Search Results (386)

Background: Metabolic syndrome (MetS) is a set of cardiometabolic abnormalities, including central obesity, dyslipidemia, hypertension, and hyperglycemia, that substantially increases the risk of cardiovascular disease and type 2 diabetes. Marine-derived omega-3 polyunsaturated fatty acids (n-3 PUFAs), especially eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), may improve MetS components through triglyceride-lowering, anti-inflammatory, and insulin-sensitizing effects; however, randomized controlled trial (RCT) results remain inconsistent, and the influence of dose and intervention duration is unclear. Methods: Following PRISMA guidelines, PubMed, Embase, Scopus, and Web of Science were searched to June 2024 for RCTs in adults with MetS or its components. Eligible trials assessed marine-derived omega-3 supplementation (EPA/DHA) versus placebo or control and reported at least one MetS diagnostic criterion (triglycerides, HDL cholesterol, fasting plasma glucose, blood pressure, or waist circumference) or related parameter (LDL cholesterol, HOMA-IR, or HbA1c). Data were extracted in duplicate and quality assessed using the Cochrane Risk-of-Bias Tool. Trials were categorized by dose—low (<1000 mg/day), medium (1000–2000 mg/day), and high (>2000 mg/day)—and duration: short-term (ST; ≤8 weeks), medium-term (MT; >8–12 weeks), and long-term (LT; >12 weeks). Meta-regression using ordinary least squares estimated dose–duration effects. Publication bias was assessed with funnel plots and Egger’s test for outcomes with ≥3 studies. Results: Twenty-one RCTs (n ≈ 1950) were included. For triglycerides, the largest reductions occurred in the high-dose LT (−56.78 mg/dL ± 3.44) and ST (−50.873 mg/dL ± 3.04) groups, and MT duration (−41.536 mg/dL ± 4.12), showing that in high doses of omega-3, the beneficial effect of reducing TGs was more prominent in long-term and short-term treatment other than with medium-term duration of treatment. In comparison, the result for medium-dose with MT duration was (−24.93 mg/dL ± 0.464) and for LT duration was (−31.843 mg/dL ± 0.46), all p < 0.001. In LDL cholesterol, an increase in the low-dose ST group (+7.04 mg/dL ± 4, p < 0.001) and low-dose LT group (+35.525 mg/dL ± 4.33, p < 0.001) was observed. In other subgroups, either there were no data available or the number of studies was limited and could not be considered as statistically significant in meta-analysis due to low power. As for HDL cholesterol, FBS, SBP, DBP, waist circumference, BMI, and HOMA-IR, the data extracted from the included studies were not sufficient to be eligible for the meta-analysis. Conclusions: Marine-derived omega-3 supplementation produces substantial triglyceride reductions, especially at doses >2000 mg/day for ≥8 weeks. HDL cholesterol and blood pressure benefits are not consistent, fasting glycemia is largely unaffected, and LDL cholesterol may increase, especially in low doses. High-dose marine omega-3s can be considered as part of dietary strategies for MetS management, with monitoring for LDL changes. Standardized intervention protocols and long-term RCTs are needed to clarify dose and duration–response relationships. Full article

The growing global demand for secure, transparent, and efficient electoral systems has highlighted the limitations of traditional voting methods, which remain susceptible to voter impersonation, ballot tampering, long queues, logistical challenges, and delayed result processing. To address these issues, this study presents the design and implementation of a Radio Frequency Identification (RFID)-based electronic voting framework that integrates robust voter authentication, encrypted vote processing, and decentralized real-time monitoring. The system is developed as a scalable, cost-effective solution suitable for both urban and resource-constrained environments, especially those with limited infrastructure or inconsistent internet connectivity. It employs RFID-enabled smart voter cards containing encrypted unique identifiers, with each voter authenticated via an RC522 reader that validates their UID against an encrypted whitelist stored locally. Upon successful verification, the voter selects a candidate via a digital interface, and the vote is encrypted using AES-128 before being stored either locally on an SD card or transmitted through GSM to a secure backend. To ensure operability in offline settings, the system supports batch synchronization, where encrypted votes and metadata are uploaded once connectivity is restored. A tamper-proof monitoring mechanism logs each session with device ID, timestamps, and cryptographic checksums to maintain integrity and prevent duplication or external manipulation. Simulated deployments under real-world constraints tested the system’s performance against common threats such as duplicate voting, tag cloning, and data interception. Results demonstrated reduced authentication time, improved voter throughput, and strong resistance to security breaches—validating the system’s resilience and practicality. This work offers a hybrid RFID-based voting framework that bridges the gap between technical feasibility and real-world deployment, contributing a secure, transparent, and credible model for modernizing democratic processes in diverse political and technological landscapes. Full article

Background/Objectives: Hydrogels are highly hydrated, biocompatible polymer networks increasingly investigated as drug-delivery systems (DDS) for analgesics. Their ability to modulate local release, prolong drug residence time, and reduce systemic toxicity positions them as promising platforms in perioperative, chronic, and localized pain settings. This scoping review aimed to systematically map clinical applications, efficacy, and safety of hydrogel-based DDS for analgesics, while also documenting non-DDS uses where the matrix itself contributes to pain modulation through physical mechanisms. Methods: Following PRISMA-ScR guidance, PubMed, Embase, and Cochrane databases were searched without publication date restrictions. Only peer-reviewed clinical studies were included; preclinical studies and non-journal literature were excluded. Screening and selection were performed in duplicate. Data extracted included drug class, hydrogel technology, clinical setting, outcomes, and safety. Protocol was registered with Open Science Framework. Results: A total of 26 clinical studies evaluating hydrogel formulations as DDS for analgesics were included. Most were randomized controlled trials, spanning 1996–2024. Local anesthetics were the most frequent drug class, followed by opioids, corticosteroids, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), and neuromodulators. Application sites were predominantly topical/transdermal and perioperative/incisional. Across the DDS cohort, most of the studies reported improved analgesic outcomes, including reduced pain scores and lower rescue medication use; neutral or unclear results were rare. Safety reporting was limited, but tolerability was generally favorable. Additionally, 38 non-DDS studies demonstrated pain reduction through hydrogel-mediated cooling, lubrication, or barrier effects, particularly in burns, ocular surface disorders, and discogenic pain. Conclusions: Hydrogel-based DDS for analgesics show consistent clinical signals of benefit across diverse contexts, aligning with their mechanistic rationale. While current evidence supports their role as effective, well-tolerated platforms, translational gaps remain, particularly for hybrid nanotechnology systems and standardized safety reporting. Non-DDS applications confirm the intrinsic analgesic potential of hydrogel matrices, underscoring their relevance in multimodal pain management strategies. Full article

Background/Objectives: Carbapenem-resistant Klebsiella pneumoniae (CRKP) threatens Intensive Care Units (ICU), particularly in settings where serine (KPC) and metallo-β-lactamases (NDM) co-circulate. The aim of this study was to assess CRKP susceptibility especially to novel β-lactam/β-lactamase inhibitor combinations, characterize the genetic determinants of resistance, and contribute to the understanding of local epidemiology in the ICU of our hospital. Methods: We studied 32 non-duplicate CRKP isolates (30 ICU, 2 wards) collected at Hippokration General Hospital, Thessaloniki (May–Oct 2023). Bacterial identification and Antimicrobial susceptibility testing (AST) were performed by VITEK-2; Minimum inhibitory concentrations (MICs) for ceftazidime/avibactam (CAZ/AVI), meropenem/vaborbactam (MER/VAB), and imipenem/relebactam (IMI/REL) were determined by E-tests. Colistin MICs were performed by broth microdilution. Carbapenemases were screened phenotypically and by immunochromatography and confirmed by multiplex PCR. One bronchial isolate co-harboring bla_NDM and bla_KPC genes underwent WGS. Results: All isolates were carbapenem-resistant and showed extensive resistance to β-lactams and fluoroquinolones. By PCR, 8/32 (25%) carried bla_KPC alone, 8/32 (25.0%) bla_NDM alone, and 16/32 (50%) co-harbored bla_KPC and bla_NDM. KPC-only isolates were generally susceptible in vitro to CAZ/AVI, MER/VAB, and IMI/REL, whereas dual KPC-NDM producers were resistant to all three combinations. Tigecycline showed the highest retained activity; colistin remained active in a minority. WGS of one ST512 (CG258) isolate revealed co-harboring bla_NDM-1 and bla_KPC-3 with additional resistance determinants and plasmid replicons, consistent with high-risk spread. Conclusions: Half of CRKP isolates in this ICU-predominant series co-produced KPC and NDM, severely limiting β-lactam/β-lactamase inhibitor options. These data support routine screening for carbapenemases, strict infection prevention, antimicrobial stewardship, and access to agents active against MBLs. Full article

Background: The Pharm2Home Initiative’s Community Health Arm adopts a health-equitable approach to chronic disease education and medication therapy management (MTM). We serve senior residents of Solano County, California, who live in affordable housing and have limited financial resources. Aim: This evaluation assesses the uptake of chronic disease management recommendations provided by clinical pharmacists during MTM sessions at community events. Methods: The program engaged clinical pharmacists to provide tailored education and healthcare interventions in senior housing facilities. The goal was to empower seniors to manage their health effectively. The sessions covered various topics, including expired or duplicated medications, incorrect medication use, consultations on medication management, immunizations, and lifestyle adjustments. Results: Over an 18-month period, from January 2022 to August 2023, the program involved 65 participants across ten community health events. These events provided approximately 65 h of direct intervention. Many participants reported significant improvements in understanding their treatment plans and navigating their health needs more confidently. Feedback from 60 seniors after the sessions indicated that 88% felt much better informed about their medications, and 75% expressed that their concerns were addressed extremely well. Conclusions: These outcomes demonstrate the importance of clinical pharmacist-led interventions in improving seniors’ medication use and chronic disease management. The initiative’s approach advocates for integrating clinical pharmacists into community health settings, suggesting a scalable model for enhancing person-centered care. However, further studies are necessary to assess the long-term impacts of these interventions and explore their effectiveness across diverse age groups and more complex conditions. Full article

Instance segmentation in high-resolution images is essential for applications such as remote sensing, medical imaging, and precision agriculture, yet remains challenging due to factors such as small object sizes, irregular shapes, and occlusions. Tiling-based approaches, such as Slicing-Aided Hyper Inference (SAHI), alleviate some of these challenges by processing smaller patches but introduce border artifacts and increased computational cost. Overlapping tiles can mitigate certain boundary effects but often result in duplicate detections and boundary inconsistencies, particularly along patch edges. Conventional deduplication techniques, including Non-Maximum Suppression (NMS) and Non-Mask Merging (NMM), rely on Intersection over Union (IoU) thresholds and frequently fail to merge fragmented or adjacent masks with low mutual IoU that nonetheless correspond to the same object. To address deduplication and mask fragmentation, Spatial Mask Merging (SMM) is proposed as a graph clustering approach that integrates pixel-level overlap and boundary distance metrics while using R-tree indexing for efficient candidate retrieval. SMM was evaluated on the iSAID benchmark using standard segmentation metrics, with tile overlap configurations systematically examined to determine the optimal setting for segmentation accuracy. The method achieved a nearly 7% increase in precision, with consistent gains in F1 score and Panoptic Quality over existing approaches. The integration of R-tree indexing facilitated faster candidate retrieval, enabling computational performance improvements over standard merging algorithms alongside the observed accuracy gains. Full article

Background/Objectives: Climate change is intensifying vector-borne disease (VBD) transmission globally, causing over 700,000 annual deaths, yet systematic evidence comparing climate–health pathways across urban and rural settlements remains fragmented. This scoping review aimed to synthesize evidence on the differential impacts of extreme weather events on vector-borne disease transmission between urban and rural environments and identify settlement-specific prevention and healthcare preparedness strategies. Methods: A scoping review following PRISMA-ScR guidelines searched PubMed, EMBASE, Web of Science, and Scopus databases for studies examining climate–vector-borne disease relationships across settlement types. Sixteen empirical studies were analyzed using narrative synthesis, with urban–rural comparisons largely inferential given limited direct comparative studies. Results: From 6493 records identified, 4875 were screened after duplicate removal, yielding 16 studies for analysis. Studies covered multiple vector-borne diseases, including malaria, dengue, leishmaniasis, chikungunya, and Zika, across diverse geographic regions. Urban environments demonstrated infrastructure-mediated transmission dynamics characterized by heat island amplification exceeding vector survival thresholds, drainage system vulnerabilities creating breeding habitats, and density-driven epidemic spread affecting healthcare surge capacity. Rural settings exhibited ecosystem-mediated pathways involving diverse vector communities, agricultural breeding sites, and seasonal spillover from wildlife reservoirs, with healthcare accessibility challenges during extreme weather events. Critical research gaps included a limited number of longitudinal comparative studies and geographic variations in evidence generation. Conclusions: Extreme weather events create fundamentally distinct vector-borne disease transmission pathways across urban–rural gradients, necessitating settlement-specific prevention strategies and healthcare preparedness approaches. Evidence-based recommendations include urban infrastructure improvements, rural early warning systems, and cross-sectoral coordination frameworks to enhance the adaptive capacity for climate-resilient vector-borne disease prevention. Full article

Objective: The Staub™ Cranial system is based on defined anatomical reference points of edentulous casts that can guide the reconstruction of artificial teeth on the edentulous jaw. The aim of this study was to evaluate the validity of the Staub™ Cranial system in reconstructing the position of natural teeth in edentulous maxillae. Materials and methods: To reconstruct the original position of natural teeth, 20 fully dentate maxillary casts were produced, and 20 duplicates had all teeth eliminated. Subsequently, following the Staub™ Cranial system guidelines, an artificial teeth set-up was completed. The measured distances included the intermolar width #16–26, the intercanine width #13–23, and the incisocervical length #11. Measurements were made using the principle of stripe projection with specially developed software. Original and reproduced casts were then compared. The reproduced casts with measured distances deviating less than 5% from the mean values of control models were considered successful reconstructions. Results: The ability of the system to reconstruct the original position of lost teeth in the edentulous jaw was precise. With a narrow tolerance range of 5%, 80% of the models could be reproduced with zero or a deviation in one dimension only. Conclusions: The results of this study confirmed the efficacy of the Staub™ Cranial system to provide guidance for the customized arrangement of artificial teeth in edentulous jaws. Full article

Rett syndrome (RTT) and MECP2 duplication syndrome, a subtype of autism spectrum disorder (ASD), are neurodevelopmental disorders caused by MeCP2 loss and gain of function, respectively. While MeCP2 is known to regulate transcription through its interaction with methylated DNA and chromatin-associated factors such as topoisomerase IIβ (TOP2β), the downstream transcriptional consequences of MeCP2 dosage imbalance remain partially characterized. Here, we present a transcriptome-centered analysis of mouse primary cortical neurons subjected to MeCP2 knockdown (KD) or overexpression (OE), which model RTT and ASD-like conditions in parallel. Using a robust computational pipeline integrating generalized linear models with quasi-likelihood F-tests and Magnitude–Altitude Scoring (GLMQL-MAS), we identified differentially expressed genes (DEGs) in KD and OE relative to wild-type (WT) neurons. This study represents a computational analysis of secondary transcriptomic data aimed at nominating candidate genes for future experimental validation. Gene Ontology enrichment revealed both shared and condition-specific biological processes, with KD uniquely affecting neurodevelopmental and stress-response pathways, and OE perturbing extracellular matrix, calcium signaling, and neuroinflammatory processes. To prioritize robust and disease-relevant targets, we applied Cross-MAS and further filtered DEGs by correlation with MeCP2 expression and regulation directional consistency. This yielded 16 high-confidence dosage-sensitive genes that were capable of classifying WT, KD, and OE samples with 100% accuracy using PCA and logistic regression. Among these, RTT-associated candidates such as Plcb1, Gpr161, Mknk2, Rgcc, and Abhd6 were linked to disrupted synaptic signaling and neurogenesis, while ASD-associated genes, including Aim2, Mcm6, Pcdhb9, and Cbs, implicated neuroinflammation and metabolic stress. These findings establish a compact and mechanistically informative set of MeCP2-responsive genes, which enhance our understanding of transcriptional dysregulation in RTT and ASD and nominate molecular markers for future functional validation and therapeutic exploration. Full article

Background/Objectives: Although vaccinations are a priority for patients with cancer, achieving high coverage remains challenging. Evidence on effective strategies in oncology settings is still limited. This systematic review aimed to identify interventions to improve vaccination uptake or reduce hesitancy among cancer patients. Methods: A systematic search was conducted in PubMed, Embase, and Scopus, including studies published up to the end of 2023. The protocol was registered in PROSPERO (CRD42024511008). Results: Out of 10,927 non-duplicate records, 15 studies describing unique interventions were included. All studies were published between 2011 and 2022, primarily conducted in Europe/UK (40%) and in North America (40%). The most common study design was pre-post (60%), and 33.3% included a control group. Most interventions were multi-component (60%) and were classified into three main categories: educational materials/campaigns (46.7%), reminders (40%), and patient counselling (33.3%). Additional components included guideline development in two studies. Some studies also highlighted the importance of specific key figures, such as dedicated professionals, general practitioners, and pharmacists. Interventions mainly targeted patients (40%), with 33.3% addressing both healthcare professionals and patients and 26.7% professionals only. They most frequently concerned vaccinations against influenza and pneumococcal disease (26.7%), pneumococcal disease alone (26.7%), or Coronavirus Disease 2019 (COVID-19) (26.7%). Vaccination uptake was the primary outcome in 86.7% of studies, with 66.7% reporting significant improvements. Conclusions: This review identified a variety of strategies, with education, reminders, and counselling as key components. Multicomponent interventions and those involving both patients and providers were most promising. However, methodological limitations and limited generalizability highlighted the need for more rigorous research. Full article

Background: The depressed population needs to be treated and they do not have access to evidenced-based psychological practices (EBPPs). The consequences lead to significant daily impairments and huge economical costs. A large amount of research has focused on the demand for a more extensive use of EBPPs. However, despite these practices being essential to the mental health system, EBPPs are poorly applied in clinical settings. This situation has led to the development of Implementation Research (IR), a scientific field that aims to address the challenge of translation and identify the factors involved in the implementation process. Several implementation studies have been carried out in the field of health. However, the evidence from implementation studies of psychological treatments addressing depression has not yet been summarized. The aim of this study is to conduct a systematic review to assess implementation studies that use EBPPs to address depression. Methods: A systematic review was conducted following the PRISMA guidelines, including implementation studies that applied EBPPs to address depressive disorders. The following databases were used: PubMed, Embase, APA PsycInfo, Cochrane Central, Scopus, and Web of Science. Two independent reviewers revised the studies to determine whether the eligibility criteria were met. Results: A total of 8797 studies were identified through database searches. After removing duplicates, a total of 3757 studies were screened based on titles and abstracts. Finally, 127 full-text articles were reviewed, yielding 31 studies that satisfied the inclusion criteria. Conclusions: This review offers valuable insights into the current state of IR in the implementation of EBPPs for treating depressive disorders. It underlines the necessity for a standardized nomenclature for study designs within the realm of IR and emphasizes the potential of hybrid efficacy–implementation studies to help close the gap between research and clinical practice. Despite the challenges encountered, this review points to a positive outlook for the use of IR in clinical psychology. A gradual adoption of IR is likely to strengthen its role in psychology and support the development of more effective strategies for implementing evidence-based interventions in clinical settings. Full article

Exposure to light is an important factor in regulating sleep and sleep quality, especially for elderly people with a high risk of sleep problems. A systematic literature review was conducted to explore the current understanding of the relationship between light and sleep quality of the elderly, and to identify methodological gaps and soundness of existing studies to inform the design of future experimental studies. Specific focus is given to healthcare centres and similar settings due to their controlled environment and the high prevalence of sleep disturbances. Out of 406 publications screened from four databases—namely Google Scholar, Semantic Scholar, Lens.Org, and Scopus—380 studies remained after removing duplicates, and 19 studies published after 2002 that were relevant to the review topic were selected based on the PRISMA 2020 guidelines. The selected studies were analysed using six key aspects, which reflect typical components of experimental design such as participants’ characteristics, experiment and exposure duration, mode of light exposure, lighting and light interventions, experiment procedure, and data collection methods. The results indicated that many studies have limitations in terms of the accuracy and generalisability of findings in representing the entire elderly population due to issues with experimental design or control of the participants’ attendance. The results suggest that future studies should increase the duration of light intervention to around 21–35 days and the number of participants to around 14 and 47. The issues identified from the experimental designs of the selected studies provide valuable insights for establishing guidelines and recommendations for future studies. Full article

Background: Mesenteric cystic lymphatic malformations (MCLMs) are rare benign lymphatic malformations predominantly diagnosed in children. Adult cases are exceptional and typically discovered incidentally during imaging or surgery for unrelated conditions. Their intraoperative identification, particularly in emergency settings, poses diagnostic and surgical challenges due to anatomical complexity and potential vascular involvement. Methods: A literature review was performed in PubMed and Scopus to contextualize this case, focusing on intraoperative management strategies, recurrence risk, and surgical decision-making in mesenteric lymphatic malformations. Case reports, case series, and reviews in English with relevant clinical and surgical data were included, while duplicates, non-English publications, abstracts without full text, and studies lacking essential information were excluded. Case Presentation: We report a 45-year-old male who presented with acute right lower quadrant pain, clinically and radiologically consistent with acute appendicitis. Contrast-enhanced CT incidentally identified a mesenteric cystic lesion near the terminal ileum. Intraoperative findings confirmed phlegmonous appendicitis coexisting with a large MCLM, requiring segmental enterectomy and appendectomy. Histopathology confirmed the diagnosis of MCLMs. Conclusions: This case highlights the rare coexistence of acute appendicitis and mesenteric lymphatic malformations in an adult, illustrating the surgical challenges of unexpected lymphatic lesions in emergency settings. Emphasizing real-time intraoperative decision-making, we propose an anatomy-driven algorithm that balances complete excision with safer, conservative options based on lesion features, surgical risk, and multidisciplinary input. Full article

Background: Dissection around the superior mesenteric artery (SMA) is a key step for local clearance of periampullary cancers in pancreaticoduodenectomy (PD). Since the 2000s, SMA-first approaches have gained popularity in open surgery to allow early vascular control and resectability assessment. With the rise of robotic pancreaticoduodenectomy (RPD), various SMA dissection techniques have been adapted to the robotic setting. Objective: To map current evidence on SMA dissection techniques in RPD and summarize technical variations. Eligibility Criteria and Sources of Evidence: A PubMed search identified 116 records. After title and abstract screening and full-text review, 27 studies focusing on SMA dissection for periampullary tumors in RPD with sufficient technical detail were included. Studies on open/laparoscopic PD, lacking technical description, or reporting duplicate techniques were excluded. Charting Methods: Data were charted based on the SMA approach type, surgical details, and institution. Results: Among the 27 included studies, multiple approaches were identified—anterior, right posterior, left posterior, uncinate, and mesenteric—each adapted to the robotic platform. Techniques varied in exposure, lymphadenectomy, and vessel control. Conclusions: This scoping review reveals diverse SMA dissection strategies in RPD. While technical innovation is progressing, further studies are warranted to standardize approaches and assess their oncologic and surgical outcomes. Full article

Background: The U.S. Medicare Annual Wellness Visit (AWV) offers a structured opportunity for cognitive screening and personalized prevention planning among older adults. Yet, implementation of AWVs, particularly for individuals with cognitive impairment, remains inconsistent across primary care or other diverse care settings. Methods: We conducted a scoping review using the Consolidated Framework for Implementation Research (CFIR) to explore multilevel factors influencing the implementation of the Medicare AWV’s cognitive screening component, with a focus on how these processes support the detection and management of cognitive impairment among older adults. We searched four databases and screened peer-reviewed studies published between 2011 and March 2025. Searches were conducted in Ovid MEDLINE, PubMed, EBSCOhost, and CINAHL databases. The initial search was completed on 3 January 2024 and updated monthly through 30 March 2025. All retrieved citations were imported into EndNote 21, where duplicates were removed. We screened titles and abstracts for relevance using the predefined inclusion criteria. Full-text articles were then reviewed and scored as either relevant (1) or not relevant (0). Discrepancies were resolved through consensus discussions. To assess the methodological quality of the included studies, we used the Joanna Briggs Institute critical appraisal tools appropriate to each study design. These tools evaluate rigor, trustworthiness, relevance, and risk of bias. We extracted the following data from each included study: Author(s), year, title, and journal; Study type and design; Data collection methods and setting; Sample size and population characteristics; Outcome measures; Intervention details (AWV delivery context); and Reported facilitators, barriers, and outcomes related to AWV implementation. The first two authors independently coded and synthesized all relevant data using a table created in Microsoft Excel. The CFIR guided our data analysis, thematizing our findings into facilitators and barriers across its five domains, viz: (1) Intervention Characteristics, (2) Outer Setting, (3) Inner Setting, (4) Characteristics of Individuals, and (5) Implementation Process. Results: Among 19 included studies, most used quantitative designs and secondary data. Our CFIR-based synthesis revealed that AWV implementation is shaped by interdependent factors across five domains. Key facilitators included AWV adaptability, Electronic Health Record (EHR) integration, team-based workflows, policy alignment (e.g., Accountable Care Organization participation), and provider confidence. Barriers included vague Centers for Medicare and Medicaid Services (CMS) guidance, limited reimbursement, staffing shortages, workflow misalignment, and provider discomfort with cognitive screening. Implementation strategies were often poorly defined or inconsistently applied. Conclusions: Effective AWV delivery for older adults with cognitive impairment requires more than sound policy and intervention design; it demands organizational readiness, structured implementation, and engaged providers. Tailored training, leadership support, and integrated infrastructure are essential. These insights are relevant not only for U.S. Medicare but also for global efforts to integrate dementia-sensitive care into primary health systems. Our study has a few limitations that should be acknowledged. First, our scoping review synthesized findings predominantly from quantitative studies, with only two mixed-method studies and no studies using strictly qualitative methodologies. Second, few studies disaggregated findings by race, ethnicity, or geography, reducing our ability to assess equity-related outcomes. Moreover, few studies provided sufficient detail on the specific cognitive screening instruments used or on the scope and delivery of educational materials for patients and caregivers, limiting generalizability and implementation insights. Third, grey literature and non-peer-reviewed sources were not included. Fourth, although CFIR provided a comprehensive analytic structure, some studies did not explicitly fit in with our implementation frameworks, which required subjective mapping of findings to CFIR domains and may have introduced classification bias. Additionally, although our review did not quantitatively stratify findings by year, we observed that studies from more recent years were more likely to emphasize implementation facilitators (e.g., use of templates, workflow integration), whereas earlier studies often highlighted systemic barriers such as time constraints and provider unfamiliarity with AWV components. Finally, while our review focused specifically on AWV implementation in the United States, we recognize the value of comparative analysis with international contexts. This work was supported by a grant from the National Institute on Aging, National Institutes of Health (Grant No. 1R01AG083102-01; PIs: Tzeng, Kuo, & Raji). Full article