and patients with hepatic impairment, in whom altered PK and increased susceptibility to adverse effects may further complicate treatment. Although substantial progress has been made in understanding cannabinoid pharmacology, important knowledge gaps remain regarding the clinical significance of many predicted interactions, the interaction profiles of minor phytocannabinoids, full-spectrum preparations, and terpenes and the long-term safety of cannabinoid-based therapies. Careful differentiation between mechanistically plausible and clinically demonstrated interactions, together with consideration of cannabinoid composition, dose, route of administration, patient vulnerability, and concomitant medications, can support safer and more individualized clinical management while guiding future research priorities.

The independent and combined associations of resting heart rate (RHR) and physical activity (PA) with mortality in diverse chronic kidney disease (CKD) populations remain unclear. We analyzed 12,042 patients from three cohorts using Cox regression, restricted cubic splines, joint-effect, mediation, and meta-analytic approaches. Elevated RHR was associated with increased risks of all-cause and cardiovascular mortality, whereas higher PA levels showed consistent protective associations across cohorts. Combined analyses demonstrated that high RHR with low PA was associated with the greatest mortality risk, while high PA attenuated the adverse association of elevated RHR with mortality. Mediation analyses suggested that RHR partially contributed to the association between PA and mortality. RHR and PA are independent and modifiable risk markers for mortality in patients with CKD. Promoting PA and monitoring RHR should be integrated into CKD management to improve survival.

Perceived stress is associated with adverse clinical features of major depressive disorder (MDD), but the role of multisystem physiological dysregulation remains uncertain. We examined whether allostatic load (AL) was statistically associated with the relationship between perceived stress and cognitive impairment or severe suicidal ideation.

This retrospective, cross-sectional electronic medical record study included 385 adults with DSM-5 MDD assessed within a single three-day index window. Perceived stress was measured with the 14-item Perceived Stress Scale (PSS-14), and chronic exposure context was characterized from documented negative life events. AL was calculated from 15 cardiovascular, metabolic, immune-inflammatory, and neuroendocrine indicators. Cognitive impairment was defined as Montreal Cognitive Assessment (MoCA) <26 and severe suicidal ideation as Columbia-Suicide Severity Rating Scale (C-SSRS) ideation severity ≥4. Sequential logistic regression and bootstrap product-of-coefficients statistical mediation analyses were performed.

Compared with Low AL, High AL was associated with cognitive impairment (adjusted odds ratio [aOR] 6.17, 95% CI 2.89-13.15) and severe suicidal ideation (aOR 6.43, 95% CI 2.98-13.88; both P<0.001). Continuous AL showed consistent associations with both outcomes. The indirect effect through AL was supported for cognitive impairment (0.39, 95% bootstrap CI 0.16-0.69), but not for severe suicidal ideation (0.14, 95% bootstrap CI -0.12 to 0.41).

Higher AL was independently associated with both adverse clinical phenotypes. Statistical mediation was supported for the perceived stress-cognitive impairment association but not for suicidal ideation. Because exposure, mediator, and outcomes were assessed within the same index window, temporal and causal mediation cannot be inferred.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper limb and seriously affects patients' quality of life. Ultrasound-guided percutaneous release has emerged as a minimally invasive alternative to conventional surgery. This prospective case series aimed to evaluate the clinical efficacy and safety of ultrasound-guided needle knife release of the transverse carpal ligament in patients with CTS.

Eighteen patients diagnosed with CTS were enrolled and treated with ultrasound-guided needle knife release of the transverse carpal ligament. Clinical and electrophysiological assessments were performed at baseline and 3 days post-treatment, including sensory nerve conduction velocity (SNCV), distal motor latency (DML), compound muscle action potential (CMAP) amplitude, ultrasound imaging parameters, and Numerical Rating Scale (NRS) scores for pain and numbness. Telephone follow-ups were conducted at 1 and 3 months to evaluate NRS, Boston Carpal Tunnel Questionnaire (BCTQ), and Short-Form 36 (SF-36) scores.

At 3 days post-treatment, significant improvements were observed in the median nerve flattening ratio and NRS scores for both pain and numbness (P<0.05). At 1 and 3 months, significant improvements were maintained in pain intensity, numbness intensity, symptom severity, and functional status as measured by BCTQ. The SF-36 domains of physical functioning (PF), bodily pain (BP), general health (GH), vitality (VT), role emotional (RE), and mental health (MH) all showed significant improvements at both time points, while social functioning (SF) showed significant improvement at 3 months (P<0.05). No adverse events were observed during the study period.

In this preliminary prospective case series, ultrasound-guided needle knife release of the transverse carpal ligament was associated with significant improvements in symptoms, hand function, and quality of life in patients with CTS, with a favorable safety profile. These findings support its potential as a minimally invasive treatment option for CTS.

Psychiatric readmission among children and adolescents is a major concern in mental health services and is influenced by clinical, familial, and demographic factors. However, the contribution of family-related variables remains insufficiently understood, particularly in non-Western contexts.

This cross-sectional study included 78 children and adolescents with psychiatric disorders and their primary caregivers. We collected data using standardized questionnaires assessing caregiver burden, parenting styles, and parent-child relationship quality, along with demographic and clinical variables. We used Poisson regression to identify predictors of psychiatric readmission.

Family-related variables were significantly associated with psychiatric readmission. Higher caregiver burden, particularly emotional burden, was associated with increased readmission risk. Authoritarian parenting and greater parent-child conflict were also linked to higher readmission, whereas emotional closeness and permissive parenting showed protective associations. Contrary to conventional expectations, authoritative parenting was not significantly associated with readmission in the final model. Most demographic variables were also not significantly associated with readmission.

Psychiatric readmission among children and adolescents appears to be strongly influenced by family emotional functioning. Notably, permissive parenting was associated with lower readmission risk, whereas authoritative parenting was not significantly associated with outcomes. These findings underscore the need for family-centered and culturally informed approaches in child and adolescent mental health care.

Quality of life (QoL) is significantly impaired by chronic liver disease (CLD) due to socioeconomic, psychological, and physical reasons. In a cohort of Egyptian cirrhosis patients, this study evaluated QoL and its determinants and examined association between QoL, disease severity, and mental health.

In this cross-sectional study at the National Liver Institute (from January to May 2024), 197 cirrhotic patients completed the Chronic Liver Disease Questionnaire (CLDQ) and Depression Anxiety Stress Scales-21 (DASS-21). Child-Pugh and model for end-stage liver disease (MELD) scores were used to assess disease severity. Spearman correlation, Mann-Whitney U, and Kruskal-Wallis tests evaluated nonparametric data, and ridge and gamma regressions examined QoL determinants.

The median age was 62.0 (11.0) years; most patients had compensated cirrhosis and mild disease severity. Substantial psychological distress was observed, with (mild to very severe) depression, anxiety, and stress reported in 31.0%, 40.6%, and 21.8%, respectively. Significant negative correlations were found between CLDQ scores and all DASS-21 domains (ρ (rho) = -0.625 to -0.697). Poorer QoL was independently associated with higher DASS subscale scores (all P < 0.001), ascites (ridge -0.627; unit-gamma EXP(B) 0.37, P < 0.001), and moderate-severe Child-Pugh class (ridge -0.300, P = 0.020; EXP(B) 0.50, P < 0.001). Better QoL was associated with health insurance (ridge 0.280, P = 0.027; EXP(B) 1.40, P = 0.040) and a greater number of rooms in the household (ridge 0.179, P = 0.053; EXP(B) 1.53, P < 0.001).

QoL in Egyptian cirrhotic patients is significantly affected by psychological distress, disease severity, and socioeconomic factors, highlighting the need for integrated biopsychosocial management approaches.

Freezing of gait (FoG) belongs to most pressing unmet symptoms in the treatment of Parkinson's disease.

To explore whether combined subthalamic and nigral (STN + SNr) deep brain stimulation improves FoG compared with optimized STN stimulation alone; to identify clinical variables associated with therapeutic response.

In this exploratory multicenter randomized controlled double-blind trial, we recruited patients from our existing cohorts and randomized them 1:1 to STN or STN + SNr. After baseline, patients were followed with close interim visits (visits 1-5) for 90 days (visit 6). The Freezing of Gait Assessment Course (FoG-AC) was the primary endpoint and was evaluated at P < 0.2 with exploratory intent. Secondary endpoints assessed responder rates, treatment dynamics, predictors of response, and patient preferences.

At V6, STN (n = 23) and STN + SNr (n = 22) FoG-AC outcomes did not differ significantly. We identified responders with clinically meaningful FoG improvement in both the STN (n = 7) and STN + SNr (n = 8) groups. In STN + SNr responders, mean disease duration was ~12 years, which was ~4.5 years shorter than in non-responders, but there were no differences in motor and cognitive functions. Treatment dynamics suggested that FoG responders improved slowly and gradually. The STN + SNr responder group showed numerically stronger FoG improvement compared with STN responders. Additionally, 15 STN compared to 10 STN + SNr patients wished to change treatment after the RCT phase and before unblinding. Both STN and STN + SNr treatment was safe.

Future trials evaluating adjunctive STN + SNr stimulation should stratify patients by disease duration to optimize outcomes.

Colonoscopy is central to colorectal cancer prevention but remains a high-demand psychomotor and cognitive procedure, characterized by operator dependency, variable performance, and substantial physical and mental workload. Increasing evidence links procedural quality and safety to clinician-related factors, including musculoskeletal strain, fatigue, and non-technical skills. Concurrently, artificial intelligence (AI) and robotic technologies are emerging as potential tools to address these limitations. We conducted a scoping review with narrative synthesis of literature on human factors, ergonomics, AI, robotic technologies, and shared autonomy in colonoscopy and surgical robotics. Evidence synthesis: Colonoscopy performance remains limited by non-negligible miss rates and variability driven by both technical and human factors. Ergonomic constraints and cognitive workload contribute significantly to operator strain and may affect vigilance and decision-making. AI systems-including computer-aided detection (CADe), diagnosis (CADx), and quality monitoring-have demonstrated improvements in detection metrics and procedural standardisation, although concerns regarding cognitive offloading and potential deskilling persist. In parallel, emerging robotic and soft-robotic platforms aim to enhance navigation, improve procedural ergonomics, and reduce operator musculoskeletal strain, although clinical evidence remains limited. These technologies converge within a task-based shared-autonomy paradigm integrating physical, perceptual, and cognitive augmentation, with different procedural tasks operating at different levels of human-system control. A task-based shared-autonomy framework may provide a coherent model for integrating AI and robotics into colonoscopy while preserving human supervision and clinical judgement. Future developments should prioritise human-centred design, workflow integration, and multidimensional evaluation strategies to ensure safe and effective clinical implementation.