Risultati per: Il dolore neuropatico: review

Background
Intralesional corticosteroid injection (ILCSI) has been proven to successfully treat hypertrophic scars (HTSs) and keloids and attain remission in 50% of keloids. Pain is a significant problem with ILCSI, which can affect treatment compliance and effectiveness. To date, many techniques involving ILCSI have been described and used to achieve scar treatment while reducing side effects. The injection technique remains the most widely available method in many healthcare centres.

Objective
This scoping review explores strategies for alleviating pain while administering ILCSIs for hypertrophic scarring and keloid management. ILCSI is a second-line treatment for HTSs and a first-line treatment for keloids.

Eligibility criteria
This scoping review included studies where HTSs and keloids were treated with ILCSI and considered diverse demographics and injection methods. This review excludes other methods of corticosteroid drug delivery where injection is not involved and where the pain assessed is unrelated to injection or infiltration of the scar.

Sources of evidence
This review systematically searched critical databases from inception to December 2023, including ScienceDirect, PubMed and Web of Science, and handpicked articles traced from available review papers. Only English-language publications focused on pain management during ILCSIs for HTSs and keloids were included. All levels of scientific evidence were considered. An in-depth evaluation of the injection technique, type of analgesia or anaesthesia administered, effectiveness of pain management and overall treatment outcomes was conducted.

Charting methods
Citations were compiled in an Excel spreadsheet, with three authors screening the titles and abstracts based on inclusion criteria. Decisions were finalised collaboratively, exclusions were documented and results were presented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram.

Results
16 prospective studies, 2 retrospective studies, 1 case study and 15 journal articles were included. These studies examined ILCSI for hypertrophic scarring and keloid treatment. No differences in pain intensity between HTSs and keloids were reported. 11 studies systematically explored pain reduction methods such as topical analgesia, cryoanaesthesia, mixing triamcinolone acetonide with local analgesics, slow infiltration techniques, vibration analgesia and needle-free injectors.

Conclusion
Pain can significantly impact patient compliance and treatment outcomes. This review offers a foundational reference for healthcare providers and researchers in the field of scar management, providing insights into current practices and highlighting areas for future research and development.

Objectives
The postdischarge period is crucial for vulnerable newborns at risk of morbidity, readmission and mortality in low- and middle-income countries (LMICs). Addressing gaps in care during this period could improve outcomes. This review consolidates evidence on caregiver information needs and relevant information tools used in postdischarge care for vulnerable newborns in LMICs.

Design
Scoping review using the methodological framework developed by Arksey and O’Malley.

Data sources
We searched six databases for relevant articles published in English between 2001 and 2021. Additional articles were identified through citation and reference checking.

Eligibility criteria
Articles on postdischarge care for newborns in LMICs, excluding economic and technical development studies, discharge to other healthcare facilities (rather than to home) and maternal-focused studies.

Data extraction and synthesis
Data extraction followed Arksey and O’Malley’s data charting method. Using a descriptive synthesis approach, heterogeneous data were collated in narrative format.

Results
From 5190 articles, 22 were included. Only a small number of articles discussed caregiver challenges, like receiving insufficient information at discharge which led to uncertainty in caring for vulnerable newborns. Caregivers had a number of needs in relation to maternal and newborn care, including in terms of coordination of follow-up care. Although a number of tools have been used to support relevant needs (for postnatal care in general rather than specifically for postdischarge care of vulnerable newborns), these have shown mixed effectiveness due to challenges with completeness, lack of training and support, supply chain issues and cultural barriers to adoption, such as preference for alternative providers.

Conclusion
Our understanding of postdischarge information needs for those looking after vulnerable newborns in LMICs remains limited. More effective use of information tools could help address some of these needs and contribute towards reducing neonatal mortality rates.

Introduction
Sports-related dystonia, also called the yips, are often seen in athletes in multiple sports. In this condition, an athlete abruptly loses the ability to perform a repetitive motion performed thousands of times. Such occurrences are often assumed to be psychological in nature, and thus evaluation for other causes is often lacking. All reviews on the topic have failed to focus on athletes in overhand sports. This scoping review will evaluate the available evidence regarding upper extremity focal dystonias (yips) in athletes participating in overhand sports in any worldwide clinical or sport setting.

Methods and analysis
We will conduct our scoping review with guidance from the latest version of the Joanna Briggs Institute’s (JBI) Manual for Evidence Synthesis, a widely accepted methodology for conducting reviews. We organised our research question and inclusion criteria to the JBI’s mnemonic; Participants: athletes that participate in overhand sports; Concept: upper extremity focal dystonias or yips; and Context: any worldwide clinical or sports setting. Search results were retrieved on 26–27 June 2024, in the following databases: MEDLINE (Ovid) 1946–2024, SPORTDiscus (EBSCOhost) 1800–2024, APA PsycINFO (EBSCOhost) 1872–2024, Embase (Elsevier) 1974–2024, Web of Science Core Collection (Clarivate) 1900–2024, Sports Medicine & Education Index (ProQuest) 1970–2024 and Dissertations and Theses Global (ProQuest) 1861–2024. Using Covidence, two reviewers from a team of three will independently screen titles and abstracts, screen full text articles for inclusion, and independently extract data from our included studies. Results will be presented as a narrative descriptive analysis along with tabular data on the prevalence, diagnostic criteria and treatment for yips in athletes of overhand sports.

Ethics and dissemination
As this describes a scoping protocol, ethical approval is not necessary. Review findings will be submitted to peer-reviewed publications and presentations at local and national conferences.

Trial registration number
This protocol is registered with the Open Science Framework.

Objectives
To explore the literature about the role of unpaid informal carers in medication management for people with long-term conditions.

Design
Systematic review designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Information source
MEDLINE (Ovid), Embase (Ovid), PsycINFO, Cumulated Index in Nursing and Allied Health Literature (EBSCO), Scopus and Web of Science were searched from inception until April 2024. Additional papers were identified by searching backwards and forwards the reference lists of included papers.

Eligibility criteria
Primary research studies were included if they reported medication-related activities undertaken by carers for people with long-term conditions. Qualitative and mixed methods studies were considered without restriction on language or country.

Data extraction and synthesis
Relevant data were extracted and summarised in a table. The Mixed Method Appraisal Tool was used for quality assessment. Data were narratively synthesised.

Results
From 12 473 identified records, 107 underwent full text screening and 20 studies were included. Family carers were the predominant type of carer. Spouses and adult children constituted the largest caregiving dyads. Based on the required skills, two groups of roles were identified: physical roles, such as prescription management, and cognitive roles, such as decision-making. Carers used different strategies and tools to undertake medication-related activities including compliance aids and alarms. However, carers reported challenges in their experiences of caregiving, flagging up their need for additional support and education to commence such activities.

Conclusion
Informal carers undertake a wide variety of medication-related activities. The studies emphasised the need to support families as partners in health outcomes. This systematic review identifies the importance of bridging the gap between carers and healthcare providers. More efforts are needed to empower carers towards better and safer caregiving. Future work could address how to optimise carer involvement and engagement and provide best practice recommendations for carers’ support.

PROSPERO registration number
CRD42024506694.

Introduction
Empathy is a core component of high-quality care yet is expressed and received in different ways depending on the characteristics (including gender, race, socioeconomic status and disability) of both practitioners and patients. However, the evidence exploring how these characteristics or their overlap (‘intersectionality’) influence empathy has not been synthesised.

Methods and analysis
We will systematically review and meta-analyse studies exploring the influence of healthcare practitioners and patient characteristics on empathy in healthcare. MEDLINE, EMBASE (via Scopus), Scopus, PsycINFO, CINAHL, CENTRAL Web of Science, Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects will be searched from database inception to present. Reference chasing will be used to identify additional studies. Studies that report empathy levels using either (1) the patient-reported Consultation and Relational Empathy Measure or (2) the practitioner or student-reported Jefferson Scale of Empathy. This will include validated versions or translations of both scales.
Two reviewers will independently screen titles, abstracts, and full texts and extract data using Rayyan. Discrepancies will be resolved in discussion with a third author if necessary. Two independent authors will evaluate the risk of bias using the Joanna Briggs Institute tools.
Continuous data will be analysed based on the mean, SD, sample size and 95% CIs. Sensitivity analyses will be used to explore the potential impact of risk of bias and use of imputed data. We will explore differences between countries, demographic characteristics, disciplines and lengths of time in practice experience, as well as differences over time (comparing more recent with older studies). We will also explore differences between patient-reported and practitioner-reported empathy.
We will report our findings following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and flowchart.

Ethics and dissemination
Ethical approval is not required for this review as primary data will not be collected. The review will be disseminated through peer-reviewed publication and presented at conferences.

PROSPERO registration number
CRD42024604677.

Objectives
Pregnant women in low- and middle-income countries (LMICs), including Mali, often face challenges such as limited access to comprehensive health information and services. Mobile health (mHealth) interventions, particularly SMS-based interventions, have shown promise in addressing maternal health challenges. This review aims to provide an overview of existing SMS-based antenatal care (ANC) applications and assess their effectiveness in improving maternal and child health outcomes.

Design
A systematic literature review was conducted based on updated PRISMA 2020 guidelines.

Data sources
PubMed, Scopus, Web of Science, Cochrane Library, Association for Information Systems eLibrary, Direct Science and Google Scholar were searched through 25 March 2024.

Eligibility criteria
Studies that focused on SMS-based interventions designed to improve ANC information and attendance, published in English or French, conducted in LMICs and published between 2014 and 2024 were included. Exclusion criteria eliminated studies that did not report primary outcomes or did not directly involve SMS-based interventions for ANC.

Data extraction and synthesis
Relevant data were systematically extracted, including study characteristics, intervention details, and outcome measures. The risk of bias was assessed using the Cochrane Risk of Bias tool for randomised trials (RoB 2), the Risk Of Bias In Non-randomised Studies-of Interventions (ROBINS-I) and the Checklist for Reporting the Development and Evaluation of Complex Interventions in Healthcare (CReDECI), depending on the study design. A subgroup analysis was performed to explore variations in outcomes by region and study design.

Results
The review identified a range of SMS-based interventions (n=12) that differed in target audience, message frequency (weekly, pregnancy stage-oriented) and content (reminders (91.7% of cases, 11/12), educational (75%) and danger signs (16.7%)). Regional analysis highlighted significant research activity in East Africa but with mixed significance levels. The study design analysis revealed that randomised controlled trials yielded the most significant results, with five of eight studies showing full significance, whereas quasi-experimental studies demonstrated consistent but less frequent effectiveness. Implementation tools varied from SMS gateways to custom applications and third-party platforms, with some interventions combining these approaches. SMS interventions positively impacted ANC attendance, maternal health knowledge and behaviours, with effectiveness varying based on the intervention type, content, frequency and implementation approach.

Conclusion
SMS-based interventions have the potential to enhance ANC in LMICs by providing tailored health information and promoting healthy behaviours. Further research should focus on refining or replicating these interventions and exploring their long-term effects on maternal and child health outcomes, particularly in underrepresented regions.

Introduction
The amount of scientific data on liver surgery is exploding. There is a critical unmet need to develop tools that will facilitate navigating the literature and offer easy, fast and accurate access to data with a high level of evidence. Evidence maps (EM) combining living systematic reviews (SR) and user-friendly synthesis with graphs and figures were developed for this purpose in other medical fields and showed promising results but remain yet unavailable in liver surgery. The present study protocol aims to generate an EM in liver surgery, gathering randomised clinical trials (RCT) and SR.

Methods and analysis
A systematic search will be conducted in the Cochrane Central Register of Controlled Trials, Web of Science, Embase and Medline to identify all RCT and SR concerning liver surgery. RCT and SR will be classified in research topics. Selected endpoints will be extracted and meta-analysed. Results will be freely available for patients, clinicians and researchers via a web-based evidence map platform. EM and meta-analyses (MA) will be updated at regular intervals.

Ethics and dissemination
Including publicly available data, this type of study design did not require ethical committee approval. EM displays the required properties to facilitate literature search and to get a rapid overview of the current evidence, an unavailable tool in liver surgery, to date. Generating such an aid may considerably help patients, clinicians and researchers in many aspects: accessing accurate data, helping in decision-making and identifying gaps in the field. On completion of the project, results will be published, freely available via www.evidencemap.surgery and permanently updated.

PROSPERO registration number
CRD42023489201 (https://www.crd.york.ac.uk/prospero/)

Objectives
We aimed to examine the predictive accuracy of functioning, relapse or remission among patients with psychotic disorders, using machine learning methods. We also identified specific features that were associated with these clinical outcomes.

Design
The methodology of this review was guided by the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy.

Data sources
CINAHL, EMBASE, PubMed, PsycINFO, Scopus and ScienceDirect were searched for relevant articles from database inception until 21 November 2024.

Eligibility criteria
Studies were included if they involved the use of machine learning methods to predict functioning, relapse and/or remission among individuals with psychotic spectrum disorders.

Data extraction and synthesis
Two independent reviewers screened the records from the database search. Risk of bias was evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool from Cochrane. Synthesised findings were presented in tables.

Results
23 studies were included in the review, which were mostly conducted in the west (91%). Predictive summary area under the curve values for functioning, relapse and remission were 0.63–0.92 (poor to outstanding), 0.45–0.95 (poor to outstanding), 0.70–0.79 (acceptable), respectively. Logistic regression and random forest were the best performing algorithms. Factors influencing outcomes included demographic (age, ethnicity), illness (duration of untreated illness, types of symptoms), functioning (baseline functioning, interpersonal relationships and activity engagement), treatment variables (use of higher doses of antipsychotics, electroconvulsive therapy), data from passive sensor (call log, distance travelled, time spent in certain locations) and online activities (time of use, use of certain words, changes in search frequencies and length of queries).

Conclusion
Machine learning methods show promise in the prediction of prognosis (specifically functioning, relapse and remission) of mental disorders based on relevant collected variables. Future machine learning studies may want to focus on the inclusion of a broader swathe of variables including ecological momentary assessments, with a greater amount of good quality big data covering longer longitudinal illness courses and coupled with external validation of study findings.

PROSPERO registration number
The review was registered on PROSPERO, ID: CRD42023441108.

Introduction
Both physical adaptations (e.g., altered neck kinematics and muscle coordination) and psychological features are common in people presenting with neck pain (NP). Additionally, both physical and psychological features may be relevant for the development of persistent or recurrent NP. Although a number of original studies have reported this, currently there is no available systematic review reporting physical and psychological predictors for the recurrence of non-specific NP.

Methods and analysis
The report of this systematic review protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Studies will be searched from PubMed, MEDLINE, EMBASE, CINAHL Plus, PsycINFO and grey literature. Title, abstract and full-text screening, data extraction and risk of bias assessment will be conducted by two independent reviewers. Studies investigating the prediction of persistent or recurrent NP from physical or psychological predictors will be included. Physical predictors will be commonly reported objective measures including neck kinematics, measures of muscle activity and sensory function. Psychological predictors will include variables such as kinesiophobia, self-efficacy, pain coping strategies and quality of life. The main outcomes of interest are the Neck Disability Index, presence of pain recurrence, as well as pain intensity and frequency during a persistent or recurrent NP episode. Observational cohort studies will be included, and studies on both single-factor and multifactor predictions or associations will be investigated. Risk of bias will be assessed using the Quality in Prognosis Studies (QUIPS) tool. The certainty of evidence will be rated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). A random-effect meta-analysis will be conducted if methodological and clinical homogeneity is deemed satisfactory.

Ethics and dissemination
Ethical approval will not be required for this review as there is no primary data collection involving humans. The findings will be published in peer-reviewed journals.

PROSPERO registration number
CRD42024596844.

Presentato alla Camera su iniziativa di Ciocchetti

This narrative review summarizes current evidence on the pathophysiology, clinical presentation and diagnosis, risk stratification, and treatment of essential thrombocythemia.

This study compares knowledge of diagnosis and worry among adults presented with prostate biopsy reports in a patient-centered format, which presents important clinical data in plain language, vs standard report format.

Lifestyle interventions modestly improve depressive symptoms and quality of life in children and adolescents with overweight or obesity, with additional benefits for self-concept and emotional functioning observed in NRSIs. These findings underscore the potential of lifestyle interventions to address both physical and mental health. Future research should focus on evaluating long-term psychological outcomes and developing cost-effective, culturally tailored interventions.

Objectives
Antithrombotic therapy (ATT) prevents atherothrombotic events (AE) in patients with peripheral arterial disease (PAD). However, the benefit may be compromised by poor medication adherence (MA). Therefore, our primary objective was the proportion of patients with PAD with poor MA in literature following patient-reported, pharmacy-reported or laboratory-reported outcome measurements. Poor MA is a combined outcome of primary non-adherence (inability to initiate a prescription), secondary non-adherence (incorrect daily intake) and non-persistence (discontinuation of daily intake).

Design
Systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

Data sources
PubMed, EMBASE and Cochrane Library were searched from 2000 to June 2023.

Eligibility criteria
Publications with a (sub)cohort of patients with PAD that reported on patients’ MA to ATT were included.

Data extraction and synthesis
All articles were reviewed on eligibility and methodological quality by two independent researchers. The data were retrieved and collected in Review Manager Web and the percentages were calculated per subgroup. The risk of bias was assessed by using the Cochrane risk-of-bias tool for randomised controlled trials (RCT) and the methodological index for non-randomised studies score for non-RCTs.

Results
We identified 274 potential records of which 10 studies (32 628 patients) were included. Six studies were RCTs and two prospective and two retrospective studies. Most studies scored a moderate risk of bias and had heterogeneous study designs. Poor MA rates ranged between 2% and 45%. Higher rates of poor MA were found in studies with longer follow-ups, pharmacy-reported outcome measurements and registry-based cohorts.

Conclusion
Heterogeneous study designs create a wide dispersion in the proportions. However, poor MA to ATT was found in approximately one-third of the patients with PAD and seemed to increase with longer therapy duration, which highlights the magnitude of this societal challenge. Enhancing patients’ MA to ATT might be a key element in reducing the risk of AE, and therefore, more attention to MA in clinical and research settings is warranted.

PROSPERO registration number
CRD42023431803.

Introduction
Across different populations, listening difficulties have been shown to adversely impact social interactions and work performance, and substantively contribute to poorer quality of life. Following a stroke, people also report listening difficulties in noisy, everyday environments such as cafes and workplaces. Despite the prevalence of these challenges, there is limited understanding of this issue, which means the listening needs of stroke survivors remain under-recognised and unmet. The aim of this scoping review is to map the breadth and depth of the existing literature on stroke survivors’ experiences of listening in noisy environments, encompassing qualitative descriptions and quantitative assessments of listening-in-noise abilities, to identify contributing factors, knowledge gaps and potential intervention strategies.

Methods and analysis
This protocol has been registered with the Open Science Framework (protocol number: 39TCA) and follows the Joanna Briggs Institute guidelines for scoping reviews. The protocol was developed by a multidisciplinary and multiprofessional team, led by a survivor of stroke and informed by additional patient input. A mixed-methods approach will be used to generate independent narrative summaries of qualitative and quantitative studies, followed by an integrated narrative of findings across data types. We will first conduct a comprehensive search using Medline, Embase, PsycInfo, Scopus, Cumulated Index in Nursing and Allied Health Literature and Web of Science databases in February 2025. Eligible studies will include stroke survivors as participants and focus on listening-in-noise experiences or abilities. Qualitative studies must explore personal experiences or perceptions related to listening in noisy environments, and quantitative studies must assess listening-in-noise performance. Studies addressing mediating factors, such as cognition, comorbidities (eg, hearing loss, aphasia), environmental factors and intervention strategies (eg, auditory training, assistive devices) will also be included. Two independent reviewers will assess the studies for eligibility. In cases of disagreement, a third reviewer will independently compare and resolve any discrepancies, ensuring a consensus is reached. This approach aims to minimise bias and enhance the validity of the review findings. The data extraction and synthesis will adhere to established guidelines, ensuring a robust and transparent analysis.

Ethics and dissemination
Ethical approval is not required as this review will analyse the existing literature. The results will be published in an open-access peer-reviewed journal and presented at local and international conferences. This dissemination strategy aims to reach a wide audience, including clinicians, researchers, policymakers and people with lived experience of stroke.

Trial registration number
Open Science Framework (https://osf.io; protocol number: 39TCA).

Objectives
Preterm birth (PTB) is a major cause of neonatal morbidity and mortality worldwide. Effective use of tocolytic agents may improve perinatal outcomes. This study aims to compare the effectiveness and safety of nifedipine and magnesium sulfate in the treatment of PTB.

Design
A systematic review and meta-analysis.

Data sources
China National Knowledge Infrastructure, China Science and Technology Journal Database, WanFang, PubMed, Embase, Web of Science and Cochrane were searched from inception to 1 December 2024.

Eligibility criteria
We included randomised controlled trials (RCTs) and cohort studies that compare the efficacy and safety of magnesium sulfate versus nifedipine in treating PTB.

Data extraction and synthesis
Two researchers independently screened studies and extracted data. Risk of bias was assessed using the Cochrane risk-of-bias assessment tool for RCTs and the modified Newcastle-Ottawa Scale for non-randomised studies. Meta-analysis was conducted using Review Manager V.5.4.

Results
In all, 50 articles were included in this review, comprising 6072 cases (n=3014 for the magnesium sulfate group; n=3058 for the nifedipine group). Compared with the magnesium sulfate group, the nifedipine group was more favourable in terms of time to onset of action and prolongation of days of gestation, as well as higher neonatal 1 min Apgar scores. The use of magnesium sulfate was associated with a higher incidence of maternal side effects, specifically tachycardia, flushing, palpitations, dizziness and nausea. In addition, the magnesium sulfate group also showed a higher incidence of neonatal respiratory distress syndrome than the nifedipine group.

Conclusion
Compared with magnesium sulfate, nifedipine is more effective with a faster onset of action and a longer prolonging pregnancy. Additionally, nifedipine may be safer for fewer maternal side effects and better neonatal outcomes. Further studies are needed to confirm the long-term safety and efficacy of these treatments.