Risultati per: Progressi nel trattamento della psoriasi: review

Objectives
To evaluate whether postpartum haemorrhage (PPH) can be predicted using both machine learning (ML) and traditional statistical models.

Design
Diagnostic systematic review and meta-analysis of observational and clinical studies, prospectively registered on PROSPERO, performed accordingly to the Preferred Reporting Items for Systematic Reviews and Meta-analysis and Prediction model risk of bias assessment tool for studies developing, validating or updating prediction models, with the use of an independent analysis by a large language model (GPT-4 Open AI).

Data sources
MEDLINE/PubMed, LILACS-BVS, Cochrane Library, Scopus-Elsevier, Embase-Elsevier and Web of Science.

Eligibility criteria for selected studies
The literature search was conducted on 4 January 2024 and included observational studies and clinical trials published in the past 10 years that assessed early PPH and PPH prediction and that applied accuracy metrics for outcomes evaluation. We excluded studies that did not define PPH or had exclusive PPH subgroups evaluation.

Primary and secondary outcome measures
The primary outcome is the accuracy of PPH prediction using both ML and conventional statistical models. A secondary outcome is to describe the strongest risk factors of PPH identified by ML and traditional statistical models.

Results
Of 551 citations screened, 35 studies were eligible for inclusion. The synthesis gathered 383 648 patients in 24 studies conducted with conventional statistics (CS), 9 studies using ML models and 2 studies using both methods. Multivariate regression was a preferred modelling approach to predict PPH in CS studies, while ML approaches used multiple models and a myriad of features. ML comparison to CS was only performed in two studies, and ML models demonstrated a 95% higher likelihood of PPH prediction compared with CS when applied to the same dataset (OR 1.95, 95% CI 1.88 to 2.01, p

Objective
The objective of this study is to perform a comprehensive systematic review and meta-analysis of the accuracy of signs, symptoms and case definitions for the diagnosis of influenza.

Design
Systematic review and meta-analysis of diagnostic accuracy.

Setting
Inpatient or outpatient setting.

Participants
Three databases (PubMed, CINAHL and EMBASE) were searched through February 2024 for studies of clinical diagnosis of influenza using prospective data collection and a high-quality reference standard. Data were abstracted by researchers working in parallel and resolving discrepancies by discussion.

Primary and secondary outcome measures
Quality was assessed using QUADAS-2. Summary estimates (or ranges) of sensitivity and specificity, likelihood ratio (LR), the Youden Index and the area under the receiver operating characteristic curve were calculated.

Results
The final meta-analysis included 67 studies, each with between 119 and 155 866 participants. Most were judged to be low risk of bias. The signs and symptoms with the highest overall accuracy for all studies based on the Youden Index were any fever (0.32), overall clinical impression (0.28), coryza (0.25), cough and fever (0.25), and measured fever (0.25). Accuracy varied widely by age group. Only the overall clinical impression had a positive LR greater than 2.0. Cough was the most sensitive finding (0.92) with a negative LR of 0.28 in adults. The absence of any fever also had a low negative LR (0.30). The Centers for Disease Control and Prevention (CDC) definition of influenza-like illness (ILI) had good specificity but poor sensitivity in adults, while in infants, it had good sensitivity but widely varying specificity. The European CDC and WHO case definitions for ILI had modest sensitivity and specificity.

Conclusions
Individual signs and symptoms, their combinations, and ILI case definitions have very limited accuracy for identifying persons with influenza. More accurate surveillance and diagnosis will require the development and validation of accurate risk scores or greater use of point-of-care testing.

Introduction
Globally, osteoarthritis (OA) is the most prevalent musculoskeletal disease, affecting approximately 600 million people. It is characterised by progressive degeneration of the articular cartilage, osteophyte formation and asymmetric joint space narrowing, leading to pain, stiffness and functional impairment. The current focus of disease management is on symptom relief and functional improvement. However, these interventions frequently do not provide adequate outcomes. This may be attributed to a lack of consideration for contextual factors, including the presence of comorbidities such as depression. Several studies indicate that depression is highly prevalent, affecting up to 20% of patients with OA. As depression is known to be a multifactorial disorder, there are various risk factors that may increase the likelihood of comorbid depression in patients with OA. Consequently, the scoping review’s objective is to map the existing literature on risk factors for comorbid depression in individuals with OA. Furthermore, the review is expected to provide important information for further in-depth investigation and the development of predictive tools to support the early identification of patients with OA at risk of comorbid depression.

Methods and analysis
The intended review will target studies reporting risk factors for comorbid depression in individuals with OA. All available primary and grey literature will be considered for inclusion. Only articles published in English or German will be included in the review. The review will follow the format specified by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews and the Joanna Briggs Institute Manual for Evidence Synthesis. Original research in published and unpublished literature from inception until August 2024 will be included in the review. The databases to be searched will include PubMed, EMBASE, PsycInfo and Web of Science. In addition, further literature will be identified by searching the reference lists of the included studies. Three reviewers will independently screen the identified studies for final inclusion. The data will be extracted and presented in tabular form and in a narrative summary that aligns with the review’s objective. Furthermore, a quality assessment of the included studies will be conducted using appropriate tools, and the results will be incorporated into the synthesis. Any disagreements that arise between the reviewers will be resolved through discussion or with an additional reviewer.

Ethics and dissemination
Ethics committee approval will not be required because only published and publicly available data will be examined to answer the research question of the scoping review. We will not collect any personal information or any information that requires ethical approval. Following the conclusion of the review, the information will be disseminated to clinicians, health administrators and researchers via publications in peer-reviewed journals and conference presentations.

Objective
We aimed to synthesise existing literature on the health literacy of primary caregivers (PCGs) of children with cerebral palsy (CP) in low- and middle-income countries (LMICs).

Design
Systematic review informed by Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data sources
Ovid MEDLINE, Ovid EMBASE, CINAHL via EBSCO, Scopus and Web of Science were searched from inception to January 2024.

Eligibility criteria
Original studies including observational or experimental data, examining health literacy and/or health literacy proxies using Optimising Health Literacy and Access domains as indicators (eg, education, social support, self-efficacy, health attitudes, reading and writing skills) in primary caregivers of children with CP in LMICs.

Data extraction and synthesis
Data from included studies were systematically recorded using an Excel template, with information extracted independently by two reviewers. We used the Study Quality Assessment Tool developed by the National Health, Lung, and Blood Institute.

Results
The systematic review yielded 2734 articles, with 15 eligible for inclusion. None used health literacy (HL) measurement tools, and there was limited reporting on specific HL domains. Studies spanned 11 LMICs across 5 major regions. PCGs, predominantly mothers, exhibited varying levels of service awareness, service utilisation and social support. Literacy levels significantly impacted HL proficiency, exposing a notable research gap in LMICs.

Conclusions
This study presents the first comprehensive analysis of health literacy among PCGs of children with CP in LMICs. Findings reveal a striking absence of tailored health literacy literature, impacting current considerations of PCGs’ understanding and management of their child’s condition. Additionally, challenges in social support, healthcare navigation and low literacy levels further hinder effective caregiving in LMICs.

Introduction
Cerebral palsy (CP) is a paediatric disorder with permanent impairment of movement and posture with a prevalence of about 2.11 in 1000 births in the world. Given the therapeutic effect of hand-arm bimanual intensive therapy including lower extremities (HABIT-ILE) in children with CP, a systematic review of the available literature on this topic is warranted. The objective of this study is to systematically review the effectiveness of HABIT-ILE on upper extremity, lower extremity and trunk outcomes within the domains of body functions and structures, activity and participation of the International Classification of Functioning, Disability and Health in children with CP.

Methods and analysis
This study will be conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches will be conducted in six databases: MEDLINE, PubMed, Cochrane Library, Scopus, OT seeker and Web of Science for available published literature. The grey literature sources will include WorldCat, National Technical Information Service, Agency for Healthcare Research and Quality, Open Grey, WHO and OpenDOAR. Manual searches of citations of included papers will be performed to collect all experimental studies of HABIT-ILE in children with CP. The level of evidence for included articles will be classified according to the level of evidence in the guidelines for systematic reviews on the American Occupational Therapy Association website. Based on the study design of the included articles, the risk of bias will be assessed using the revised Cochrane risk-of-bias tool, the Cochrane Risk Of Bias In Non-randomised Studies – of Interventions tool and the quality assessment tool recommended by the American Occupational Therapy Association. In order to synthesise the data, narrative synthesis will be used, along with meta-analysis, if available.

Ethics and dissemination
As this study only reviewed previously published articles, ethical approval was not required. The findings will be published in a peer-reviewed scientific journal.

PROSPERO registration number
CRD42024518179.

Introduction
The Central Chronic Medicines Dispensing and Distribution (CCMDD) programme, a differentiated alternative service delivery programme, initiated by the Department of Health, South Africa, allows clinically stable patients to receive chronic medication refills at the clinic-based or community-based pick-up points, offering stable patients suffering from non-communicable diseases an easy way to collect their medication. This facilitates the achievement of positive therapeutic outcomes and underscores the importance of this programme, which has resulted in decreased stigma concerns and optimising the workload for public health facilities and health workers. Therefore, this scoping review aims to explore and describe how the improved CCMDD programme has widened access to medications in South Africa in readiness for the implementation of the National Health Insurance.

Methods and analysis
This scoping review will be conducted using the Arksey and O’Malley framework and further refined by the Levac framework. The review will follow a six-step approach: (1) identifying the research question, (2) identifying relevant studies, (3) studying selection eligibility, (4) charting the data, (5) collating, summarising and reporting the results and (6) consultation. A comprehensive search strategy will be developed by searching studies published between 2014 and 2024 using the following electronic databases; PubMed, Web of Science and Google Scholar. Grey literature including conference abstracts and reports will also be searched. The Preferred Reporting Items for Systematic Reviews and the Meta-Analysis for Scoping Reviews (PRISMA-ScR) will be used as a guide for this scoping review protocol. Two independent reviewers will screen identified studies’ titles, abstracts and full texts. Discrepancies will be handled by consensus or consulting a third reviewer author. Data extraction will be conducted using a standardised form. The selection of studies for the review is anticipated to be completed within 10 weeks, from 15 March to 30 May 2025, with strict adherence to the guidelines of the PRISMA-ScR checklist.

Ethics and dissemination
This review, not requiring ethical approval, will inform policymakers, researchers and healthcare professionals to improve the deliverables of the CCMDD programme for all chronic conditions and ailments with a high prevalence in South Africa and identify any research gaps. We plan to disseminate our findings via a peer-reviewed journal, policy briefs, conference presentations and stakeholder engagement.

Introduction
Self-harm behaviour is commonly observed in adolescents and can serve as a potential warning sign for suicide. It is prevalent among adolescents in sub-Saharan Africa, with a median lifetime prevalence of 10.3%. The negative impacts of adolescent self-harm include poor educational performance, impaired physical functioning and unemployment. Despite its significance, there is limited knowledge and intervention programmes addressing self-harm in sub-Saharan Africa.

Objective
The proposed scoping review aims to identify and analyse the current literature on the types and factors associated with self-harm among adolescents in sub-Saharan Africa. The findings will guide future systematic reviews and qualitative and quantitative studies that will help address the knowledge gap. Findings from this study will also inform strategies to address this critical issue.

Methods
This scoping review will follow the Joanna Briggs Institute methodology. Studies on self-harm among adolescents between ages 10 and 19 years in any sub-Saharan African country done between 2000 and 2024 will be included. The literature search will be conducted across the following databases: Embase (Ovid), Medline (Ovid), PsycINFO (Ovid), PubMed, African Journals Online and African Index Medicus (WHO). Additional relevant articles will be searched in grey literature databases such as Google Scholar, conference proceedings, PhD theses and dissertations. Two reviewers will conduct title and abstract screening as well as full-text screening, with any conflicts resolved by a third independent reviewer.

Ethics and Dissemination
Ethics approval is not required for this scoping review protocol. The review process and findings will be shared with and informed by relevant knowledge users. The findings of this review will be shared globally through an open-access peer-reviewed publication and conference presentations. The results will provide new insights for future systematic reviews and both quantitative and qualitative studies. Additionally, they will inform policies and intervention programmes for self-harm among adolescents in sub-Saharan Africa.

Introduction
Emergency humanitarian situations can be caused by extreme weather events, natural disasters, civil conflicts, international wars, terrorism and pandemics, which threaten our health and compromise health systems worldwide. Pharmacists are the third-largest healthcare professional group globally and provide pharmaceutical care and advice to people in need. However, the training opportunities to prepare pharmacists to respond in emergency humanitarian areas are not well described and may be limited. This scoping review aims to understand the extent and type of evidence in relation to training and education activities to prepare future pharmacists for disaster management in humanitarian emergency situations.

Methods and analysis
We will analyse peer-reviewed literature relating to educational or training activities for pharmacists/pharmacy students in the delivery of pharmacy services in humanitarian emergency situations. Relevant medical subject headings and keywords will be used to search Ovid MEDLINE, Scopus, EMBASE, ERIC, Informit, Web of Science and CINAHL databases from inception to the end of July 2024. Hand searching of any key references identified will also be performed. The title and abstract of search results will be screened to identify articles eligible to be included for full review. Articles meeting the inclusion criteria will undergo data extraction, content analysis and synthesis of the evidence using NVivo qualitative analysis software. A narrative summary of key themes and concepts in the literature will be presented as results. An international panel of experts will be consulted to inform decision-making processes during the development and interpretation stages, and we propose a template for the incorporation of participatory/consultative methodology into the scoping review process.

Ethics and dissemination
Ethics approval is not required for this study protocol because the members of the expert panel consulted are researchers who are participating based on their professional skills. Findings will be disseminated via publication in a peer-reviewed journal and presentation at international conferences.

To the Editor The randomized clinical trial by Wong et al comparing hypofractionated (HF) with conventional fractionation (CF) postmastectomy radiation therapy following implant-based reconstruction raises several methodological concerns that require further discussion.

In Reply We thank Chan and Wong for their comments about the FABREC study. It is important to note that the study conclusion was based on the result of the prespecified primary analysis (P = .80) at the .05 α level. Thus, the overall type 1 error regarding the intervention effect was controlled to be the .05 α level.

This study provided comparative evidence for first-line and post-chemotherapy second-line mCRPCa treatment options. Second-generation ARIs exhibited good efficacy, particularly when combined with other treatments. However, the safety analysis necessitated balance between benefits and adverse events, especially for combination therapies. Stronger evidence is needed through direct comparisons in future clinical trials.

Objectives
Several studies have demonstrated a significant association between the consumption of pickled foods and an increased risk of gastrointestinal cancer. However, the relationship between pickled food intake and non-digestive system cancers (NDSCs) remains uncertain. This meta-analysis aims to systematically review and analyse the risk of NDSCs associated with the consumption of pickled foods.

Design
Systematic review and meta-analysis.

Data sources
The PubMed, Cochrane Library, Embase and Web of Science databases were comprehensively searched from inception to July 2024.

Eligibility criteria
Observational studies with a focus on the association between pickled food consumption and the development of NDSCs in children and adults were included.

Data extraction and synthesis
A random-effects model was used for meta-analyses to calculate the pooled risk of NDSCs, including lung cancer, breast cancer, prostate cancer, kidney cancer, bladder cancer, brain cancer, cervical cancer, thyroid cancer and lymphoma. Meta-sensitivity analysis and subgroup analysis were conducted to explore potential sources of heterogeneity.

Results
A total of 51 studies, encompassing 2 518 507 individuals, met the eligibility criteria. The results of our study suggested a notable correlation between elevated intake of pickled food and heightened susceptibility to breast cancer (OR: 1.22, 95% CI: 1.07 to 1.39, I2=85.1%, p

Stroke, Ahead of Print. BACKGROUND:Demographics and comorbid conditions play a role in vascular health, yet their specific impact on cerebrovascular bypass patency remains unclear.METHODS:An institutional database of 357 patients with intracranial bypass procedures between August 2001 and May 2022 was retrospectively reviewed. Patients with bypass for all causes (eg, aneurysm, atherosclerotic disease, moyamoya disease) were included. Medical history, surgical technique, and flow-related measurements (intraoperatively and on quantitative magnetic resonance angiography at follow-up) were compared across biological sex and in relation to bypass patency. Bonferroni correction was applied to the initial analysis (P≤0.00167). The remaining analyses were considered exploratory. Propensity score–matched analysis matched cardiovascular risk factors and compared women and men in bypass patency.RESULTS:Of 357 patients, 141 were men (39.5%) and 216 were women (60.5%) with average age of 49.0±16.7 years and an average follow-up of 1.97 years. Bypass patency at last follow-up was 84.4% (n=114) for men versus 69.2% (n=148) for women (P=0.001). Differences were seen in underlying diagnoses, with more aneurysm and moyamoya cases represented in female sex (P

Introduction
The primary therapeutic approach to glaucoma involves the long-term use of intraocular pressure (IOP)-lowering eyedrops. However, the prevalent use of benzalkonium chloride (BAK) as a preservative in glaucoma eyedrops has been associated with ocular side effects, prompting a demand for alternatively preserved (AP) or preservative-free (PF) eyedrops. Studies comparing various preservatives have shown conflicting evidence concerning the safety of BAK-preserved (BP) eyedrops, some studies indicating no notable concerns and others reporting adverse effects. The current protocol concerns a network meta-analysis enabling systematic investigation of the IOP-lowering efficacy and safety profiles of BP, AP and PF eyedrops in patients with glaucoma for whom randomised controlled trials (RCTs) are available.

Methods and analysis
This study will evaluate the IOP-lowering effects of glaucoma eyedrops, comparing formulations with and without preservatives in patients with glaucoma. A systematic search for RCTs, regardless of language or publication date, will be conducted across three electronic databases (Cochrane search engine, Embase and MEDLINE) from 1 March 2024. Two reviewers will conduct a sequential screening of titles and abstracts, followed by full-text papers, to extract useful data. The two reviewers will also assess the internal validity of studies using the relevant and domain-based risk of bias assessment tool. Overall evidence quality will be assessed using the Confidence in Network Meta-Analysis approach and presented in summarised form with network diagrams. Forest plots will be generated for enhanced visualisation of the included glaucoma eyedrops’ effects, and pairwise effect sizes will be calculated based on available evidence in the network.

Ethics and dissemination
No ethics review or approval is required for this work, as it will synthesise evidence obtained from published studies. A paper presenting the findings will be submitted to a peer-reviewed journal for publication.

PROSPERO registration number
CRD42024498328

Objective
The efficacy of balneotherapy in rheumatology remains unclear. We aimed to estimate its benefits and risks in rheumatology.

Methods
We conducted a systematic review of randomised trials assessing any European balneotherapy for a rheumatological indication in adults versus any control, on clinical outcomes. We searched PubMed, Cochrane Library, Embase and https://clinicaltrials.gov/ (up to 28 November 2023). We used the Cochrane risk of bias tool version 2, funnel plot and asymmetry tests. We used a random effects model with an inverse-variance weighting method for standardised mean difference (SMD) and risk ratio (RR). We used the Grading of Recommendations Assessment, Development and Evaluation approach for two primary outcomes, pain and quality of life (QoL) at 3 months, and two safety outcomes, withdrawal and any adverse event (AE).

Results
We included 29 trials in mechanical disorders, 9 in inflammatory diseases and 4 in fibromyalgia. The synthesis suggested a decrease in pain of a very low level of certainty (SMD: –0.72 (95% CI (–1.00; –0.44)), very serious risk of bias and of inconsistency, publication bias strongly suspected); an increase in QoL of a very low level of certainty (SMD: 0.56 (95% CI (0.37; 0.75)), very serious risk of bias and serious risk of inconsistency); inconclusive results regarding the risk of withdrawal (RR: 0.75 (95% CI (0.46; 1.20)), very serious risk of bias and serious risk of imprecision) and of AE (RR: 0.80 (95% CI (0.43; 1.50)), serious risk of bias and of inconsistency and very serious risk of imprecision).

Conclusion
The certainty of the effect of balneotherapy in rheumatology was very low.

PROSPERO registration number
CRD42023448206.

Objective
Chronic kidney disease (CKD) is associated with a high economic burden, which is exacerbated by the high susceptibility to drug-related problems (DRPs) in this patient population. This study aimed to evaluate the cost-benefit ratio of medication reconciliation supplemented with medication review for inpatients with CKD, compared with the absence of this intervention.

Design
This was a cost-benefit analysis conducted along with a prospective interventional study.

Setting
The study was conducted at two hospitals in Jordan between February and May 2023.

Participants
The prospective interventional study included 142 admitted patients with CKD.

Interventions
Patients received medication reconciliation at admission and discharge as well as medication review throughout admission.

Primary and secondary outcome measures
The primary outcome measures were the net benefit and the benefit-to-cost ratio of the intervention. A cost-benefit analysis was conducted from the healthcare system perspective by assessing the cost of the service (the pharmacist time required to complete the service per patient) and the economic benefit, including total and per-patient cost savings and cost avoidance.

Results
The total estimated cost of all DRPs in the absence of interventions (cost avoidance) was $83 052 (average of $585±308 per patient); among which $20 623 was attributed to medication discrepancies. The cost savings were estimated at –$467. The supplemented medication reconciliation service was estimated to cost $714. As a result, the estimated net benefit totalled $81 871, averaging $577 per patient, with a benefit-to-cost ratio of 115.7:1 over the 4-month study period.

Conclusions
Delivering a supplemented medication reconciliation service by a clinical pharmacist for patients with CKD is cost beneficial from the healthcare perspective in Jordan, an example of a low- and middle-income country. This finding further confirms the pivotal role of clinical pharmacists in multidisciplinary healthcare teams.