Sepsis is a life-threatening response to infection and remains a critical challenge with high morbidity and mortality rates. The Surviving Sepsis Campaign (SSC) guidelines serve as a cornerstone for sepsis management and are pivotal in standardising care. Taylor et al’s article1 scrutinises the real-world implications of updated SSC antibiotic timing recommendations2 and offers critical insights into the practical effects of the revised antibiotic timing guidelines.

The Research Domain Criteria (RDoC) approach initiated by the National Institute of Mental Health provides a comprehensive framework for guiding research on mental illness and health. Since retrospective studies have indicated associations between RDoC characteristics and clinically relevant as well as care-relevant outcomes, there is a need for prospective, theory-driven investigations that systematically link a priori defined assessments of RDoC constructs to clinically and care-relevant outcomes in a transdiagnostic psychiatric sample.

This prospective observational study assesses six domains—Positive Valence Systems, Negative Valence Systems, Cognitive Systems, Social Processes, Arousal and Regulatory Systems and Sensorimotor Systems—employing a comprehensive set of self-report and additional paradigms to assess cognitive functioning developed a priori in alignment with the RDoC framework while also assessing clinically and care-relevant variables (eg, length of hospital stay). A total of 300 adult participants will be recruited among in- and outpatients of two psychiatric hospitals in Germany (patient group) as well as from the general population (healthy control group). Including healthy individuals will allow for the investigation of continuous variations in psychological functioning rather than categorical distinctions between health and disease. Data collection includes self-reports, clinician ratings, file review and behavioural assessments. Electroencephalography is recorded in a subgroup of participants. A confirmatory factor analysis will be conducted to reproduce the factor structure and regression models will be used to investigate associations between RDoC domains and clinically relevant as well as care-related variables.

Ethics approval was obtained from the local ethics committee of the Brandenburg Medical School—Theodor Fontane (E-01-20220822). Results will be disseminated through peer-reviewed journals and academic conferences.

Exercise-based interventions are well-established in reducing falls and fall-related injuries, but adherence and accessibility remain key challenges, particularly in rural areas. While conventional in-person training is widely used, digital interventions may offer scalable solutions to enhance engagement and reach. However, pragmatic trials evaluating the real-world effectiveness of conventional and digitally supported fall prevention interventions are lacking, limiting the evidence base for their implementation in routine healthcare settings. The SURE-Footed into the Future Fall Intervention Trial (SURE-FIT) aims to compare the effectiveness of two structured fall prevention interventions—a conventional centre-based exercise programme and a hybrid telemedical programme combining in-person and tablet-supported training—against a wait-list control group in reducing falls and fall-related injuries among community-dwelling older adults.

This study is a pragmatic three-arm, parallel-group, randomised controlled superiority trial with a 1:1:1 allocation ratio. Participants (≥65 years, community-dwelling, planned n=2778) will be randomly assigned to (1) conventional centre-based training supplemented with printed materials for home-based continuation (conventional group), (2) a hybrid model integrating centre-based and tablet-supported training for continuation (tablet group) or (3) a wait-list control group. The intervention includes a 9-week supervised phase followed by 43 weeks of independent home-based training. The primary outcomes are the incidence rate of falls and fall-related injuries over 12 months. Secondary outcomes include physical functioning, physical activity, concerns about falling, loneliness and the risk of low protein intake. A process evaluation will assess intervention feasibility and implementation. Additionally, qualitative interviews will be conducted with participants, course instructors and municipal stakeholders to explore experiences, facilitators and challenges related to programme participation and implementation. A health-economic evaluation will be conducted to assess the cost-effectiveness of the structured fall prevention interventions. Data collection will take place at baseline and every 3 months via standardised questionnaires, with a subgroup undergoing physical performance testing and sensor-based activity monitoring. Analyses will follow an intention-to-treat approach.

Ethical approval has been granted by the Ethics Committee of Ulm University (271/23). Written informed consent will be obtained from all participants before enrolment. Study findings will be disseminated through peer-reviewed publications, scientific conferences and national fall prevention initiatives. Additionally, results will be shared with key municipal representatives, and the German National Association of Senior Citizens’ Organisations (BAGSO). A publicly accessible website will provide ongoing access to study information and findings in plain language.

DRKS00032878, German Clinical Trials Register

To assess maternal medical conditions, physical and surgical ailments, contraceptive use and barriers to its use, maternal mental health, neonatal health, breastfeeding practices and available social support in the postpartum period.

A prospective cohort study.

A large tertiary care centre.

12 245 women who delivered after 22 weeks gestation in the year 2022.

Three pre-specified exposures, namely mode of delivery, presence of significant risk factors and preterm delivery within the cohort, were used to identify potential groups of women who would need additional support.

The primary outcome was the number of unscheduled visits by the mother or child and the indications for these visits.

The secondary outcomes in mothers included unhealed wound sites, anaemia, increase in body mass index (BMI) by >3, persistent high blood pressure, pain in the abdomen or pelvis, urinary or bowel problems, musculoskeletal pain, abnormal maternal mental health, breast-related issues and barriers to breastfeeding, contraceptive use and sexual activity.

Only 2% of women and children were lost to follow-up. Nine women and 75 babies died. The majority of infant deaths were related to serious congenital diseases. Unscheduled visits to the health facility were seen in 44% of the cohort, most commonly for upper respiratory infections and fever in the mother and baby. 41 mothers and 741 infants needed admission to hospital. Hospitalisation was more common in those with risk factors or preterm delivery. High blood pressure was seen in 3 to 4% and anaemia in 4% of the cohort. Wound infection was seen in 3 to 4% and urinary incontinence in 2% of women. Wound infection was more common with instrumental delivery. Bowel incontinence was rare. A fourth of the cohort had musculoskeletal pain, especially back pain, which was more common after caesarean delivery. Only 5.5% of the cohort had unsatisfactory mental health, and these women were more likely to have abnormal mental health scores with the NICE Questionnaire at screening. The family APGAR of the cohort was 9/10, and 95% belonged to the middle-income group. 2.6% of neonates had delayed milestones, and this was more common in the group with risk factors and preterm delivery.

Healthcare utilisation was mainly for minor complaints. Re-admissions were rare, as intrapartum and immediate postpartum care were optimal. Women who delivered by caesarean section or delivered a preterm child needed additional support in the postpartum phase. NICE Questionnaire is a quick and easy screening tool to identify unsatisfactory mental health and should be used before discharge, postnatally, even in busy settings. The implementation of formal telephonic support 24 hours a day in birthing facilities should be explored in the future. Holistic postnatal care of mother and child during the immunisation of the baby would be the best opportunity to improve the quality and coverage of care in the postnatal phase.

CTRI/2022/03/041343.

To evaluate the impact of the Medicaid Balancing Incentive Programme (BIP) on long-term services and supports utilisation among older adults, focusing on differences in living arrangements.

Quasi-experimental study using a generalised difference-in-differences approach.

States that participated and completed BIP (treatment group: 18 states) and states that were eligible but did not participate (control group: 17 states).

Older Medicaid beneficiaries from the Health and Retirement Study (2006–2018) across states that participated in BIP and those that did not. A negative control analysis was conducted using non-Medicaid beneficiaries.

We examined the probability of long-term nursing home stays (over 100 days), professional home healthcare and three types of home care services for activities of daily living: paid professional caregiving, paid informal caregiving and unpaid informal caregiving. Analysis was stratified by living arrangement (living alone vs with others).

BIP participation was associated with a 5 percentage point (pp) decrease in long-term nursing home stays among Medicaid beneficiaries living alone (average treatment effect on the treated, ATT=–0.06, 95% CI –0.10 to –0.02; p

BIP contributed to a reduction in institutionalisation for individuals living alone while increasing support for family caregivers in multiperson households. These findings highlight the importance of tailoring long-term care policies to the specific needs of populations based on their living arrangements.