Search Results for: Low Back Pain: raccomandazioni

A woman in her 40s with a medical history of complex regional pain syndrome presented to the dermatology department for evaluation of a pruritic recurrent rash on her right anterior thigh. What is your diagnosis?

Objective
The present study employed latent profile analysis (LPA) to identify three distinct profiles of subjective well-being (SWB) among Chinese nurses. It further examined the factors influencing these profiles and aimed to provide a foundation for targeted interventions to enhance nurses’SWB.

Design
A cross-sectional study was conducted between November 2023 and March 2024.

Setting
Data were collected from three Class III Grade A hospitals in China.

Participants
A total of 2272 nurses were recruited for this study.

Outcome measures
Data collection used a demographic questionnaire, the SWB Scale, the Nurse Job Satisfaction Scale and the Perceived Social Support Scale. LPA identified distinct SWB characteristics, and influencing factors were analysed using 2 tests and multivariable logistic regression analysis.

Results
Nurses’ SWB was classified into three profiles: (1) high health concern–low well-being (27.3%), (2) moderate health concern–moderate well-being (41.1%) and (3) low health concern–high well-being (31.6%). Multivariable regression analysis revealed significant associations of gender, age, years of experience, professional title, position, self-perceived health, social support and job satisfaction with these profiles (p

Objective
To investigate whether prophylactic nebulised antibiotic inhalation reduces the incidence of ventilator-associated pneumonia (VAP) in critically ill adults undergoing mechanical ventilation.

Study design
Systematic review and meta-analysis of randomised controlled trials.

Data sources
PubMed, Embase and the Cochrane Central Register of Controlled Trials were searched from inception to 1 January 2024 without language restrictions.

Eligibility criteria for selecting studies
We included randomised controlled trials comparing prophylactic nebulised antibiotics with placebo or no treatment in mechanically ventilated adult intensive care unit (ICU) patients. Two independent reviewers conducted data extraction and assessed risk of bias. A meta-analysis was performed using random-effects models to calculate relative risks (RRs) for VAP and secondary outcomes.

Results
Of the 2663 studies screened, four were deemed suitable for analysis, involving a total of 1160 patients (574 receiving prophylactic antibiotics via nebulised inhalation). Nebulised antibiotics reduced the incidence of VAP compared with control (RR 0.70, 95% CI 0.52 to 0.93, I²=38%, low-certainty). There were no statistically significant differences in ICU mortality (RR 0.89, 95% CI 0.73 to 1.09, I²=0%, low-certainty, moderate-certainty) or hospital mortality (RR 0.93, 95% CI 0.78 to 1.11, I²=0%, moderate-certainty). Risk of bias varied across studies, with one trial assessed as high risk, one with some concerns and two with low risk.

Conclusions
Nebulised prophylactic antibiotics may reduce the incidence of VAP in critically ill patients receiving mechanical ventilation, though secondary outcomes did not differ between the intervention and control groups. The findings should be interpreted with caution due to the small number of included trials and low certainty of evidence.

PROSPERO registration number
CRD42024496276.

Objectives
This study explored knowledge of dementia, attitudes towards dementia risk prediction and barriers and facilitators to accessing dementia services for diverse populations in England.

Design
Qualitative study using task group methodology, interrogated through framework analysis.

Setting
Task groups were held primarily in-person at local community venues (n=12) with one task group conducted online.

Participants
147 individuals (mean age=63 years old, 62% female) were recruited, representing low-income and ethnically diverse groups from two sites (Nottingham and Newcastle, UK). Participants were from diverse ethnic backgrounds with 37% Black or Black British, 24% Asian or Asian British, 20% white, 9% not provided, 7% Arab and 1% other ethnicities.

Results
Participants possessed some knowledge about dementia but highlighted a need for better access to information about dementia. Participants were knowledgeable about dementia risk factors, but knowledge of risk prediction was low. Attitudes towards dementia risk prediction were cautiously optimistic, and the use of risk prediction tools was viewed as empowering. However, participants stressed the need to consider the psychological impact of a high-risk result. Barriers to accessing dementia services included stigma, denial, language, cultural and religious views about dementia. Recommendations for service improvement included engaging with communities in their spaces, workforce training around dementia awareness, cultural competency and communicating with diverse groups, improving the provision of information in different languages and access to translators.

Conclusions
As international policy on dementia shifts focus to prevention, there is a growing interest in identifying those at high risk and intervening early. This study illustrates current levels of dementia knowledge and attitudes towards risk prediction among socioeconomically and ethnically diverse groups in the UK. Barriers to health services for diverse populations and service improvement recommendations offer a starting point for providers to develop culturally aware and inclusive dementia services.

Objectives
To systematically evaluate the intervention effect of modified constraint-induced movement therapy (m-CIMT) on upper limb function in patients who had a stroke.

Design
Systematic review and meta-analysis.

Data sources
A computer-based search was conducted in PubMed, Cochrane Library, Embase, Web of Science and China National Knowledge Infrastructure for randomised controlled trials (RCTs) on the intervention effect of m-CIMT on upper limb function in patients who had a stroke, with the search conducted up until 23 May 2024.

Eligibility criteria
We included only RCTs in which patients who had a stroke performed m-CIMT or m-CIMT in addition to the control group, and the outcome was upper limb function.

Data extraction and synthesis
Data extraction and synthesis used the reporting checklist for systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The risk of bias and methodological quality of included studies were evaluated by two independent investigators under the guidance of Cochrane risk of bias. Effect sizes were pooled, funnel plots were created and subgroup analyses were conducted using Stata V.17.0. If I² >50%, a random-effects model was applied; otherwise, a fixed-effects model was used. Publication bias was assessed through funnel plots and Egger’s test. In the presence of publication bias, a trim-and-fill method was employed for further examination. The quality of evidence was evaluated using GRADEpro.

Results
A total of 16 studies including 612 patients were included. Rehabilitation outcomes were assessed using the Fugl–Meyer Assessment (I²=90.34%), Motor Activity Log—Quality of Movement (I²=36.02%), Motor Activity Log—Amount of Use (I²=65.76%), Action Research Arm Test (I²=62.66%) and the Wolf Motor Function Test (I²=36.78%). Low-level evidence suggests that m-CIMT improves upper limb function in patients who had a stroke (all p2 months’ (p=0.005). Intervention periods of ‘2–4 weeks’ (p=0.008) and ‘5–12 weeks’ (p

Introduction
Methadone has emerged as a promising option for perioperative pain management, primarily due to its rapid onset of action and prolonged duration of effect, which provides sustained analgesic benefits. Despite its clinical advantages and minimal reported risks for postoperative respiratory depression, concerns about its potential respiratory complications persist. This protocol outlines a meta-analysis aimed at evaluating the risk of respiratory depression associated with methadone administration in the perioperative setting compared with other opioids or placebo.

Methods and analysis
We will perform a systematic review of literature published in English from 1 January 1970 to the present using Ovid MEDLINE, Ovid Embase and Cochrane CENTRAL. Eligible studies will consist of randomised controlled trials, cohort studies and case–control studies reporting respiratory depression in surgical patients receiving intravenous methadone. Case reports, reviews and non-English studies will be excluded. The primary outcome is respiratory depression, defined as naloxone administration, a respiratory rate of fewer than 8 breaths per minute, or an arterial oxygen saturation below 90%. Secondary outcomes include the timing and dose–response effect of methadone on respiratory depression. Bias will be evaluated using the Cochrane Risk of Bias Assessment 2 and ROBINS-I tools. Meta-analyses will be performed, and effect estimates will be presented as relative risks or ORs with 95% CIs. The certainty of the evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation methodology.

Ethics and dissemination
Ethics approval is not necessary for this systematic review and meta-analysis. The results will be published in a peer-reviewed journal and presented at national and international conferences focused on perioperative medicine and pain management.

PROSPERO registration number
CRD42025630383.

Objective
The Canadian Real-world Evidence for Value in Cancer (CanREValue) Collaboration was established in response to growing interest in using real-world evidence (RWE) to support health technology assessment (HTA). CanREValue has developed a framework to generate and use RWE to inform cancer drug funding decisions.

Design and participants
The RWE framework was developed using a multistage, multistakeholder approach. First, an environmental scan and qualitative study were conducted to understand the current state and key stakeholder perspectives on RWE. Next, five formal working groups (WGs) were established consisting of stakeholders with cancer drug funding expertise including clinicians, patients, methodologists, payers, regulatory decision-makers and data analysts. Through stakeholder consultations, including modified Delphi exercises and workshops, each WG developed specific framework components and identified facilitators and barriers that may impact the uptake of RWE.

Setting
The CanREValue Collaboration consisted of membership and participation from stakeholders and expertise from across Canada. Central research operations were managed from Toronto, Ontario, Canada.

Outcomes
Development of an RWE framework reflective of the needs and perspectives of stakeholders directly involved and/or impacted by cancer drug funding decisions across Canada.

Results
Through an iterative process, a comprehensive RWE framework was developed that outlined the end-to-end processes necessary for the generation and use of RWE for HTA reassessment in Canada. The framework consists of four phases that uses various tools, templates and processes, which can be applied as a whole or in part. A diverse range of stakeholders and expertise is involved in the decision-making of each phase of the process: Phase I: identification, selection and prioritisation of RWE questions; phase II: initiating and planning the RWE study; phase III: conducting the RWE study and phase IV: conducting reassessment.

Conclusions
As the cancer drug funding landscape continues to evolve, the need for RWE to support evidence-based policy reform, pricing and reallocation of funding from low to high value settings is crucial. We have developed a framework that is adaptable and responsive to the changing landscape. The tools, templates and processes within the framework can be applied by various stakeholder groups in whole or in part to support cancer drug funding decision-making in Canada and can be adapted for use in other jurisdictions.

Introduction
Early and accurate diagnosis of tuberculosis (TB) is central to ensuring the proper treatment and curbing the transmission of the disease. Despite the significant burden, the diagnosis of peripheral lymph node(LN)TB, the most prevalent form of extra pulmonary tuberculosis (EPTB), has been challenging in low resource settings. To meet the existing needs, the Mobile-TB-Lab study set out to evaluate two innovative approaches, including thermal imaging and recombinase-aided amplification assay (RAA) in Minoo for point-of-need diagnosis of LNTB. The synergy of these index tests is expected to pave the way for rapid detection of EPTB in resource-constrained settings.

Methods and analysis
Mobile-TB-Lab is a multicountry diagnostic evaluation study to be performed in Bangladesh and Uganda. Under this protocol, a total of 200 suspected EPTB patients with cervical lymphadenitis will be enrolled from tertiary healthcare facilities in Bangladesh and Uganda. Each participant will be subjected to laboratory investigations including microscopy, real-time PCR, cytology, culture and Xpert MTB/RIF Ultra with the tissue sample following fine-needle aspiration (FNA). As the index tests, thermal imaging will be performed before performing the FNA, and the leftover aspirate will be used to perform RAA in the Minoo device. The diagnostic efficiency of the index tests will be determined against a composite reference standard based on the laboratory methods. Besides, latent class analysis will be performed to assess the diagnostic accuracy of the index tests. Finally, health economic evaluation will be performed to determine the cost-effectiveness of the investigative methods.

Ethics and dissemination
The study protocol (PR-23031) has been approved by the research review committee (RRC) and the ethical review committee (ERC) under the institutional review board (IRB) of icddr,b in Bangladesh. In Uganda, the study protocol has been approved by the Research Ethics Committee of the Infectious Diseases Institute of Makerere University under reference number IDI-REC-2023–62 and approval from the Uganda National Council for Science and Technology (UNCST) under reference number HS3494ES. All the study materials and procedures to be used for the enrolment of the participants have been approved by the ethical review committee. The study will be performed according to the declaration of Helsinki and the International Council for Harmonisation–Good Clinical Practice to ensure the participants’ rights, safety and well-being. The findings from this study will be submitted to peer-reviewed journals and presented at relevant national and international meetings.

Objectives
Alopecia areata (AA) is a chronic immune-related disease with non-scarring hair loss. Treatment may reduce disease activity but cannot cure. Even though AA can be very burdensome to patients, the German social act has categorised AA as a ‘lifestyle disease’ and treatment is not covered by statutory health insurances (SHI). We aimed to characterise the healthcare situation of patients with AA in Germany, including potential inequalities, and to derive recommendations for action.

Design
This mixed-methods study combined: (1) semistructured qualitative interviews with patients and dermatologists, analysed through qualitative content analysis and (2) claims data analyses of a large nationwide German SHI from 2016 to 2020. Both types of data were collected and analysed in parallel to enable integrated analysis. Consecutively, an expert panel derived recommendations for action.

Setting
Interviews were conducted online or via telephone.

Participants
Patients were recruited conveniently via a dermatological outpatient clinic, patient organisations and social media. Dermatologists were recruited from a nationwide network and the dermatological societies.

Primary and secondary outcome measures
Exploration of the healthcare situation of adult persons with AA in Germany, investigating potential barriers to adequate care and identifying potential inequalities of access to care.

Results
We interviewed 20 patients (mean age 40.7 years; 75.0% female) and 14 dermatologists (mean age 48.4 years, 50.0% female). SHI data included 4692 persons with AA in 2020 (prevalence 0.23%; mean age 55.8 years; 76.2% female). The lack of reimbursement was criticised by both patients and dermatologists. Though 57.5% of patients received at least one drug prescription, mostly topical therapies, access to approved systemic drugs was very low. Drugs were prescribed mostly by general practitioners (41.1%) and dermatologists (32.8%). Some patients were sceptical regarding the side effects of treatment and criticised exclusively symptomatic treatment. Patients reported an urge for information and exchange with others, as well as different ways of handling their disease, such as acceptance, and frustration or desperation. Patients living in urban areas received topical therapies more often than patients in rural areas. Furthermore, women were more likely to receive treatment than men. Recommendations for action include reimbursement of AA medication and developing a platform providing information on AA to physicians and patients.

Conclusions
The disease burden and frustration of patients with AA is high, mostly caused by limited treatment options and lack of reimbursement, limiting access to approved drugs such as Janus kinase inhibitors.
Through the mixed-methods design, we were able to combine patient experiences and quantitative data reflecting the reality of healthcare in Germany.

Objectives
Subanaesthetic doses of esketamine may attenuate the opioid-induced cough reflex and prevent intraoperative haemodynamic fluctuations. This study aims to evaluate the effect of subanaesthetic doses of esketamine on the quality of recovery in patients who underwent abdominal surgery.

Design
Retrospective cohort study using propensity score matching (PSM) methodology.

Setting
A tertiary academic hospital.

Participants
Patients who underwent abdominal surgery under general anaesthesia with tracheal intubation between 20 December 2022 and 30 April 2023, were retrospectively reviewed. Patients were assigned to the esketamine or control group based on whether they received a subanaesthetic dose of esketamine.

Primary and secondary outcome measures
The primary outcome was extubation time (T1). Secondary outcomes included post-anaesthesia care unit (PACU) observation time (T2), total PACU time (T3), postoperative pain at multiple time points and adverse events including respiratory depression, hypertension and others.

Results
A total of 2177 patients underwent abdominal surgery. After PSM, 1196 patients were analysed, 598 in each group. Esketamine significantly reduced the extubation time compared with the control group (20.00 vs 23.00 min, p=0.001). Total PACU time was shorter in the esketamine group than in the control group (62 vs 66 min, p=0.015), although PACU observation time did not show a significant difference. Compared with the control group, the esketamine group had a lower incidence of severe postoperative pain immediately after extubation (0.33% vs 2.01%, p=0.007) and respiratory depression (2.68% vs 5.35%, p=0.027), but a higher incidence of hypertension (9.53% vs 6.35%, p=0.042). There were no other significant differences in adverse events between the two groups.

Conclusions
The use of subanaesthetic doses of esketamine for induction of anaesthesia in patients undergoing abdominal surgery may shorten the extubation time and reduce the incidence of postoperative complications.

Trial registration number
ChiCTR2300072154.

Stroke, Ahead of Print. Perioperative stroke, defined as a cerebrovascular event occurring during surgery or within 30 days postoperatively, remains a devastating complication associated with substantial morbidity, disability, mortality, and increased healthcare utilization. Although overall incidence is relatively low—up to 1% in most surgical populations—it is significantly elevated in cardiac, major vascular, and neurosurgical procedures, often exceeding 5%. The rising prevalence of perioperative stroke, primarily driven by an aging surgical population burdened by multiple chronic vascular conditions and increasingly eligible for high-risk surgical interventions, underscores the urgency of optimizing preventive and management strategies. This review synthesizes insights into patient- and procedure-related risk factors, highlighting the intricate interplay of embolic, thrombotic, and hypoperfusion mechanisms underpinning perioperative ischemic strokes. Key patient-specific risks include advanced age, recent cerebrovascular events, atrial fibrillation, carotid stenosis, and chronic cardiovascular comorbidities. Procedural factors, such as the type and complexity of surgery, intraoperative hypotension, and vascular manipulations, further modulate stroke risk. Emphasizing an evidence-based approach to risk mitigation, this review examines preoperative risk stratification, intraoperative techniques designed to minimize cerebral embolization and preserve adequate perfusion, and structured postoperative protocols aimed at rapid stroke detection. Acute management complexities are also discussed, with careful consideration of intravenous thrombolysis and mechanical thrombectomy in the postoperative setting. Finally, gaps in current guidelines and promising areas for future research are identified, advocating a multidisciplinary approach involving neurology, surgery, anesthesiology, and allied specialties to enhance patient outcomes and reduce the perioperative stroke burden.

Objectives
This study aims to compare the outcomes of different pharmacotherapies for subjective tinnitus patients using a comprehensive network meta-analysis.

Design
Systematic review and network meta-analysis.

Data sources
PubMed, EMBASE, Web of Science and CINAHL Complete databases were searched from inception until 6 March 2025.

Eligibility criteria
Randomised controlled trials (RCTs) comparing pharmacotherapy treatment effects for subjective tinnitus patients were included with tinnitus severity as the primary outcome, and annoyance and tinnitus loudness as secondary outcomes.

Data extraction and synthesis
Two reviewers independently retrieved and screened full articles using a standardised and prepiloted Excel form. Network meta-analysis was conducted with heterogeneity, study risk of bias (ROB), risk of publication bias and certainty of evidence examined using I2, 2, ROB2, funnel plots and Grading of Recommendations, Assessment, Development, and Evaluation assessments.

Results
Sixty full-text RCTs from 21 countries were included in the analysis with 22% low ROB, 58% some concerns and 20% high ROB. The heterogeneity parameter I2 was 0.67 (95% CI 0.33 to 0.84), 0 (95% CI 0 to 0.9) and 0.63 (95% CI 0 to 0.89) for the severity, annoyance and loudness network analysis, respectively. The only significant publication bias assessment by Egger’s test was detected in the loudness network analysis (p

Introduction
Emerging studies have compared the analgesic effects of quadratus lumborum block versus caudal block in paediatric surgeries, but the results remain controversial. This protocol of a systematic review and meta-analysis aims to determine whether quadratus lumborum block is better than caudal block for postoperative analgesia in paediatric surgeries.

Methods and analysis
PubMed, EMBASE, the Cochrane Library and Web of Science will be systematically searched from inception to 30 May 2025. The language will be restricted to English. Randomised controlled trials that compared the efficacy and safety of quadratus lumborum block and caudal block in paediatric patients will be included. The duration of analgesia, defined as the time to first analgesic request, will be the primary outcome. The secondary outcomes will include total opioid consumption over the first 24 hours postoperatively, pain scores at rest and during movement, and the incidence of side effects. RevMan V.5.4 software will be used for the statistical analysis. The Grading of Recommendations Assessment, Development and Evaluation approach will be applied to assess the evidence quality.

Ethics and dissemination
Ethical approval is not applicable. The results will be publicly published when completed.

PROSPERO registration number
CRD42025637094

Introduction
Animal studies suggest that elevated sympathetic nervous system (SNS) activity can accelerate bone loss. However, this area has not been well researched in humans. High-intensity Resistance and Impact Training (HiRIT) is recognised as an effective treatment for osteoporosis and osteopenia. Alternate forms of exercise such as mind-body exercise may be used to modulate sympathetic activity, which could have an additive benefit for skeletal adaptation when used in conjunction with HiRIT. The aim of this study is to investigate whether the combination of mind-body exercise (Tai Chi) and HiRIT can be used to concurrently modulate SNS activity and improve skeletal health.

Methods and analysis
The CHILL BONES trial is a semi-randomised controlled trial where consenting adults over 60 years, who have low bone mass (total hip, femoral neck and/or lumbar spine T-score