Introduction: Meniscal injury represents one of the most prevalent knee injuries observed in the athletic population, carrying a substantial risk of threatening career longevity. The selection between the two primary management strategies—partial meniscectomy or meniscal repair—presents a critical clinical dilemma, balancing the need for rapid recovery against the imperative of preserving long-term joint health. The specific characteristics of the tear, including its anatomical location (medial versus lateral) and its vascularization zone, are recognized as major determinants influencing the final functional outcome. Methods: This systematic review was rigorously executed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A comprehensive literature search was performed across major electronic databases, including PubMed, Semantic Scholar, Springer, and Google Scholar. The search utilized a detailed set of Boolean keywords targeting the athlete population, meniscal repair interventions, comparisons with meniscectomy and tear location, and return-to-sport outcomes. Following the screening of 6,756 initial records, a total of 32 eligible studies were ultimately included in the final analysis. These studies involved athletes with arthroscopically or radiologically confirmed meniscal tears, explicitly reported recovery outcomes, and utilized appropriate study designs. Results: The findings demonstrate a clear difference in recovery timelines: Meniscectomy consistently enabled athletes to achieve a faster return to sport (RTS), typically within 1 to 4.3 months, compared to the longer duration required for meniscal repair (5.6–7.6 months). Despite this variance in timing, the overall return-to-sport rate was generally comparable between the two procedures, consistently falling within the range of 77% to 93%. Repair of the lateral meniscus is clinically favored due to its inherently superior healing potential. Conversely, the rate of repair failure exhibited significant variation contingent on the tear morphology, reaching up to 27.4% for specific patterns such as bucket-handle tears. The rates at which athletes successfully returned to their pre-injury performance level were broadly distributed (53.9% to 92.6%) and tended to be lower following complex interventions, such as meniscal allograft transplantation. Discussion: The evidence highlights a fundamental trade-off: the rapid functional recovery afforded by meniscectomy contrasts sharply with the long-term joint preservation advantages provided by meniscal repair. The optimal treatment strategy requires meticulous individualization, demanding careful consideration of the specific tear location (with repair strongly advocated for the lateral meniscus), the tear pattern, the athlete’s age, and their professional activity level. Furthermore, the systematic review established that accelerated rehabilitation protocols do not correlate with an increased risk of repair failure, thereby supporting the implementation of earlier functional recovery programs. Conclusion: The clinical management of meniscal tears in athletes should prioritize tissue preservation through meniscal repair whenever technically feasible, particularly in the context of lateral tears and for young athletes. Although this preservation approach mandates a longer period of rehabilitation, it constitutes a vital investment in the athlete’s long-term joint health and the sustainability of their athletic career.

This case study uses a hospital family safety reporting intervention, coproduced with key partners, with the aim to garner lessons for developing complex, hospital-based interventions. Health equity, communication science, health literacy, and organizational behavior principles were utilized to develop a family safety reporting intervention consisting of a family safety reporting tool, staff and family education, and a process for reviewing and sharing family reports with unit and hospital leaders. We evaluated intervention training rates and hospital impact (comparing family-reported safety incidents received by the hospital through voluntary incident reports at baseline to incidents received through voluntary incident reports and after the intervention). Additionally, we analyzed field notes and minutes to describe lessons learned from applying these principles in complex, hospital-based interventions. We trained 208 families, 149 nurses, 42 resident physicians, and 7 attending physicians in the intervention. After implementing the intervention, the frequency of families from whom the hospital documented safety concerns increased from an average of 0.4 per month at baseline to 4.4 per month after the intervention. Four key lessons emerged: (1) Build deep and regular partnerships across all intervention key partners, including initial skeptics. (2) Tailor the intervention message to each audience. (3) Embrace flexibility and a growth mindset when weighing suggestions and adapting interventions. (4) Equity is an investment, not a checkbox. We conclude that health equity, communication science, health literacy, and organizational behavior can inform inclusive, effective, complex hospital-based interventions but require deep partnerships, tailored messaging, flexibility, a growth mindset, and a commitment to equity.

Scaling up effective public health interventions is crucial for achieving universal health coverage, yet remains challenging. We report the use of the Plan-Do-Study-Act (PDSA) quality improvement model to support the iterative scale-up of a community-based cardiovascular disease risk management program in Malang District, East Java, Indonesia. A pragmatic implementation study comprising three PDSA cycles was conducted in 10 ‘test of scale-up’ villages between April 2021 and December 2022. Each cycle included: 1) the capture of quantitative outcomes, such as the number of new community members screened per month and diagnostic summaries with predicted risk status; and 2) semi-structured interviews and focus group discussions with health care workers, community members, and community health workers in each village to assess acceptability, adoption, adaptations and perceived effectiveness. Based on identified implementation barriers, local Technical Working Groups designed change strategies, which were implemented and evaluated in subsequent cycles. The COVID-19 pandemic disrupted program delivery in the first two PDSA cycles, reducing screening to an average of 112 and 7, respectively. In cycle 3, 463 community members were screened. Across the 10 participating villages, 42 interviews and 30 focus group discussions were conducted per PDSA cycle. Key barriers included difficulty reaching male community members, inadequate resourcing, limited essential medications and poor integration with existing health information systems. Change strategies included centralising screening activities, leveraging instant messaging platforms, additional activities to engage men and streamlined procurement processes. Each village demonstrated versatility in addressing implementation challenges. These findings highlight the utility of the PDSA model in supporting the iterative scale-up of a community-based cardiovascular disease risk management programs in real-world settings, even amid significant disruptions such as the COVID-19 pandemic.

Behavioural weight management interventions are complex interventions having several coexisting components designed to facilitate weight loss. Existing evidence has shown behavioural weight management interventions to be effective; however, the magnitude of weight loss varies among programmes. There is value in understanding whether differences in the intervention components influence the overall effectiveness of the interventions. The current study is the first attempt to explore the effects of individual components of interventions using data from both randomised controlled trials and real-world services based in the United Kingdom. To deconstruct behavioural weight management interventions into constituent components and identify the effectiveness of individual components for weight loss. A component network meta-analysis of data from randomised controlled trials and real-world services. Real-world services and randomised controlled trials based in the United Kingdom for weight management in adults. Adults over 18 years of age, living in the United Kingdom and attending behavioural weight management interventions in the real world (n = 76,201) or participating in randomised controlled trials (n = 4051). Mean change in weight after 12 weeks of active weight loss sessions. Bayesian two-staged component network meta-analysis using an additive model. In the analysis of randomised controlled trials, significant weight loss was associated with components tailoring (mean difference -5.54 kg; 95% credible interval -7.72 to -3.35), flexibility in attendance (mean difference -3.18 kg; 95% credible interval -4.29 to -2.07) and multimodal referral (mean difference -2.57 kg; 95% credible interval -4.89 to -0.25). In real-world services, the components associated with significant weight loss included multimodal referral (mean difference -2.01, 95% credible interval -2.13 to -1.88), personalised dietary advice (mean difference -1.22, 95% credible interval -1.33 to -1.11), flexibility (mean difference -0.41, 95% credible interval -0.47 to -0.35) and in-person delivery (mean difference -0.45, 95% credible interval -0.52 to -0.38). However, co-design (mean difference 3.46 kg; 95% credible interval 2.12 to 4.82) in randomised controlled trials, and added extras (mean difference 0.99 kg; 95% credible interval 0.88 to 1.10) and tailoring (mean difference 0.33 kg; 95% credible interval 0.27 to 0.40) in real-world services, were not shown to be effective in short-term weight loss. The findings from this study highlight the importance of understanding the impact of intervention components such as accessibility, flexibility, tailoring and dietary advice and in-person delivery in weight loss at 12 weeks. Future research should consider exploring the component interactions and long-term weight loss for improved understanding and developing effective programmes. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR129523.

Healthcare professionals as promoters and barriers of innovative complex outpatient interventions: A case study of an intervention to increase participation of people living with MS.

ObjectivesTo test whether improving a Christmas tree meringue recipe using reporting guidelines yields more appealing and sweeter meringues.DesignA prospective, superiority, single-blind, cluster-randomised (1:1) controlled trial.SettingA public participatory event in a large cultural facility in France.ParticipantsBudding chefs with basic culinary skills, possessing the utensils necessary for baking Christmas tree meringues, and not having burned pasta in the past month (for safety reasons). Bunding chefs represent the cluster and meringue the unit.InterventionsEach budding chef was randomised to a standard recipe for making Christmas tree meringues or to the same recipe written in consultation with a professional baker using the TIDieR checklist—a reporting guideline for description of complex interventions—plus a short video tutorial.Main outcome measuresThe primary outcome was reproducibility in terms of visual aspect. Secondary outcomes included colour, size, taste and survival time in the course of a sale organised as part of the public event. The visual aspect, colour and size was rated by an independent jury which compared the cooked Christmas tree meringues with the recipe picture on a scale from 1 to 10. Analyses were performed in intention-to-eat (randomization unit: budding chefs / analysis unit: Christmas trees).Results60 budding chefs (30 in each group) baked a total of 845 Christmas tree meringues. There was no significant difference between the groups (mean difference = -0.1; [95%CI -0.99; 0.80]; p-value = 0.84; intra-cluster correlation, ICC = 0.77) on visual aspect. No difference was found for reproducibility in terms of colour (mean difference = -0.31; [95%CI -0.97; 0.35]; p-value = 0.35; ICC = 0.67) or size (mean difference = -0.17; [95%CI -1.07; 0.73]; p-value = 0.71; ICC = 0.74). There was no significant difference in terms of taste between the groups (mean difference = -0.55; [95%CI -1.62; 0.52]; p-value = 0.31). 400 meringues were sold during the public event with no difference in survival time between groups (hazard ratio = 1.26 [95% CI 0.75–2.09], p-value = 0.38, with values > 1 in favour of the control group). e.g. 75% survived for 134 min in intervention group and for 124 min in the control group.ConclusionsOur study failed to demonstrate that an improved recipe using the TIDieR reporting guideline with a video tutorial improved the reproducibility in terms of visual aspect, colour, size, taste and sales for Christmas tree meringues. The best way to succeed in reproducing Christmas tree meringues alike those showcased by the recipe—and thereby to improve reproducibility of experiments—remains a mystery still to be solved by further explorations.Trial registrationhttps://osf.io/dnhbx.Supplementary InformationThe online version contains supplementary material available at 10.1186/s41073-025-00167-x.

Abstract OP 8: Health Services 6, B304 (FCSH), September 3, 2025, 15:45 - 16:45 Background The aim of this scoping review is to systematically map the existing evidence of complex interventions used to improve access and/or engagement of ethnic minority groups with healthcare services in the UK, and the inclusivity of the evidence. Methods The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews Checklist. Six databases were searched. Analysis was completed using reflexive and thematic content analysis. Interventions were mapped against the five domains of the Patient-centred access framework and the PROGRESS-Plus equity framework. Results A total of 35 studies met the inclusion criteria. Of these studies 63% were completed in primary care, 31% in mental health, 3% in maternity services and 3% in dental care. Several communities were represented, including Gypsy, Roma and Travellers, African Caribbeans, Jewish communities, and broader groups such as South Asians, migrants and Muslims. Complex interventions were spread across the five domains of the patient centred access framework and included strategies such as outreach workers, using community settings such as places of worship, cultural adaptations and cultural training for healthcare staff. Efficacy of interventions was assessed in a third of studies. PROGRESS-Plus analysis identified exclusion criteria including age groups (e.g. below 18 years), ethnic groups (e.g. not first-generation migrants), disabilities (e.g. severe mental health problems) and plus (e.g. language proficiency). Conclusions All domains of the patient centred access framework were represented with approachability and acceptability being the most common. Whilst the other domains were well represented, affordability and appropriateness had the least number of supporting sources. Efficacy assessment was not included in two thirds of studies however, complex interventions show promise to improve equity in underserved groups. Future research should endeavour to assess effectiveness and the translation of interventions in healthcare contexts outside of primary care and mental health.

Development of an evidence-based auriculotherapy program for urinary incontinence in men after radical prostatectomy.

Development of a dyadic mindfulness self-compassion intervention for patients with lung cancer and their family caregivers: A multi-method study

It is time to recognise shared decision-making as a complex intervention

Targeting health equity through complex health interventions: Which evaluation methods and designs are used? A scoping review.

Nonfatal Firearm-Related Vascular Injuries: Clinical and Financial Implications in Trauma Care.

Worldwide, pneumonia, diarrhea, and malaria remain leading causes of death for children under the age of five, even though these diseases are preventable and can be treated. In public health, complex behavioral change interventions are often used. These interventions employ multi-component strategies and work on domains, such as education, policy, and environmental change, to promote prevention, control, and management of childhood diseases. In Tando Muhammad Khan (TMK), the Community Mobilization and Community Incentivization (CoMIC) trial employed a complex, participatory community engagement strategy and included conditional community-based incentives and showed promising results by improving child health related behaviors. A study was conducted to explore the experiences and perceptions of community members regarding the implementation and engagement processes of the CoMIC trial. A total of 13 IDIs and 16 FGDs were conducted to understand the factors behind the community engagement and behavior change that led to the success of the CoMIC trial and its adaptability for wider scale-up. The study identified four key motives for driving community engagement: egoism, altruism, collectivism, and principlism. The community’s close-knit social structure and shared sense of collective growth played a crucial role in encouraging participation and adapting to required behaviors. The trial focused on empowering the community by reinforcing health-seeking behaviors as a community responsibility, promoting cost-sharing to ensure long-term sustainability, and creating collective ownership through active community engagement and Conditional, Collective, Community-based Incentives (C3Is). By strengthening WASH and IYCF practices, increasing immunization uptake, promoting care-seeking behaviors, the intervention aimed to reduce the burden of childhood illnesses such as diarrhea, pneumonia, and malaria, ultimately improving child health outcomes.

Acceptability and feasibility of a midwifery intervention to promote active labour and decision-making: a qualitative study with women and nurse-midwives.

Patients' experiences of group-delivered sleep restriction therapy in primary care: a qualitative study undertaken alongside a randomized controlled trial.

ABSTRACTIntroductionA cancer diagnosis may have negative consequences on family members' health and well‐being. Although support for family members has been stressed for decades, family members continue to report unmet needs for support. Suggested explanations are the lack of individualisation and the lack of implementation. Therefore, the overall aim of this project is to develop and evaluate a support model for individualised support in routine cancer care. The objective of this paper is to describe the support model's development and validation.MethodTo address the complex phenomenon of offering individualised support for family members in routine cancer care, we applied a dynamic multi‐method approach, guided by the Medical Research Council's Framework for Development and Evaluation of Complex Interventions. The support model was developed with healthcare professionals, family members, and stakeholders to ensure relevance and applicability. The development and validation involved a literature review, qualitative interviews, and repeated consultations. Ethical approval and written informed consent were obtained.ResultsThe FamCASP support model is a nurse‐led, interprofessional model for structured yet individualised support for family members to prevent cancer‐related illnesses in routine cancer care. It consists of two parts—one generic model and diagnosis‐specific modules—and is adaptable to local contexts and allows for the integration of existing support.LimitationsThroughout the support model development, local (national) fit was emphasised, which may limit international application. Further, to this date, only one diagnose‐specific module has been developed (colorectal cancer). Hence, the applicability of the support model in other contexts needs further exploration.ConclusionThrough concurrent consideration of family members' needs and prerequisites for support in routine care, a tailored support model was developed and assessed as relevant, usable and implementable by healthcare professionals, family members and stakeholders. Evaluations of feasibility and effectiveness are warranted prior to implementation.

ABSTRACTBackground and AimsMedication adherence is the extent to which a patient's behavior corresponds with the prescriber's recommendations for taking medications. Non‐adherence is particularly high in patients with hypertension, leading to poor blood pressure control, increased cardiovascular risk, and increased burden on the healthcare system. A multitude of techniques and interventions to measure and improve medication adherence have been evaluated with mixed results. This protocol outlines a systematic review and meta‐analysis of randomized controlled trials evaluating interventions aimed at improving medication adherence in people with hypertension. There will be a focus on investigating intervention impact on the duration of medication adherence, persistence, analysis of subjective versus objective medication adherence measurement techniques, the impact of patient demographics on intervention effectiveness, and the use of the Behavior Change Taxonomy to categorize behavior change interventions and facilitate their evaluation.MethodsThis protocol was developed using the PRISMA‐P checklist and prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42024614468). A comprehensive literature search was conducted using Medline (Ovid), CINAHL and Embase electronic databases for articles published from inception to November 27th, 2024. In addition, CENTRAL was searched for articles published up to the end of 2024. Fixed and/or random‐effects meta‐analysis will be used as appropriate, according to between study heterogeneity, and the risk of bias of included studies will be assessed using the Cochrane risk of bias tool.ResultsThe results and findings of this review will be reported in accordance with PRISMA guidelines and published in a peer‐reviewed journal.ConclusionThe findings of this review will evaluate the evidence for interventions designed to improve medication adherence in people with hypertension. The results will provide evidence on which adherence interventions, or components of complex interventions, are effective and how they impact blood pressure control. Recommendations will be made for further research, including the design of interventions and methodology for medication adherence measurement.

ABSTRACT Introduction There is a high prevalence of poor mental health among people with HIV, intersecting with structural inequalities, stigma and co-morbidities. A new person-centred approach to care that utilises health coaching to prioritise health and well-being and connects people to existing sources of support or voluntary sector organisations (social prescribing) could benefit people with HIV. Methods Theory of Change (ToC) methodology was used to develop a health coaching and social prescribing intervention for people with HIV. Two successive ToC workshops were held in September 2023 with a multi-disciplinary group of 39 stakeholders from across the HIV sector. Results The two workshops resulted in a TOC map which specified the components and intended outcomes of the intervention, identified the target population of people with HIV for the intervention, identified training requirements for healthcare staff and developed process indicators for monitoring and evaluation of the intervention. Conclusion The ToC method enabled stakeholders with broad-ranging experience, skills and perspectives concerning the mental health and well-being among people with HIV, to co-develop an appropriate which is being evaluated in the “Psychosocial intervention for people Living with HIV: Evidence from a Randomised Evaluation (SPHERE)” trial across eight HIV clinics in England in 2025.

Older adults with frailty often face functional decline and limitations in doing everyday activities after being discharged from acute hospital admission affecting their health and quality of life. However, engaging them in training interventions can be challenging. The aim of this study was to evaluate a combined training, nutrition, and social intervention from the perspective of newly discharged older adults with frailty participating in the intervention. Semi-structured interviews were conducted with 14 participants of whom 10 were interviewed twice. Data were analyzed using a theory-based evaluation approach using a CIMO (Context-Intervention-Mechanism-Outcome) framework, followed by subsequent analysis of key elements. The study found that a skilled and person-centered physiotherapist was crucial to making strength training feasible for participants, resulting in adherence and effort in training, although continuation after the intervention was challenged by different aspects such as geography and social factors. Including goal setting and test results could potentially be relevant motivational tools, but goal setting was not implemented well, according to the experiences of the participants. The social part of the intervention was important for encouraging participation and the well-being of participants, as groups were cohesive, and participants were accepting of each other. Participants did not recall the nutritional intervention very well, and it seemingly only had a small impact. The physiotherapist's approach was essential for ensuring compliance and motivation for strength training for the older adults with frailty. Furthermore, fostering social cohesion within training groups could be important for promoting compliance and participant well-being. Factors influencing the continuation of training should be considered to ensure its long-term sustainability. Further research is warranted on incorporating nutritional guidance to enhance the impact of interventions for newly discharged older adults with frailty.

Personalised Care Planning for Older People with Frailty (PROSPER) is a complex intervention comprising four work packages with multiple layers of public involvement. We explored the perceived value of public involvement within PROSPER and evaluated the current structure using the six core standards for public involvement developed by the UK National Institute for Health and Care Research (NIHR). Two lay members trained as peer researchers. They conducted semi-structured interviews with other lay members, the trial and programme managers and chief investigator. Interviews were not audio-recorded. Interview notes were written up and returned to participants for verification. Documentary analysis of minutes was also undertaken. Twelve interviews were conducted. Lay members felt involvement in the programme made them reflect on their own experience of older age and encouraged them to be more involved in future research. Lay member input resulted in tangible benefits, including securing funding. The use of the NIHR framework highlighted areas of strength and weakness in the public involvement structure and underpinned an action plan for improvements in the final work package. Public involvement in PROSPER had both perceived and tangible benefits for individuals, the programme, the NHS and wider society. The NIHR standards framework is a useful tool for evaluating public involvement structures in programmes of complex interventions.