Risultati per: Progressi nel trattamento della psoriasi: review

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.

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.

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).

This meta-analysis confirms the high performance of PCR for diagnosing mucormycosis and supports the instatement of PCR detection of free-DNA in blood, BALF and tissue into future updated definitions and diagnostic guidelines for mucormycosis.

Objectives
With rising poverty and widening health inequity among children in the UK, the objective of this study is to evaluate the impact of the Sure Start programme on child health outcomes in disadvantaged children.

Design
Systematic review.

Data sources
We conducted a comprehensive search of three databases: Embase, Medline and Social Policy and Practice, with grey literature searched using Open Grey, Social Care Online and Google Scholar. The search was conducted in January 2024.

Eligibility criteria for selecting studies
All primary studies investigating health outcomes in children as a result of Sure Start intervention were eligible for inclusion, without limitations on study design.

Data extraction and synthesis
Full-text articles in English were independently screened according to the eligibility criteria by two researchers. Results were synthesised and presented in both a quantitative and narrative format. We assessed the risk of bias in each included study.

Results
Our initial search identified 585 records, of which 9 met our inclusion criteria with a further 3 grey literature reports included. Three themes were identified: physical health, social functioning and neurodevelopmental disorders. In terms of physical health, our findings indicate significant reductions in hospitalisations in older children, accidental injury and obesity prevalence. Furthermore, Sure Start increased the prevalence of breastfeeding and improved dental hygiene in children. In the social functioning domain, the Sure Start programme produced mixed findings: with children from certain backgrounds observing adverse effects as a result of the intervention. Yet, Sure Start demonstrated significant improvement in education attainment, with a maximal improvement of grade improvement in children from low socio-economic and ethnic minority backgrounds. For neurodevelopmental disorders, Sure Start was able to significantly improve conduct disorder and attention-deficit hyperactivity disorder symptomatology with long-term clinical stabilisation, as well as improving screening rates for developmental disorders.

Conclusion
This study examines the evidence of the Sure Start programme, as an example of an early-years community-based intervention, to mitigate health inequity among disadvantaged children. The findings suggest the Sure Start programme to be effective in health generation across the domains of physical health and neurodevelopmental disorders for disadvantaged children, but with mixed findings for social development that can only partially be explained by methodological flaws.

Trial registration number
PROSPERO CRD42024503234.

Objectives
To understand how and under what circumstances midwife-led continuity of care (MLCC) can be implemented in high-income countries.

Design
A realist review was conducted to examine interactions between contexts, mechanisms and outcomes.

Methods
An initial programme theory described a hypothesis of how MLCC might be implemented successfully. Literature from a systematic search on the implementation of MLCC was synthesised and supplemented with unstructured searches to identify literature that reinforced the emerging concepts. The synthesis was an iterative process, endorsed in consultation with stakeholders, leading to a refined programme theory.

Results
A total of 45 documents were included. The mechanisms identified can be grouped around macrolevel challenges, leadership, role ambiguity and conflict, and personal and professional boundaries. Despite strong evidence supporting MLCC, diverse stakeholder interests and power dynamics hinder its implementation. Implementing MLCC disrupts established roles and power structures, creating uncertainty and anxiety at all levels. To successfully navigate healthcare providers through the transition, both formal and informal leaders must demonstrate the courage and vision to challenge existing norms.

Conclusions
Realist methodology allowed the identification of mechanisms that often remain unnoticed but significantly impact the implementation of MLCC. Concrete policies and guidelines are essential to ensure consistency in care delivery. Collaborative efforts and a shared philosophy among all stakeholders, combined with strong leadership that builds trust and addresses anxiety, can create a supportive environment for MLCC implementation.

PROSPERO registration number
CRD42023446437.

Introduction
Youth vaping has become a significant public health concern globally. Effective prevention messages are essential to reduce the prevalence of vaping among young people. However, evidence on the design of youth vaping prevention messages is limited. This scoping review aims to systematically map the existing evidence, identify research gaps, and provide recommendations for future research and practice.

Methods and analysis
The review will be conducted following the Joanna Briggs Institute methodology for scoping reviews and reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A comprehensive search strategy has been developed focusing on the population-concept-context elements of youth, vaping, prevention, message design and global context. Six databases will be searched: Web of Science Core Collection (including MEDLINE), PubMed, Embase, Scopus, APA PsycInfo and China National Knowledge Infrastructure. Grey literature sources, including relevant organisational websites, will also be searched. Two reviewers will independently screen titles and abstracts, review full texts, and extract data using a predefined data charting form. The extracted data will be synthesised narratively.

Ethics and dissemination
As this scoping review will only include published data and does not involve human participants, institutional review board approval is not required. The findings will be disseminated through peer-reviewed publications, conference presentations, academic networks, and social media.

Background and objectives
Peer review is ubiquitous in evaluating scientific research. While peer review of manuscripts submitted to journals has been widely studied, there has been relatively less attention paid to peer review of grant applications (despite how crucial peer review is to researchers having the means and capacity to conduct research). There is spirited debate in academic community forums (including on social media) about the perceived benefits and limitations of grant peer review. The aim of our study was to understand the experiences and challenges faced by grant peer reviewers.

Methods
Therefore, we conducted qualitative interviews with 18 members of grant review panels—the Chairs, peer reviewers and Scientific Officers of a national funding agency—that highlight threats to the integrity of grant peer review.

Results
We identified three threats: (1) lack of training and limited opportunities to learn, (2) challenges in differentiating and rating applications of similar strength, and (3) reviewers weighting reputations and relationships in the review process to differentiate grant applications of a similar strength. These threats were compounded by reviewers’ stretched resources or lack of time. Our data also highlighted the essential role of the Chair in ensuring transparency and rigorous grant peer review.

Conclusions
As researchers continue to evaluate the threats to grant peer review, the reality of stretched resources and time must be considered. We call on funders and academic institutions to implement practices that reduce reviewer burden.

Jakobsen MI, Schaug JP, Storebø OJ, et al. What is the current scope of research assessing patients’ and clinicians’ perspectives on clozapine treatment? A comprehensive scoping review. BMJ Open 2025;15:e085956. doi: 10.1136/bmjopen-2024-085956 This article was previously published with an error. Few lines in the Abstract and the Conclusion sections have been rephrased to avoid misinterpretation regarding the recommendations for future research. The following sentences have been reworded in the Abstract’s Results section: Three gaps in research were identified: (1) studies exploring clozapine-eligible, yet clozapine-naïve, patients’ attitudes towards clozapine commencement, (2) studies exploring clinicians’ reasons for clozapine withholding and perceived facilitators of clozapine treatment in individual patient-cases and (3) studies on patient and clinician perspectives on clozapine discontinuation, continuation and rechallenge in individual patient cases. The following are the revised sentences in the Conclusions section: This behaviour leaves three distinct gaps in research: (1) studies exploring clozapine-eligible, yet clozapine-naïve, patients’…

Background
Statins are considered a promising therapy in traumatic brain injury (TBI) because of their role in mediating inflammatory injury and other endothelial properties. Whether they can improve patient outcomes is unknown.

Objectives
To evaluate the effect of statins in critically ill patients with TBI.

Design
Systematic review and meta-analysis of randomised controlled trials.

Eligibility criteria
Trials of adult patients with acute moderate or severe TBI.

Methods
We searched Medline, Embase, Cochrane Central and Web of Science databases for trials comparing the use of any statin with placebo or other interventions. Our primary outcome was the Glasgow Outcome Scale (GOS or GOS extended); secondary outcomes were mortality, intensive care unit (ICU) and hospital length of stay. We used inverse variance random-effects models to calculate risk ratios (RR) and weighted mean differences. We assessed the risk of bias of trials using the Cochrane risk of bias assessment tool and the presence of statistical heterogeneity using the I2 index. Levels of evidence for summary effect measures were evaluated using Grading of Recommendations Assessment, Development and Evaluation methodology.1

Results
Of the 2418 retrieved records, 7 trials met our eligibility criteria. Three studied simvastatin, and four studied atorvastatin. The duration of the intervention ranged from 2 to 10 days, and outcomes were assessed between ICU discharge and 6 months. Five trials were considered at high risk of bias. We observed no statistically significant association between statins and the GOS (RR 0.42; 95% CI, 0.14 to 1.22; two trials; n=84, I2=0%; very low certainty) or mortality (RR 0.59; 95% CI, 0.25 to 1.44; three trials; n=160, I2=0%; very low certainty). No significant effect was observed for ICU length of stay, while hospital length of stay was evaluated in one trial showing shorter duration.

Conclusion
We found no conclusive evidence supporting the use of statins in critically ill adult patients with TBI at this time. Nevertheless, the trials were limited, and wide confidence intervals resulted in significant uncertainty of the findings. A potential benefit cannot be ruled out, underscoring the need for a larger, well-designed trial.

PROSPERO registration number
CRD42023421227.

Objectives
To summarise and synthesise existing literature on the implementation of decarbonisation actions in general practice, to outline the actions being implemented, factors influencing decarbonisation, identify evidence gaps and questions for future research.

Design
A systematic review and narrative synthesis.

Data sources
MEDLINE, Embase, CINAHL, Web of Science and ProQuest (grey literature) were searched for literature published up to 29 March 2024.

Eligibility criteria for selecting studies
Studies of any design investigating the implementation of decarbonisation actions in general practice.

Data extraction and synthesis
Two reviewers extracted data and conducted quality assessments using a mixed methods appraisal tool. Narrative synthesis was used to analyse findings.

Results
Fifteen studies were included. Studies were primarily from the UK (n=5), followed by Australia (n=3), USA (n=2), Germany (n=2) and one each from France, Switzerland and Israel. Study designs were qualitative (n=7), quantitative (n=7) and one mixed methods. Participants included healthcare staff (n=7), patients (n=5), health stakeholders (n=2) and the general public (n=1). There was evidence of general practices adopting decarbonisation actions such as resource reuse, improved waste management, energy-efficient systems and preventive care to reduce overmedication, with strong leadership and institutional support being crucial for their success. However, barriers such as high costs, resource constraints and limited awareness among clinicians and patients highlighted the need for enhanced communication, education and the structured promotion of initiatives to improve patient and community engagement.

Conclusions
There is limited evidence on the implementation of decarbonisation actions in general practice. A range of factors may impact on the extent to which implementation occurs. Addressing these will be crucial for effectively promoting and scaling decarbonisation actions in general practice. Future research should focus on understanding the role of institutional context, evaluating the real-world impact of interventions on greenhouse gas emissions and exploring patient and community involvement.

PROSPERO registration number
CRD42023470889.

Introduction
Chronic depression represents a common and highly disabling disorder. Several randomised controlled trials (RCTs) investigated the effectiveness of psychological, pharmacological and combined treatments for chronic depression. This is the first overarching systematic review and network meta-analysis (NMA) based on aggregated and individual patient data comparing the efficacy and acceptability of various treatment options for all subtypes of chronic depression. Furthermore, individual demographic and clinical characteristics that predict or moderate therapy outcomes will be investigated.

Methods and analysis
A systematic literature search of the Cochrane Library, MEDLINE via Ovid, PsycINFO, Web of Science and metapsy databases will be conducted from database inception without language restrictions to include all available samples from RCTs that investigated the efficacy of psychotherapy versus pharmacotherapy, or their combination in adult inpatients or outpatients with a primary diagnosis of chronic depression. Exclusively internet-based treatment studies will be excluded. The main outcome is depression severity measured on a continuous observer-rated scale for depression at 6 months post-treatment (range 3–12 months). Two reviewers will independently screen and select eligible studies based on the predefined inclusion and exclusion criteria. Risk of bias will be assessed using version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2). Individual patient data (IPD) will be requested and incorporated in the network when provided, as it is the gold standard of evidence. For studies which do not provide IPD, aggregate data (AD) will be extracted and incorporated in lieu of IPD for the NMA, strengthening the evidence base and leveraging all existing evidence regardless of data availability restrictions. An NMA comparing psychotherapies and a network meta-regression estimating individualised treatment effects of psychotherapy will be implemented assuming a Bayesian framework. All models will be fitted in R with calls to JAGS. Empirical informative prior distributions will be used for model parameters where available, and non-informative priors will be used in cases where empirical priors are not available.

Ethics and dissemination
This IPD-NMA requires no ethical approval. All results will be disseminated as peer-reviewed publication in a leading journal in this field and presented at (inter)national scientific conferences.

PROSPERO registration number
CRD42024526755.

Objective
To make healthcare programmes more patient-centred and efficient in light of limited resources, it is crucial to ensure patient satisfaction. There is limited information on the overall level of satisfaction with Human Immunodeficiency Virus/ Acquired Immune deficiency syndromes (HIV/AIDS) treatment and care services in Ethiopia. This meta-analysis aimed to generate a nationwide pooled estimate of the level of satisfaction with HIV/AIDS and associated factors by combining data from primary studies to provide a general overview of the effect across the country, aiming to informed policy decisions.

Design
Systematic review and meta-analysis.

Data source
PubMed, Scopus, Hinari, African journals online and Google Scholar were used to locate published studies.

Eligibility criteria
Observational studies assessing the level of satisfaction with HIV/AIDS care and treatment services and its associated factors among adult people living with HIV/AIDS receiving antiretroviral therapy in Ethiopia were included.

Data extraction and synthesis
Two authors extracted the data using a pre-established data extraction format and exported it to Stata V.17 for analysis. The Cochran-Q and I2 test statistics were used to measure the statistical heterogeneity among included studies. A random-effects meta-analysis model with the Der Simonian-Laird method was used to estimate the pooled effect size of satisfaction with HIV/AIDS care and treatment services with its 95% CI. Small study effects were assessed using Egger’s regression test at a 5% level of significance. A meta-regression analysis and a leave-one-out sensitivity analysis were also conducted.

Results
24 studies were included. The pooled level of satisfaction with HIV/AIDS treatment and care services in Ethiopia was 69.7% (95% CI 63.8, 75.5%) with a significant level of heterogeneity (I2=98.0%; p

Introduction
As educators and health professionals, school nurses are in an optimal position to improve and advocate for adolescent reproductive and sexual health. This report outlines a protocol for a systematic review to synthesize evidence on the effects of school nurse-led education interventions and barriers and facilitators to implementing the interventions to improve students’ knowledge, attitudes and behaviours related to sexual and reproductive health in high-income countries.

Methods and analysis
We will develop a protocol to systematically review school nurse-led education interventions aimed at promoting adolescent sexual and reproductive health. This protocol will be based on the methodology of the Cochrane Handbook for Systematic Reviews of Interventions. The search will be conducted in Ovid-MEDLINE, CINAHL, Cochrane Library, Ovid-Embase, PsycINFO, Koreamed and ScienceON using relevant Medical Subject Headings and text words to identify the literature on different types of studies examining school nurse-led sexual and reproductive health education interventions in April 2024. Two independent reviewers will select relevant studies and extract data using a predefined template. We will assess methodological quality using the risk-of-bias tools appropriate for study designs and will resolve discrepancies through discussion with the review team. Where appropriate, we will conduct meta-analyses to estimate the effectiveness of school nurse-led sexual and reproductive health education interventions. Additionally, a qualitative evidence synthesis will be performed for the qualitative research included in the review. Finally, both a quantitative synthesis and a qualitative synthesis will be combined into a secondary synthesis addressing the facilitators and barriers of sexual and reproductive health educational interventions provided by school nurses to adolescents.

Ethics and dissemination
This review will synthesise publicly available resources and does not require ethical approval. The findings will provide insights into how school nurses can improve students’ sexual and reproductive health. The results will be disseminated through peer-reviewed publications, reports and academic conferences.

PROSPERO registration number
CRD42022347625.

Introduction
Empirical data on the barriers limiting artificial intelligence (AI)’s impact on healthcare are scarce, particularly within the Canadian context. This study aims to address this gap by conducting a scoping review to identify and evaluate AI algorithms developed by researchers affiliated with Canadian institutions for patient triage, diagnosis and care management. The goal is to identify characteristics in the developed AI algorithms that can be leveraged for a better impact.

Methods and analysis
A scoping review will be conducted following the JBI Methodology for Scoping Reviews and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Relevant literature will be identified through comprehensive searches of MEDLINE (PubMed), CINAHL (EBSCO) and Web of Science (Clarivate) databases, combining keywords related to AI, clinical management and the Canadian context. Studies published after 2014, in English or French, that discuss AI algorithms developed for patient triage, diagnosis or care management by researchers affiliated with Canadian institutions will be included. Data from the selected articles will be extracted and analysed descriptively, and findings will be presented in tabular form accompanied by a narrative summary.

Ethics and dissemination
Ethical approval is not required for this study as it involves the review of publicly available literature. The scoping review is expected to be completed by November 2025. The findings will be disseminated through publications in peer-reviewed journals and presentations at conferences focused on AI and healthcare practice.

Introduction
Cancer remains a major global health challenge, affecting millions annually and ranking as the second leading cause of death worldwide. The complexity of cancer treatment requires an interdisciplinary approach, connecting professionals from various fields to deliver personalised and integrated care. However, structural issues and insufficient interdisciplinary training can impede effective collaboration, which is why effective interprofessional education (IPE) is needed. This protocol depicts the planned procedures for a scoping review that aims to explore the role of IPE in enhancing interdisciplinary collaboration within oncology by mapping and synthesising the implementation, impact and evaluation strategies of patient-centred IPE programmes.

Methods and analysis
This scoping review will be conducted in line with the Joanna Briggs Institute guidelines for scoping reviews. The research team will develop a comprehensive search strategy and apply it to the following databases: CENTRAL, CINAHL, Embase, MEDLINE, PsycInfo, Scopus and Web of Science . Additionally, we will search for grey literature (eg, using OpenDOAR) and contact relevant organisations for pertinent reports. Each database will be searched without date restrictions on 11 September 2024. In the first stage, eligibility criteria will be assessed through a blinded title and abstract screening, followed by a full-text review. The research team will then extract and synthesise data related to the scoping review questions, focusing on implementation, impact and evaluation strategies employed in the included studies.

Ethics and dissemination
As this protocol does not involve collecting primary data, ethical approval is not required. The results of this review will be published in a peer-reviewed journal and disseminated through institutional websites and conferences.