Risultati per: Infezione da Helicobacter pylori: review

Objective
We assessed whether Penthrox (methoxyflurane) can provide better pain relief for elective, outpatient interventional procedures compared with other methods of pain control.

Design
Systematic review.

Data sources
Cochrane Central Register of Controlled Trial, MEDLINE, Emcare, Embase, ClinicalTrials.gov and the Cumulative Index to Nursing and Allied Health Literature were searched from inception to 6 November 2023.

Eligibility criteria
All published studies including randomised controlled trials (RCTs), cohort studies and case–control studies investigating Penthrox for pain relief, during and/or after an interventional procedure, were included.

Data extraction and synthesis
Two independent reviewers identified eligible studies and retrieved data. Risk of bias was assessed using Cochrane Collaboration Risk of Bias V.2.0 and Risk of Bias in Non-randomised Studies of Interventions (ROBINS I) tools. A meta-analysis was not possible due to heterogeneity.

Results
The literature search yielded 1189 records. 12 studies were eligible for inclusion: 5 RCTs and seven non-randomised studies of interventions (NRSIs). Penthrox was used for a range of procedures across five medical specialities: gastroenterology, gynaecology, haematology, orthopaedics and urology. Two RCTs showed a significant reduction in intraprocedural pain when Penthrox was compared with placebo. However, three RCTs where Penthrox was compared with either placebo or intravenous sedation showed no significant differences in pain or comfort level. Similarly, the NRSIs showed variable results. Most patients were satisfied (63% to >98%; seven studies) with Penthrox, and seven out of eight studies reported that the majority of participants would use it again (46.8%–95%; eight studies). No serious adverse events were reported.

Conclusion
Penthrox (methoxyflurane) shows promise as an analgesic for invasive, elective interventional procedures in the outpatient setting, although the relative benefits appear to vary depending on intervention and comparator pain control measures. There is a pressing need for robustly conducted, large, generalisable multicentre RCTs to evaluate the effectiveness of Penthrox.

PROSPERO registration number
CRD42023404574.

L’organismo viene colpito da più agenti. Effetti delle cure dopo qualche giorno

Andreoni, ‘sovrainfezioni da più batteri a causa del prolungarsi del suo stato’

Introduction
Urinary incontinence (UI) is a common condition among older adults with adverse consequences to health and well-being. Shame, stigma and cultural perspectives can prevent treatment-seeking behaviour. Although there is an abundance of studies in the health research literature that explore the physiological basis of UI, there is limited evidence on the role culture plays in shaping knowledge of, attitudes to and beliefs about UI. This review aims to answer what is known about the role of culture in shaping the attitudes and beliefs on UI to identify gaps in the literature and direct future research.

Methods and analysis
The Joanna Briggs Institute method for scoping reviews will be used to conduct the review, in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The MEDLINE, Embase, PsycINFO, Cumulated Index in Nursing and Allied Health Literature, EBSCOhost, Scopus databases and WHO Index Medicus databases will be searched, without any restriction on language and publication date, enhancing the comprehensiveness and inclusivity of the review. A preliminary search of MEDLINE was conducted (09 February 2024) to identify articles. The screening and analysis of the search results from the databases will be managed using Covidence software. Two authors will screen articles, with a third involved as needed to resolve any differences. Findings will be organised using tables and key themes will be identified.

Ethics and dissemination
Formal ethics approval is not required for this review as it does not involve any human or animal participants. Findings will be disseminated in a high-impact peer-reviewed journal with a focus on open-access publication at conferences and used to inform studies on the development of culturally sensitive management programmes for UI with the full involvement of patients.

Trial registration
Open Science Framework https://osf.io/3d97f

Introduction
Cancer and its treatments can lead to a wide range of side-effects that can persist long after treatments have ended. Across Europe, survivorship care is traditionally hospital-based specialist-led follow-up, leading to gaps in supportive care. Improved screening, diagnosis and treatment increase survival rates. With more individuals living with, through and beyond cancer, the predominance of the hospital-based specialist model is unsustainable, costly and resource-intensive. An understanding of what alternative Models of Care are available and the barriers and facilitators to their implementation is a first step towards enhancing supportive care across the cancer journey. The aim of this scoping review is to source and synthesise information from studies evaluating patient-oriented models of cancer survivorship supportive care for adults in Europe.

Methods and analysis
The scoping review will be reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses—Scoping Review Extension guidelines and will be guided by a six-stage methodological framework. A search strategy has been developed according to the Population, Concept and Context structure and will be applied to seven databases. A targeted search of grey literature will be completed. All identified records will be screened using predefined eligibility criteria by at least two researchers and undergo full-text review for inclusion. Data pertaining to the conceptualisation, evaluation and implementation of sourced Models of Care will be extracted.

Ethics and dissemination
As there is no primary data, ethical approval is not required. This review will be conducted as part of the EU COST Action CA21152—Implementation Network Europe for Cancer Survivorship Care. The protocol and subsequent scoping review will be published in a peer-reviewed journal. The Action involves representatives from most countries across Europe which will assist with the dissemination of the work to key stakeholders.

Objectives
Sepsis-associated hypotension or shock is a critical stage of sepsis, and a current clinical emergency that has high mortality and multiple complications. A new restrictive fluid resuscitation therapy has been applied, and its influence on patients’ renal function remains unclear. The purpose of this study is to evaluate the influence of restrictive fluid resuscitation on incidence of severe acute kidney injury (AKI) in adult patients with sepsis hypotension and shock compared with usual care.

Design
Systematic review and meta-analysis using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach.

Data sources
PubMed, Embase, Web of Science and Cochrane Library were searched through 1 November 2024.

Eligibility criteria
We included randomised controlled trials that compared restrictive fluid resuscitation with liberal fluid therapy on patients with sepsis-associated hypotension and shock, to find out their effect on the incidence of severe AKI. Severe AKI was defined as the AKI network score 2–3 or Kidney Disease Improving Global Outcomes stages 2 and 3.

Data extraction and synthesis
Two independent reviewers used standardised methods to search, screen and code included trials. Risk of bias was assessed using the Cochrane Systematic Review Handbook for randomised clinical trials. Meta-analysis was conducted using random effects models. Sensitivity and subgroup analyses, trial sequential analysis (TSA), Egger’s test and the trim-and-fill method were performed. Findings were summarised in GRADE evidence profiles and synthesised qualitatively.

Results
Nine trials (3718 participants) were included in this research and the analysis was conducted in random effects model. There was a significant difference in the incidence of severe AKI (risk ratio 0.87, 95% CI 0.79 to 0.96, p=0.006; I2=0%) and the duration of mechanical ventilation (mean difference –41.14, 95% CI –68.80 to –13.48; p=0.004; I2=74%) between patients receiving restrictive fluid resuscitation and patients receiving liberal fluid resuscitation. TSA showed that the cumulative amount of participants met the required information size, the positive conclusion had been confirmed. The GRADE assessment results demonstrated moderate confidence in the incidence of severe AKI, as well as the results of all second outcomes except the Intensive Care Unit length of stay (ICU LOS), which received limited confidence. The result of incidence of worse AKI was rated as of high certainty.

Conclusions
It is conclusive that fluid restriction strategy is superior to usual care when it comes to reducing the incidence of severe AKI in sepsis-associated hypotension and shock. Shorter duration of ventilation is concerned with fluid restriction as well, but the heterogeneity is substantial. GRADE assessments confirmed moderate and above certainty. Traditional fluid resuscitation therapy has the potential to be further explored for improvements to be more precise and appropriate for a better prognosis.

PROSPERO registration number
CRD42023449239.

Kruisbrink M, Robertson W, Ji C, et al. Association of sleep duration and quality with blood lipids: a systematic review and meta-analysis of prospective studies. BMJ Open 2017;7:e018585. doi: 10.1136/bmjopen-2017-018585 This article was previously published with an error. The conclusions of the article are not affected. The article was adjusted on the following points: Table 1 contained a few small inaccuracies regarding the study of Meneton et al. These have been corrected. A few typographical errors were adjusted and the following piece of text has been removed: “Only Haaramo et al34 reported significant associations…those without insomnia symptoms.” The studies by Kuula et al and Byrne et al have been removed from the tables, figures and text. Kuula et al assessed lipids at one point in time only and Byrne concerned a cohort of an intervention programme, thereby not meeting the inclusion criteria. They were not included…

Objectives
To examine the authorship and content of systematic reviews (SRs) of biases experienced by medical professionals through a gender lens.

Design
Review of SRs.

Data sources
We searched PubMed, Embase, PsycINFO and CINAHL from inception. Searches were conducted in May 2022 and updated in October 2023.

Eligibility criteria
Reviews of studies reporting biases experienced by hospital physicians at any stage of their careers and in any country. Reviews were included if they used systematic methods to search the literature and synthesise the data. Non-English language publications were excluded.

Data extraction and synthesis
The main theme of each eligible review was identified through qualitative thematic analysis. We used NamSor to determine the first/last authors’ gender and computed the proportion of female authors for each review theme.

Results
56 articles were included in the review. These covered 12 themes related to gender, race and ethnicity bias experienced by physicians at any stage of their careers. The overall proportion of female authors was 70% for first authors and 51% for last authors. However, the gender of authors by theme varied widely. Female authors dominated reviews of research on discrimination and motherhood, while male authors dominated reviews on burnout, mental health and earnings. Only six reviews were identified that included race and ethnicity; 9 out of the 12 first and last authors were female.

Conclusions
Understanding the potential for a gendered evidence base on biases experienced by hospital physicians is important. Our findings highlight apparent differences in the issues being prioritised internationally by male and female authors, and a lack of evidence on interventions to tackle biases. Going forward, a more collaborative and comprehensive framework is required to develop an evidence base that is fit for purpose. By providing a point of reference, the present study can help this future development.

PROSPERO registration number
CRD42021259409; Pre-results.

Women who underwent child marriage are vulnerable to and disproportionally affected by IPV, emphasising the need for international efforts on targeted IPV interventions and ending child marriage globally to prevent more victims.

Despite common approaches to defining SMM, there are opportunities to improve comparability. No two definitions for use with administrative data in different settings involved a similar incidence and set of components and involved a similar distribution of components among cases. Harmonization of the purpose, constituent codes, and sources of data would facilitate comparisons between maternity systems.

Introduction
Nonagenarians and centenarians, compared with other age groups, often exhibit distinct physiological characteristics and a higher prevalence of comorbidities, thus further complicating their care in intensive care unit (ICU) settings. Despite the increasing number of such patients being admitted to ICUs, comprehensive research and studies on their characteristics, outcomes and complications during their ICU stays remain lacking. This scoping review will comprehensively address the following question: What are the characteristics, outcomes, complications and mortality rates among nonagenarians and centenarians admitted to ICUs, including their preadmission health status, reasons for admission, duration of hospital/ICU stays, and factors associated with adverse outcomes? The key objectives are to map the breadth and depth of the available evidence and identify key concepts, gaps and variations in research focus. Finally, we aim to highlight well-studied areas suitable for systematic synthesis, point to underexplored topics warranting further investigation and propose standardised approaches to research design and reporting in this domain.

Methods and analysis
We will conduct a systematic search of MEDLINE, Embase and the Cochrane Library in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. All studies and publications reporting data on patients aged ≥90 years will be included, from an unlimited timeline to 31 August 2024. Studies reporting the characteristics, outcomes and complications of nonagenarians and centenarians admitted to ICUs will be included. The data will be analysed and summarised descriptively through a narrative approach. Qualitative data related to quality-of-life outcomes will be analysed thematically, as applicable.

Ethics and dissemination
Ethics approval was not required. The findings will be disseminated through professional networks, conference presentations and publications in scientific journals.

Even after successful tuberculosis treatment, children and adolescents can experience respiratory impairments and disability that may reduce their quality of life, ability to participate in activities, and growth potential. The epidemiology and clinical manifestations of these impairments vary by age, reflecting distinct biological and behavioural differences. Future research should prioritize these younger populations to ensure their unique needs and challenges are adequately represented.

Weight gain in outpatient programmes was markedly slower than in inpatient treatment. Clearer reporting of weight gain and a better understanding of the sequelae of faster/slower recovery is important to set future weight gain targets. Our results set an important baseline for current programmes to benchmark against.

This CPG provides the first evidence-based recommendations on use of food restrictions to prevent infections in children and adolescents undergoing chemotherapy and paediatric haematopoietic cell transplant recipients.

Introduction
Stand-alone HIV clinics in sub-Saharan Africa (SSA) have effectively expanded antiretroviral therapy since the 2000s, transforming HIV from a deadly infection into a chronic condition. However, over the past decade, there has been a significant rise in the prevalence of non-communicable diseases (NCDs) globally and in SSA. People living with HIV are at higher risk for some NCDs, including hypertension, diabetes and different cancers. The region’s current healthcare infrastructure is not equipped to address this growing burden. Integrating health services for HIV and NCDs (ie, combining services for HIV with services for hypertension, diabetes, depression and mental health, substance use disorder or cancer) could be one strategy for responding to these challenges. In this scoping review, we aim to identify randomised controlled trials on HIV-NCD integration, assess implemented integration models and measured outcomes and highlight evidence gaps.

Methods and analysis
This scoping review will follow the Arksey and O’Malley (2005) methodological framework. Reporting will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. We will conduct a systematic search of the databases OVID Medline, Embase, Web of Science, Global, Africa Index Medicus, including terms related to HIV, NCDs and healthcare integration. Included trials must have been conducted within SSA and have been published in English or French after 1 January 2010. We will not select based on sample size or number of clusters. Both the title and abstract screening and full-text screening will be done in Covidence by at least two reviewers working independently. Data extraction will focus on key variables, including study design, geographical location, integration intervention, measured outcomes and reported findings.

Ethics and dissemination
This scoping review aims to generate new insights from publicly available research. Therefore, ethical approval is not required. Study findings will be shared through discussion with policymakers, implementation science researchers and healthcare providers. The results of this study are intended to be published in a peer-reviewed journal.

Trial registration
This protocol has been registered with Center for Open Science OSF Registry (DOI: 10.17605/OSF.IO/RGQSN). The search was conducted on 25 March 2024 and updated on 21 October 2024. The review is expected to be completed by March 2025.

Introduction
Breastfeeding is the biological norm for infant nutrition. In certain scenarios, feeding at the breast is not possible, because of either maternal or neonatal reasons. In those cases, infants can still receive expressed mother’s own milk (MOM) and its beneficial properties. Mothers can express their milk using a variety of methods, while applying different hygiene practices, in different settings; moreover, expressed milk might receive processing before it is fed to the infant, particularly to reduce transmission of viruses such as cytomegalovirus to premature infants. The present protocol was designed to gather the evidence on the effect that the expression method, the hygiene regimen and setting and any processing used on expressed MOM can have on the clinical outcomes of recipient infants.

Methods
This systematic review will follow the methodological recommendations of the Cochrane Collaboration, in accordance with WHO recommendations and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We will apply a hybrid search strategy, by combining structured database search with predefined snowballing searches. We will include primary research studies only, without restrictions on the type and including observational studies; no publication time, setting or language restriction will be applied, provided the abstract is available in English. Studies evaluating different methods of MOM expression, hygiene practices or settings during expression, processing of MOM and reporting clinical outcomes on recipient infants will be eligible. The searches have been planned to be performed in April–May 2024. Two reviewers will independently perform the reference screening, data extraction and risk of bias analysis of eligible studies, by using standardised tools specific for each study design. Quantitative and thematic narrative data synthesis will be performed and statistical heterogeneity between studies tested. Meta-analyses of extracted data will be performed where applicable. For relevant outcomes, certainty of the evidence will be tested by using the Grading of Recommendations Assessment, Development and Evaluation approach.

Ethics and dissemination
Ethical approval is not required for this study since no original data will be collected. There is patient and public involvement throughout this research process. The results of this review will be disseminated through publication in a peer-reviewed journal and through conference presentations. Moreover, this systematic review will inform recommendations on milk banking of the WHO Department of Nutrition and Food Safety.

PROSPERO registration number
CRD42024523299.