To evaluate greenhouse gas (GHG) emissions from procedure room NanoNeedle arthroscopy (NA) and its associated clinical pathway, compared with conventional arthroscopy (CA) delivered in an operating room, focusing on non-complex knee arthroscopy procedures.

Hybrid carbon footprint analysis using process-based life-cycle methods combined with economy-wide input-output data that include environmental impact factors for medical devices and components of patient care pathways. Three care pathways were evaluated: (1) CA in an OR with preoperative MRI, (2) NA in a procedure room with MRI and (3) NA in a procedure room without MRI. Emissions were calculated for all pathway components, including patient and staff travel, diagnostic imaging, medical devices, the procedure itself and postoperative care.

UK National Health Service-based care pathway model for non-complex knee arthroscopy procedures.

The primary outcome was GHG emissions (kgCO₂e) per procedure pathway. Additional analyses assessed emissions by pathway component, adoption scenarios, conversion rates from NA to CA and sensitivity analyses for selected assumptions and input parameters.

The CA pathway generated 77.0 kgCO₂e per procedure, whereas the NA with MRI produced 45.0 kgCO₂e and NA without MRI 35.3 kgCO₂e, representing reductions of 42% and 54% of kgCO₂e, respectively. Major emission contributors for CA were patient travel, consumable items and general anaesthesia; for NA pathways, patient travel and the device itself were the leading contributors. Adoption modelling indicated that using NA without MRI for 5000–20 000 knee arthroscopy procedures could yield annual CO₂e savings ranging from 208 tons to 834 tons.

Knee arthroscopy delivered via the NA procedure room pathway has the potential to substantially reduce environmental impact compared with conventional OR-based care. As healthcare providers and policymakers increasingly consider environmental sustainability, technologies that enable alternative care models, such as NA in a procedure room setting, may represent a promising approach for reducing the carbon footprint of selected procedures.

There has been considerable attention placed on ‘failures’ of maternity care in high-income countries, with little focus on the drivers of ‘high-quality’ care delivered at the organisational level. We conducted a realist review with this central focus and report on the first phase, initial programme theories (IPTs) generated from the literature, where a future phase will ‘test’ the IPTs.

A realist review methodology was employed, an interpretative, theory-driven approach designed to explore ‘what works, for whom, in what circumstances’ using context, mechanism and outcome (CMO) propositions.

The search strategy used a purposive database (MEDLINE) and hand searches, including peer-reviewed journals, grey literature and policy reports, to identify literature rich and relevant to the research question.

As per realist review approaches, we included any English-language literature from peer-reviewed journals, grey literature, policy reports, service guidance and public or professional commentary, from high-income countries, that provided explanatory insights to the operationalisation of ‘high-quality’ maternity care at the organisational level. Using an a priori definition, high-quality maternity care was defined based on four outcome criteria: higher service user and staff well-being, lower prevalence of complications/adverse outcomes and optimal use of resources.

Data extraction configured evidence using the ‘If, Then, Leading to’ CMO heuristic. The IPTs were iteratively developed from the synthesised data and refined through consultation with a diverse 26-member core stakeholder group.

The iterative search process included 17 index papers, which were a mix of systematic reviews, primary research studies, commissioned reports, evaluations and commentaries. These papers generated 292 initial CMO hypotheses, which were refined into 11 IPTs focusing on organisational-level mechanisms. The IPTs reflect a ‘both-and’ philosophy, balancing clinical excellence (safety) and values-based relational care (personalisation and staff environment). Key themes include visible and supportive leadership, responsiveness to workload assessments, ensuring operational fitness (system and workplace environment support) and broadening the definition of safety beyond physical safety to include psychological, emotional and cultural safety. The IPT related to ‘A culture of equitable care’ was identified as critical in underpinning all maternity service provision.

The 11 IPTs offer crucial insights into the context and mechanisms that may produce desired outcomes in high-quality maternity care. Learning from high-quality services (safety II) provides a novel approach compared with focusing only on failings. These globally relevant IPTs can be applied to high-income contexts as a foundation for designing future improvement programmes.

CRD420251104996.

Poststroke depression (PSD) affects approximately 33% of stroke survivors and is associated with worse outcomes, poor quality of life (QOL) and mortality. Despite its prevalence and consequences, there is no consensus on the most effective strategy for PSD prevention. Behavioural activation (BA) is an effective intervention for depression across diverse populations and is considered safer, better tolerated and a longer-lasting alternative to antidepressant medications. This study aims to test the effectiveness of a remotely delivered BA intervention to prevent PSD (Tele-BA-S).

We will conduct a randomised effectiveness trial of 350 low-income adults (≥ 55 years) within 3 months of ischaemic or haemorrhagic stroke and with subthreshold depression (Patient Health Questionnaire-9 score

Ethical approval was obtained by the University of Texas Health Science Center at Houston’s (UTHealth Houston) Committee for the Protection of Human Subjects Institutional Review Board. The trial protocol, statistical analysis plan and code, and deidentified participant data will be made available via the National Institute of Mental Health Data Archive. The results will be presented at academic conferences and submitted for publication. The authors declare that they have no conflicts of interest relevant to the content of this manuscript.

NCT06864715.