Correlates of HIV-TB co-infection and mental health of adults living in countries across sub-Saharan Africa: systematic review and meta-analysis protocol

Introduction
HIV and tuberculosis (TB) are two of the most devastating disease conditions of public health concern globally. A co-infection of the two diseases poses serious health challenges to patients including mental health problems, ranging from mild to severe, with differing outcomes. This systematic review aims to assess the correlates of HIV-TB co-infection and mental health of adults living in sub-Saharan Africa.

Methods and analysis
We will conduct comprehensive database and non-database searches for studies (published and unpublished). We will search Google Scholar, PubMed, CINAHL, LILACS, JSTOR, Cochrane Library, SCOPUS, PsycINFO, HINARI and African Journals Online from inception to 31 May 2025, without restriction on language. We will also search the grey literature, including conference proceedings, preprint repositories, databases of dissertations, WHO and governmental databases. In the event where there is a need to contact experts and corresponding authors for further information, the review team will do so to enrich the content of the review. At least three reviewers will independently undertake study selection, data extraction and risk of bias assessment using validated tools. We will resolve discrepancies or disagreements through discussion. We will analyse dichotomous data as risk ratio, OR or proportion and continuous data as mean difference with their SD; all estimates will be presented with their 95% CI. Where applicable, we will determine SD from point estimates and the appropriate denominators assuming a binomial distribution. The magnitude of heterogeneity between the included studies will be assessed quantitatively using the index of heterogeneity (I2 statistic). The I2 values of 25%, 50% and 75% will be considered to represent low, moderate and significant heterogeneity. The significance of heterogeneity will be determined by the p value of the I2 statistic, and a p value of

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Exploring the sexual and reproductive health and rights policies and their relationship to the Termination of Pregnancy Act (1977) and bodily autonomy and integrity in Zimbabwe: a multimethod research protocol

Introduction
In Zimbabwe, pregnancy termination is generally prohibited unless and only if the circumstances are in sync with the conditions stipulated in the Termination of Pregnancy (ToP) Act of 1977. This raises questions about the modern-day rights of bodily autonomy and integrity (BAI). Funded by the AIDS and Rights Alliance for Southern Africa, this study, therefore, seeks to review and analyse sexual and reproductive health and rights policies and how they relate to the ToP Act (1977) and BAI.

Methods and analysis
This study will use a concurrent multimethod approach. First, policies related to the ToP and bodily autonomy and integration will be reviewed and analysed using the policy analysis triangle. Concurrently, a qualitative and quantitative survey will be conducted on purposively selected key informants and focus group discussions with purposively selected women and men, as well as 200 stratified selected women. Qualitative findings will be recorded, transcribed and thematically analysed using MAXQDA V.20 Pro. Simultaneously, the quantitative output will be collected using KoboCollect, exported into Excel and analysed using both Excel and STATA. The strengths, weaknesses, opportunities and threats (SWOT) framework and the Basic Logic Model will guide the triangulation of the findings and development of a policy brief.

Ethics and dissemination
Ethical approval for this study was obtained from the National University of Science and Technology Institutional Review Board at Bulawayo, Zimbabwe (Ethics Number: NUST/IRB/2023/23). Written consent would also be sought from the participants. A policy brief would be developed and shared with key stakeholders. At least three manuscripts would emanate from this study and will be submitted for publication in reputable peer-reviewed journals.

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Comparison of elective hemicolectomy patients before and after establishment of a preoperative anaesthesia assessment clinic: a retrospective, observational study in a hospital in Norway

Objectives
To compare outcome data of hemicolectomy patients before and after the establishment of a preoperative anaesthesia assessment clinic (PAC).

Design
This observational study was conducted retrospectively through an electronic health record review covering periods before (2014–2017) and after (2017–2022) the PAC was established.

Setting
An acute care hospital in Norway.

Participants
A total of 612 patients undergoing elective open or laparoscopic hemicolectomy were included, of whom 338 (55.2%) had attended the PAC.

Primary and secondary outcome measures
The primary outcome was the rate of cancellation of planned surgeries, and the secondary outcomes were length of hospital stay (LOS), unanticipated intraoperative anaesthesia-related events and the presence of documentation relevant to the planning of anaesthesia in the patient’s medical records preoperatively.

Results
Compared with the after-PAC cohort, the before-PAC cohort was numerically more likely to have their planned surgery cancelled (OR=1.97, 95% CI (0.84 to 4.61); p=0.12). The before-PAC cohort also had a numerically lower rate of unanticipated intraoperative anaesthesia-related events (18.6%) than the after-PAC cohort (22.5%; p=0.240). However, neither of these differences was statistically significant. Median LOS was significantly shorter in the after-PAC cohort (4.79 days, IQR (3.80–6.12)) than in the before-PAC cohort (5.16 days (4.09–7.18); p=0.001). Moreover, the presence of documentation relevant to the planned anaesthesia in the medical records was significantly more common for after-PAC patients.

Conclusions
The establishment of the PAC reduced the rate of planned surgery cancellations but increased the rate of recorded intraoperative anaesthesia events. Patients who attended the PAC had a significantly shorter LOS and more anaesthesia-related information in their medical records.

Trial registration number
NCT05520229.

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Evaluating the efficacy and acceptability of a digital-based management system for diabetes during pregnancy: protocol for an observational cohort study

Introduction
Diabetes during pregnancy poses significant health risks for both mothers and their offspring and requires comprehensive management throughout pregnancy and the postpartum period. The increasing global prevalence of diabetes during pregnancy requires effective and efficient management. The current healthcare system can be challenging because of need for frequent hospital visits and limited availability of gestational diabetes (GDM) specialists.
This study investigates the impact of a digital-based management system designed to support women with diabetes from pregnancy through the first year post partum. This system includes a mobile application (MomStart) that allows users to log health data, receive tailored educational content and communicate with healthcare providers. The primary objective of this study is to compare pregnancy outcomes with historical data. We will also investigate the usability of the MomStart application.

Methods and analysis
The study will enrol over 100 pregnant women with diabetes from two hospitals in South Korea for the main study and an additional 500 women from across the country for a supplementary usability study. Data will be collected and analysed to assess neonatal and maternal outcomes and the app’s retention and satisfaction rates.

Ethics and dissemination
The protocol was approved by the Institutional Review Board of the Catholic University of Korea (XC23OIDI0012). We will present our findings in a national conference and in peer-reviewed medical journals.

Clinical study registration number
This study was registered in Korea’s Clinical Research Information Service system (KCT0008483).

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Low-dose versus high-dose intravenous nitroglycerin in the treatment of sympathetic crashing acute pulmonary oedema: a systematic review and meta-analysis focusing on efficacy, safety and outcomes

Objectives
Sympathetic crashing acute pulmonary oedema (SCAPE) is a menacing medical emergency and a severe form of acute heart failure that requires urgent intervention. Nitroglycerin (NTG) is commonly used in SCAPE management, but the optimal dosing remains uncertain. This meta-analysis compared the efficacy and safety of high-dose vs low-dose NTG in SCAPE patients, assessing mechanical ventilation need, symptom resolution, hospital stay and major adverse cardiovascular events (MACE).

Design
Systematic review and meta-analysis conducted per Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, registered in Prospective Register of Systematic Reviews (CRD42024527486).

Data sources
A comprehensive search in PubMed, Europe PMC and ScienceDirect up to November 2024. Reference lists of included studies were also reviewed.

Eligibility criteria
Randomised controlled trials (RCTs) and observational studies comparing high-dose NTG (≥100 mcg/min) with low-dose NTG (

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Factors that influence clinical trial participation for oncology patients in Australia: a scoping review

Objectives
Ensuring equity in clinical trials has been declared a global priority. Australia is competitive in the international clinical trial sphere. We aimed to explore factors that influence oncology clinical trial participation in Australia.

Design
Scoping review.

Data sources
On 27 May 2024, a systematic search using a predefined strategy was conducted across four electronic databases (Medline, CINAHL, EMBASE and Scopus), grey literature and hand searches.

Eligibility criteria
All cancer (haematological and non-haematological) clinical trials that discussed factors influencing participation in Australia were included. There were no language or age restrictions.

Data extraction and synthesis
Data were extracted using a predesigned extraction tool. Quantitative results were analysed using descriptive statistics. Qualitative data were synthesised using a framework method into four domains (1) patients, (2) healthcare professionals, (3) clinical trials and (4) health services.

Results
Of 1084 citations identified, 393 duplicates were removed. Of the 691 titles and abstracts screened, 54 articles underwent full-text review, and 42 articles were included in the final analysis. Key factors that influence clinical trial participation were identified across all domains, many consistent with the international literature. For example, while self-reported willingness emerged as a key facilitator across diverse patient groups, cohort studies revealed lower participation rates for migrant populations, older patients and those residing in regional areas. Importantly, we were also able to identify the foundations of an evidence base of interventions that directly support increased clinical trial participation.

Conclusion
This scoping review contributes new findings to a body of international literature, while contributing a unique Australian perspective. These findings establish the foundations of an evidence base that supports inclusive clinical trial participation.

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Risk and protective factors associated with teenage pregnancy and intergenerational interventions: a scoping review protocol

Introduction
Teenage pregnancy remains a critical global health issue, particularly in low- and middle-income countries. The intergenerational transmission of teenage pregnancy underscores the need for targeted interventions. Existing research on intergenerational approaches is fragmented, with varying methodologies and outcomes. This scoping review seeks to address this gap by answering the following research questions: What are the available intergenerational interventions for teenage pregnancy, and what are the associated risks and protective factors for early and late teenage pregnancy?

Methods and analysis
This study does not involve primary data collection and therefore does not require ethical approval. The review will be conducted in five stages: identifying the research question; identifying relevant studies; study selection; charting the data; and collating, summarising and reporting the results. A comprehensive search of electronic databases, grey literature and relevant organisational websites will be conducted for literature published between 2014 and 2024. Data will be extracted using a standardised form and synthesised narratively. Stakeholder consultation will be conducted to refine findings and ensure relevance. The findings will be reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) extension for Scoping Reviews guidelines. The results will be presented through narrative synthesis, with tables and charts used to summarise key information.

Ethics and dissemination
As the review is based on publicly available data, ethical approval is not required. Ethical clearance will be sought for stakeholder consultations, if necessary. Findings will be disseminated through peer-reviewed publications, conferences, policy briefs and shared openly on the Open Science Framework (OSF). This protocol is registered in the OSF (https://doi.org/10.17605/OSF.IO/CM9WK).

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[Articles] Association between antibiotic exposure and childhood atopic dermatitis: a systematic review and meta-analysis

Antibiotic exposure during pregnancy or early childhood enhances AD risk, with childhood exposure posing a higher risk than prenatal exposure. Exposure time (during pregnancy and childhood) and the age at outcome measurement are important influencing factors for this association. Diagnostic criteria, race, frequency of antibiotic exposure, and type of antibiotics may also affect this relationship. While the observed statistical significance may be associated with the increased statistical power afforded by the large sample size, the clinical implications of these findings warrant cautious interpretation.

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Effectiveness of cognitive stimulation for individuals with mild cognitive impairment: a systematic review and meta-analysis

Objective
Cognitive stimulation (CS) is a non-pharmacological intervention aimed at enhancing cognitive function. However, the effectiveness of CS in individuals diagnosed with mild cognitive impairment (MCI) remains inconclusive. Therefore, this study aimed to assess the effectiveness of CS in improving cognitive function, psychological well-being, instrumental activities of daily living (IADL) and quality of life (QoL) in individuals with MCI, based on randomised controlled trials (RCTs).

Design
Systematic review and meta-analysis.

Data sources
Six English databases were systematically searched, including PubMed, Web of Science, Embase, Cumulative Index to Nursing and Allied Health Literature, American Psychological Association PsycInfo and Academic Search Premier.

Eligibility criteria
RCTs about CS for individuals with MCI, published between January 2003 and December 2024.

Data extraction and synthesis
Data were extracted and assessed using the revised Cochrane risk of bias tool for randomised trials by independent researchers. The meta-analysis was conducted using the standardised mean difference (SMD) and 95% CIs of the included studies.

Results
The meta-analysis included five eligible studies for the primary outcomes of cognitive function and three eligible studies for the secondary outcomes of psychological wellness. In the pooled samples, the CS intervention had a significant effect on cognitive function (SMD=0.63, 95% CI 0.25 to 1.01; p=0.001) and depression symptoms (SMD=–0.29, 95% CI –0.55 to –0.03; p=0.03) in individuals with MCI. However, no significant improvements in anxiety symptoms were identified after the CS intervention (SMD=–0.05; 95% CI –0.31 to 0.21; p=0.71).

Conclusion
The CS intervention can effectively improve cognitive function and alleviate depression symptoms. Although a meta-analysis was not conducted for IADL and QoL due to the limited number of included studies, positive trends in enhancing IADL performance and augmenting QoL were observed in individuals with MCI. However, due to the scarcity of relevant studies in this research field, more comprehensive RCTs are warranted to provide a better understanding of the potential benefits of CS and to guide its clinical application in the future.

PROSPERO registration number
CRD42023494685.

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Utilisation of point-of-care ultrasound by critical care nurses: a scoping review protocol

Introduction
Point-of-care ultrasound (POCUS) is considered an essential component of intensive care practice, enabling rapid assessment and diagnosis of various medical conditions. Critical care nurses (CCNs) have increasingly adopted this bedside technology, which has demonstrated to improve patient care and streamline workflows. This scoping review aims to map and present the contexts in which CCNs use POCUS, the content and structure of the training programmes undertaken and any reported impacts on patient outcomes.

Methods and analysis
This scoping review will be conducted in accordance with the Joanna Briggs Institute guidelines and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklists. We will search Medline, EBSCOhost CINAHL and Google Scholar for relevant studies published from 2015 to the present. Additionally, the reference lists of included studies will be manually checked for further relevant articles. All review steps will be carried out by at least two reviewers to ensure accuracy and reliability. Data charting will be performed narratively, detailing the study characteristics and findings pertinent to the review questions.

Ethics and dissemination
There is no ethics disclosure required for this review protocol, as the data will be sourced from previously published primary studies. The findings of this review will be published in a peer-reviewed journal and disseminated through presentations at both national and international conferences.

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Role of health information technology in enhancing chronic disease management: a scoping review protocol

Introduction
Chronic diseases, such as diabetes, hypertension and cardiovascular diseases, represent a significant burden on global health systems. Health information technology (HIT) offers innovative solutions to improve disease management, patient outcomes and healthcare efficiency. However, the diverse applications and impacts of HIT in chronic disease management are not well understood. The objective of this scoping review is to assess the extent and type of evidence on the role of HIT in enhancing chronic disease management.

Methods and analysis
This protocol outlines a scoping review to assess the extent and nature of the evidence on the role of HIT in managing chronic diseases. The review will be conducted in accordance with the JBI methodology for scoping reviews. This review will include studies involving adult patients with chronic diseases. The focus will be on various HIT interventions, including electronic health records (EHRs), telehealth services, mobile health (mHealth) applications, remote monitoring devices and health information exchanges (HIEs). Studies conducted in primary care, hospital and community health settings will be considered. Exclusions will include studies focused on paediatric populations or non-digital health interventions. We will include quantitative, qualitative and mixed-methods studies published from January 2013 to December 2024. A comprehensive search will be conducted across PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus and Google Scholar. Reference lists of included studies will be screened for additional sources. Two independent reviewers will screen titles, abstracts and full texts, extract data and resolve discrepancies through discussion or consultation with a third reviewer. The study is scheduled to begin in May 2025 and conclude by November 2025, and the process will be documented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. The data will be presented as tables, charts and a narrative summary.

Ethics and dissemination
As this review involves the analysis of publicly available literature, ethical approval is not required. The results will be disseminated via peer-reviewed publications, conference presentations and engagements with stakeholders involved in chronic disease care and digital health policy. The authors will also explore opportunities to share supplementary materials in open-access repositories to promote transparency and reproducibility.

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Effectiveness of the BioFire FilmArray for the rapid detection of bloodstream infection in haematological patients with febrile neutropenia (the ONFIRE study): study protocol of a prospective, multicentre observational study at three reference university hospitals in Spain

Introduction
Bloodstream infection (BSI) due to multidrug-resistant Gram-negative bacilli is a serious global health problem that has a profound impact on severely immunosuppressed neutropenic haematological patients. Prompt institution of appropriate antimicrobial therapy is crucial for improving outcomes in these patients, and in an era of multidrug resistance, antimicrobial stewardship programmes are mandatory. Blood cultures, the current gold standard for the diagnosis of BSI, present two main drawbacks: the prolonged time to results and their low sensitivity, especially if the patient has received antimicrobial treatment before blood extraction. The aim of this study is to determine whether a molecular technique, the BioFire FilmArray Blood Culture Identification 2 (BCID2) panel, achieves higher sensitivity and specificity than conventional blood cultures for the microbiological diagnosis of BSI in haematological patients with febrile neutropenia.

Methods and analysis
This multicentre, prospective, observational study will be conducted at three reference university hospitals in Spain. The population will comprise haematological patients scheduled to undergo diagnostic blood cultures as standard care for the microbiological diagnosis of the febrile neutropenia episode. The BioFire FilmArray panel will be performed in patients with positive blood cultures at the time of blood culture positivity and in patients with negative blood cultures at 48 hours of incubation. The primary endpoint will be the sensitivity and specificity of the BioFire FilmArray BCID2 panel compared with conventional blood cultures. The secondary endpoints will be this same comparison in the subgroup of patients with recent (

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ARBOR-Telehealth study: an examination of telerehabilitation to improve function and reduce opioid use in persons with chronic low back pain in rural communities – protocol of a pragmatic, individually randomised group treatment trial

Introduction
Chronic low back pain (LBP) imposes significant burden on patients, healthcare systems and society. Physical therapy is a cost-effective method for improving pain and disability; however, only a small number of patients (7–13%) with LBP ever receive physical therapy services. Patients report obstacles to accessing physical therapy, such as transportation, provider availability and missed work. Access is especially limited in rural communities, where approximately 40% fewer physical therapists are available per capita than in metropolitan regions. This lack of access likely contributes to the greater rates of LBP-related disability and opioid consumption in rural communities. Innovative methods for improving access to physical therapy for patients with chronic LBP are urgently needed; these can help address differences in health outcomes and mitigate opioid dependence for patients with chronic LBP living in rural communities. Telerehabilitation increases access to physical therapy, which can potentially improve health outcomes for these patients.

Methods and analysis
This prospective, individually randomised group treatment trial will involve primary care clinics serving rural communities on Maryland’s Eastern Shore. We will enroll 434 individuals with chronic LBP. Eligible patients will be randomised to either standardised education for back pain delivered via website or to a risk-informed telerehabilitation. Standardised education will be delivered via a study website containing information consistent with materials provided by primary care providers. Risk-informed telerehabilitation will be delivered by trained physical therapists using a web-based, video-enabled telehealth platform. The primary outcome is LBP-related disability. Secondary outcomes are opioid use, pain intensity, health-related quality of life and LBP-related healthcare use assessed using standard patient-reported outcome measures, participant self-report and medical chart abstraction. Implementation outcomes are acceptability, adoption, feasibility and fidelity of our treatment approach guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework and assessed using surveys, semi-structured interviews and key performance metrics.

Ethics and dissemination
Ethics approval was obtained from the Johns Hopkins Medicine Institutional Review Boards (IRB), which serves as the single IRB for this trial. Upon completion, study data will be shared in compliance with National Institutes of Health guidelines.

Trial registration number
NCT06471920.

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Examining the challenges of people living alone with neurodegenerative conditions: a scoping review protocol

Introduction
People living alone with neurodegenerative conditions face unique difficulties in maintaining independence and accessing appropriate health and social care support. Consolidating current understanding regarding these unique difficulties would better inform health and social care services and enable more tailored and appropriate service delivery. The proposed scoping review will summarise evidence from studies that provide evidence about people with dementia, Parkinson’s disease, Huntington’s disease or motor neurone disease who live alone. This protocol sets out the processes that will be followed in the subsequent scoping review to ensure that a transparent, rigorous and reproducible approach is used to identify, select and synthesise relevant evidence.

Methods and analysis
This scoping review protocol uses well-established methodology outlined by the Preferred Reporting Items for Systematic review and Meta-Analysis and the Joanna Briggs Institute. Relevant publications will be searched using PubMed, Web of Science Core Collection, CINAHL and AgeLine via EBSCOhost and EMBASE, PsycInfo and Social Policy and Practice via Ovid. Grey literature will be searched via Google looking specifically for pdf documents. As there was no previous review on the topic, no date restrictions will be applied to the searches. Piloting of the search strategy provided an estimate of the number of titles likely to require title and abstract screening, which, along with prior experience from a similar review approach, informed the feasibility of the proposed strategy. For research publications, a two-stage screening approach will be undertaken. The first stage will involve screening titles and abstracts for relevant literature on people with neurodegenerative conditions living alone in the community. The second stage will involve full text screening of selected articles. For grey literature, the first 20 PDFs per website identified in Google will be downloaded and screened. Summary data will be extracted from publications selected for inclusion. Data synthesis will involve tabulating study characteristics and findings and preparing narrative summaries to identify commonalities, gaps and areas for future research.

Ethics and dissemination
Ethical approval is not required for this review, as the information included is in the public domain and people with lived experience are consultees rather than research participants. Consultation with people with lived experience, stakeholders and experts linked with the National Institute for Health and Care Research Policy Research Unit in Dementia and Neurodegeneration University of Exeter will help to ensure the relevance and applicability of findings. Dissemination will include a policy report and peer-reviewed publications aimed at informing policy, practice and improving support services for people living alone with neurodegenerative conditions.

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Artificial intelligence for difficult airway assessment: a protocol for a systematic review with meta-analysis

Introduction
Identifying difficult airways and avoiding unanticipated difficult airways through difficult airway assessment are crucial for patient safety prior to airway management. Therefore, accurately predicting difficult airways through airway assessment is a fundamental and significant technique in airway management by clinicians. Artificial intelligence (AI) is a rapidly evolving science with greater data processing ability than humans. AI, given its ever-expanding applications in medical diagnosis and disease prediction, has been employed to predict cases with difficult airways. Nevertheless, the diagnostic performance of AI algorithms for difficult airway assessment remains unclear due to the small sample sizes, insufficient image acquisition standards and poor predictive accuracies. Consequently, this study aims to formulate a protocol for a systematic review and meta-analysis to ascertain the diagnostic value of AI in assessing difficult airways.

Methods and analysis
English-language databases (Cochrane Library, Web of Science, PubMed, Ovid Medline and Embase), Chinese electronic databases (China National Knowledge Infrastructure, VIP and Wanfang ] and clinical trial registry databases will be searched from their inception until January 2025 to identify clinical trials of AI for difficult airway assessment. Sensitivities, specificities, areas under the receiver operating characteristic curve, diagnostic likelihood ratios and diagnostic ORs with 95% CIs will be presented as indicators of AI’s diagnostic accuracy in assessing difficult airways. Depending on the level of statistical heterogeneity evaluated by the I-square test, the fixed-effects or random-effects model will be employed. The risk of bias will be evaluated using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Furthermore, the quality of evidence concerning the outcomes will be assessed based on the Grading of Recommendations Assessment, Development and Evaluation criteria for diagnostic tests. Heterogeneity will be investigated through sensitivity, meta-regression and subgroup analyses. Additionally, Deeks’ funnel plot asymmetry test will be used to detect publication bias.

Ethics and dissemination
Ethical approval is not required for this systematic review protocol. The results will be disseminated through peer-reviewed publications.

PROSPERO registration number
CRD42023462926.

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