Risultati per: Progressi nel trattamento della psoriasi: review

Soi, in Italia un terzo delle procedure rispetto a Francia e UK

We believe this systematic review and meta-analysis to be the first to combine RCTs with vascular diseases and examine the effects of exercise in people with single conditions and polyvascular disease. We found consistent evidence that exercise improves HRQoL and reduces hospitalisations across vascular disease but does not appear to impact mortality. However, the vast majority of trials were designed to target people with a single vascular condition and did not report the presence of additional vascular diseases.

Objective
To evaluate the role of using outputs from patient-facing online triage tools in clinical decision-making in primary care.

Design
Systematic review.

Data sources
Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Scopus were searched for literature published between 1 January 2002 and 31 December 2022 and updated for literature published up to end of November 2024.

Eligibility criteria for selecting studies
Studies of any design are included where the study investigates how primary care clinicians make clinical decisions in response to patient concerns reported using online triage tools.

Data extraction and synthesis
Data were extracted, and quality assessment was conducted using the Mixed Methods Appraisal Tool. Narrative synthesis was used to analyse the findings.

Results
14 studies were included, which were conducted in the UK (n=9), Sweden (n=3) and Spain (n=2). There were no studies that examined clinical decision-making as an outcome. Outcomes relating to the impact on clinical decision-making were grouped into three categories: patient clinical outcomes (n=9), primary care practitioner experience (n=11) and healthcare system outcomes (n=14). Studies reported faster clinical decisions made in response to patient concerns. Other studies reported clinicians offering unnecessary urgent appointments as patients learnt to ‘game’ the system. Clinicians felt confident managing patient requests as they can access additional information (such as a photo attachment). Moreover, clinicians’ time was freed up from appointments with limited clinical value. Contrarily, online triage was perceived as an additional step in the workflow.

Conclusion
Clinicians should be aware that their decision-making processes are likely to differ when using online triage tools. Developers can use the findings to improve the usability of the tools to aid clinical decision-making. Future research should focus on patient-facing online triage tools in general practice and the process of clinical decision-making.

PROSPERO registration number
CRD42022373944.

Introduction
Multiple chemical sensitivity (MCS) describes reported adverse reactions to exposure to common chemical agents (solvents, odourants, air pollutants, material or substances) in low doses tolerated by most people. Symptoms involve more than one organ system and responses are triggered by multiple, chemically unrelated substances.

Methods and analysis
The systematic review will aim to answer six questions: Which definitions of MCS have been validated? What is the diagnostic performance of tools for identifying MCS? What is the prevalence and incidence of MCS? What is the empirical evidence that MCS is a distinct disorder? What is the empirical evidence for underlying biological mechanisms for MCS? What are the effectiveness and safety of treatment and management strategies for MCS?
We will conduct a comprehensive search in 22 multidisciplinary databases for primary and secondary research, research registries and clinical practice guideline repositories. We will reference-mine reviews and included studies, and confer with experts. Screening will be conducted in duplicate against prespecified eligibility criteria. Data abstraction will be pilot tested using detailed data abstraction forms to ensure accuracy and minimise ambiguity. Critical appraisal will be specific to the key question. We will synthesise data in comprehensive tables and figures. Where possible, meta-analysis will use random effects models to determine effect sizes.

Ethics and dissemination
This study was determined to be exempt from review (UP-22-00516). The results will be disseminated through a journal manuscript, and the data will be publicly accessible through an online data repository.

PROSPERO registration number
CRD420250645577.

Background
In high-income countries (HICs), migrants living with HIV (MLHIV) are more likely than other HIV subpopulations to encounter problems which hamper their adherence to the care process; these include social and administrative insecurity, discrimination and psychological distress.

Objective
This systematic review aimed to determine the specific features of adherence to the HIV care process among MLHIV in HIC.

Method
Three researchers independently selected studies from a search for papers focusing on empirical studies on MLHIV’s adherence to the care process in HIC, published between 1 January 2010 and 1 November 2024 in the following databases: MEDLINE, Embase, CINAHL, PsycINFO and Google Scholar. The three dimensions evaluated for adherence to the care process were adherence to treatment, retention in care and virological response. HICs were characterised according to the World Bank’s definition.

Results
Of 601 studies screened, 69 were included (26 (38%) analysing treatment adherence 44 (64%) 44 (64%) retention in care and 34 (48%) virological response). In 49 (71%) of these studies, MLHIV from sub-Saharan Africa accounted for the majority of persons included. MLHIV were mainly categorised according to their geographical region of origin. Only one study considered the reasons for migration. Of 52 statistically significant associations, only five found that being a migrant (vs being a non-migrant) was associated with a better HIV care process. Moreover, several individual (sociodemographic, clinical and psychological), and structural (care system organisation and political) factors associated with difficulties in adhering to the HIV care process were identified.

Discussion
MLHIV living in HIC had poorer adherence to the HIV care process for all three dimensions studied (ie, treatment adherence, retention in care and virological response). Research studies categorise MLHIV according to their geographical origin. However, this type of categorisation does not adequately capture social inequalities in health. To overcome this, studies must instead categorise MLHIV according to various intersecting factors, including, among other things, their reason for migrating, the length of time living in the destination country and violence experienced during their migratory journey.

PROSPERO registration number
CRD42021253280.

Introduction
Approximately 70% of patients with stroke experience varying degrees of cognitive impairment, which imposes a substantial direct and indirect socioeconomic burden. Previous studies have shown that scalp acupuncture (SA) or repetitive transcranial magnetic stimulation (rTMS) in combination with other therapies is effective for poststroke cognitive impairment (PSCI). Limited by interstudy heterogeneity and the limited number of included studies, there is insufficient evidence of the efficacy of rTMS in combination with SA in treating PSCI. Therefore, this protocol aims to investigate the effectiveness of rTMS in conjunction with SA for patients with PSCI through a comprehensive meta-analysis.

Methods and analysis
This study will undertake a comprehensive search across nine distinct databases (Web of Science, Embase, Cochrane Library, PubMed, China National Knowledge Infrastructure, Wanfang Data, China Science and Technology Journal Database, China Biology Medicine and SCOPUS). The primary outcome will encompass the Montreal Cognitive Assessment and the Mini-Mental State Examination. The secondary outcomes are the modified Barthel Index, the Rivermead Behavioral Memory Test and the Digit Span Test. The bias risk assessment tool from the Cochrane Handbook for Systematic Reviews of Interventions will be used to evaluate bias risk, and the GRADE will be applied to gauge the quality of evidence. Furthermore, we plan to perform an analysis of subgroups to investigate the heterogeneity, employ the leave-one-out approach for sensitivity evaluation and use funnel plots and Egger’s test to determine publication bias, respectively.

Ethics and dissemination
Ethical approval is not required in systematic review and meta-analysis. The review will be published in a peer-reviewed journal.

PROSPERO registration number
CRD42024571762.

Objectives
Explore what is known about the impact of changes made at a national level to UK postgraduate medical education during COVID-19.

Design
A scoping review, following Arksey and O’Malley’s framework, reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews Checklist.

Data sources
Ovid MEDLINE, Ovid Embase and ERIC were searched for peer-reviewed literature, and grey literature was searched via DuckDuckGo. The initial search was conducted on 17 January 2023 and updated on 5 June 2024. Forward citation tracking was performed.

Eligibility criteria
English-language studies of any design examining national-level adaptations to postgraduate medical education (eg, curricula, examinations and Annual Review of Competency Panels (ARCPs)) within the UK during the COVID-19 pandemic. Studies were excluded, which focused solely on undergraduate education, international settings, grassroots-level changes (eg, to individual teaching sessions), or where full text was unobtainable.

Data extraction and synthesis
Data were extracted using a piloted charting form and analysed thematically to identify recurring patterns across studies. Basic numerical data were collected to describe study characteristics.

Results
Of 1067 records screened, 30 studies met inclusion criteria. Most were cross-sectional surveys, with a strong representation from surgical and craft specialties. Four themes were identified: (1) impact on career development (including concerns about career delays and shifts in aspirations); (2) impact on trainee progression (highlighting delays due to ARCP outcomes 10.1/10.2 and reduced procedure accreditation); (3) changes in teaching and learning (such as a shift to online learning and cancelled rotations) and (4) supervision and support (revealing mixed experiences, with reports of burnout and inadequate organisational guidance). The systemic impact was uneven across specialties and training stages.

Conclusions
National-level changes mitigated immediate educational disruptions but are beginning to reveal long-term consequences for career development, workforce planning and trainee well-being, highlighting the need for resilient and equitable future frameworks.

Introduction
Patients with ischaemic mitral regurgitation (MR) have markedly increased cardiovascular mortality compared with those with primary MR. The sex-based prognosis of patients with ischaemic MR undergoing mitral surgery remains unclear. The goal of this systematic review is to evaluate long-term mortality, reoperation, heart failure rehospitalisation and MR recurrence in women who undergo mitral valve surgery for chronic ischaemic MR, compared with men.

Methods and analysis
The MEDLINE, EMBASE, Scopus and Cochrane Central Register of Controlled Trials databases will be searched for studies reporting surgical outcomes for ischaemic MR. Studies published before 10 June 2024 and those stratifying outcomes by sex will be included. The primary outcome of this systematic review is long-term (≥1 year) mortality following mitral surgery. Secondary outcomes include operative mortality, mitral valve reintervention, heart failure rehospitalisation and MR recurrence, as assessed by echocardiography.
Risk of bias will be ascertained with the Newcastle–Ottawa scale. Heterogeneity will be assessed using Higgin’s I2 statistic. If the included studies demonstrate adequate homogeneity in their design and comparator, meta-analyses with a random-effects model will be conducted to combine estimates.

Ethics and dissemination
This systematic review uses data from previously published studies and does not involve interaction with human subjects or access to individual patient data. Therefore, ethical approval is not required for this study. The findings from this review will be disseminated through publication in a peer-reviewed journal and various media, including but not limited to, conferences, congresses and symposia.

Trial registration number
In accordance with the guidelines, our systematic review protocol was registered with the International Prospective Register of Systematic Reviews on 5 July 2024 and was last updated on 4 April 2025 (Registration number: CRD42024560892).

Objectives
This study aimed to evaluate survival outcomes and identify key mortality predictors among patients with breast cancer in Ethiopia.

Study design
A systematic review and meta-analysis.

Study participants
The study used 11 primary studies, involving a total of 4131 participants.

Data sources
We searched PubMed, Embase, Web of Science, Scopus and Google Scholar until 7 March 2025, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Eligibility criteria for selecting studies
All observational studies that had reported the survival status and/or at least one predictor of mortality of women patients with breast cancer were considered.

Data extraction and synthesis
Three independent reviewers (HA, HKN and DGA) used a structured data extraction form to extract the data. To compute the pooled survival and mortality rates, the survival rates at different observation periods and the mortality rates reported in the included studies were extracted.

Results
Eleven studies were analysed. All studies were of good quality based on Newcastle-Ottawa Scale. However, heterogeneity was high (I² = 98.2%, p=0.00). Funnel plots showed significant publication bias. The Grading of Recommendations, Assessment, Development, and Evaluations assessment indicated moderate certainty for mortality rates and predictors, limited by heterogeneity and regional data gaps. The pooled mortality rate was 36% (95% CI: 25% to 46%). The survival rates at 1, 3 and 5 years were 85% (95% CI: 75% to 96%), 66% (95% CI: 48% to 84%) and 22% (95% CI: 1% to 43%), respectively. Key mortality predictors included advanced clinical stage (Adjusted Hazard Ratio (AHR): 4.14; CI: 2.53 to 6.78), rural residence (AHR: 1.65; 95% CI: 1.27 to 2.14), positive lymph node status (AHR: 2.85; 95% CI: 1.50 to 5.44), no hormonal therapy (AHR: 2.02; 95% CI: 1.59 to 2.56), histologic grade III (AHR: 1.76; 95% CI: 1.29 to 2.41), hormone receptor negativity (AHR: 1.54; 95% CI: 1.05 to 2.25) and comorbidities (AHR: 2.24; 95% CI: 1.41 to 3.56).

Conclusion
Breast cancer in Ethiopia poses a high mortality rate primarily due to late-stage diagnosis, rural residency, histologic grade III, positive lymph node status and comorbidities. To improve survival outcomes, it is crucial to expand access to early screening, particularly in rural areas, implement comprehensive treatment protocols and strengthen healthcare infrastructure to address these critical factors.

PROSPERO registration number
CRD42024575074.

Introduction
Developing a comprehensive understanding of the current estimates for incidence and prevalence of persistent vesicoureteral reflux (VUR) following ureteroneocystostomy or endoscopic correction is crucial. This knowledge will enable us to develop strategies for shared decision-making. Furthermore, a thorough examination of the available evidence will provide an opportunity to formulate evidence-based policies aimed at preventing VUR persistence.

Methods and analysis
A systematic review and meta-analysis on the success rate and safety of secondary surgical repair versus salvage endoscopic correction for persistent (recurrent) VUR after failed cases in children will be conducted. The following international electronic databases will be searched: MEDLINE, Embase and The Cochrane Library (from inception to February 2025). For unpublished and ongoing studies, international experts in the field of research will be contacted. There will be no language restrictions; where possible, we will translate literature in languages other than English and report any literature we are unable to translate. The methodological quality of interventional studies (the risk of bias) will be independently assessed in individual studies using the Cochrane Risk of Bias tool 2, and observational studies by The Effective Public Health Practice Project critical appraisal tool. The meta-analyses will be performed using Comprehensive Meta-Analysis, V.4. The current protocol adheres to the Preferred Reporting Items for Systematic reviews and Meta-Analyses Protocol 2015 guidelines, thereby upholding the highest methodological standards.

Ethics and dissemination
Ethical approval is not required. The outcomes of this systematic review will be presented in conference presentations and published in peer-reviewed journals.

PROSPERO registration number
CRD42024528369.

Objectives
The relationship between the volume of medical procedures conducted in hospitals and the resulting health outcomes has been described for various surgical and non-surgical medical interventions. As a policy response to this, several countries have implemented minimum volume standards. However, there is currently a lack of systematically compiled evidence assessing their impact. To close this research gap, we conducted a systematic review on the effects of minimum volume standards in hospitals.

Design
Systematic review using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

Data sources
MEDLINE, PubMed Central and Bookshelf (PubMed), EMBASE (Elsevier), CENTRAL (Cochrane Library), CINHAL (EBSCO), EconLIT (EBSCO), PDQ-Evidence for Informed Health Policymaking, Health Systems Evidence and three trial registries were searched until June 2023. Additionally, manual searches were conducted.

Eligibility criteria for selecting studies
For inclusion in this review, studies must investigate the effects of minimum volume standards. We accepted all categories of outcomes. Following the Cochrane Effective Practice and Organisation of Care (EPOC) criteria, only a strict set of study designs, namely randomised controlled trials, non-randomised controlled trials, controlled before-after studies and interrupted time series studies, were included. No restrictions were placed on language, publication date or publication status.

Data extraction and synthesis
Two reviewers independently screened titles and abstracts for eligibility, reviewed the full texts and performed data extraction of the included articles. Risk of bias was assessed using the ‘Risk Of Bias In Non-Randomised Studies—of Interventions’ (ROBINS-I) tool. Certainty of evidence was rated using the GRADE approach. For data synthesis and statistical analyses, we adhered to the EPOC guidance.

Results
We included nine studies into our systematic review. Overall, the outcomes reported in the studies are heterogeneous, which did not allow for a meta-analysis, resulting in a narrative analysis of the found evidence. While travel distance increased and length of stay decreased, other reported outcomes such as complications or reoperations were not affected by the introduction of minimum volume standards. Overall, the risk of bias was considered serious for results on outcomes of seven out of the nine included studies and moderate for the remaining two. The certainty of evidence was rated low for complications, reoperations, length of stay and travel distance and very low for mortality (in-hospital; 30 days).

Conclusion
This systematic review does not provide conclusive evidence on the effects of minimum volume standards in hospitals regarding any outcomes. The certainty of evidence for mortality (in-hospital; 30 days) is very low and low for complications, reoperations and travel distance. The results are based on a relatively small number of studies for most outcomes. There is a need for studies researching the effects of minimum volume standards based on a robust study design.

PROSPERO registration number
CRD42022318883.

Introduction
In light of the rising prevalence of sedentary behaviour worldwide, its impact on health has become a subject of growing interest. To clarify whether there is a significant correlation between sedentary behaviour and chronic pelvic pain in women and to explore its potential clinical implications, this study aims to provide a systematic review and meta-analysis of the association between the two. The findings of this study will inform the development of effective prevention and intervention strategies.

Methods and analysis
This study will conduct an exhaustive search across electronic databases, encompassing PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials and Scopus, for records published up until 26 June 2024. Two independent researchers will conduct the study selection, data extraction and assessment of bias risks, with any discrepancies resolved through the collaboration of a third reviewer. To accurately discern the underlying sources of heterogeneity, sensitivity, subgroup analyses and meta-regression will be conducted in parallel. Additionally, to ensure the rigour and integrity of our research, Begg’s and Egger’s tests will serve as the primary means of evaluating the potential for publication bias within the studies under consideration.

Ethics and dissemination
Ethical approval will not be required for this study, as it will use publicly accessible, non-identifiable data from the published literature. The research team will ensure data privacy and participant confidentiality through anonymised data processing and strict compliance with relevant regulations. The results of this study will be disseminated through publication in a peer-reviewed journal.

Prospero registration number
CRD42024562443.

Intrapancreatic fat deposition may increase the risk of cardiometabolic disturbances in children. Therefore, it requires more attention in clinical research as an early indicator of ectopic fat deposition, insulin resistance and metabolic syndrome. Longitudinal studies are necessary to understand the temporal dynamics of these associations and to determine the long-term impact of intrapancreatic fat deposition on the risk of developing type 2 diabetes and cardiovascular diseases.

Introduction
Women with a history of gestational diabetes mellitus (GDM) have a high lifetime risk of developing type 2 diabetes. Diabetes prevention programmes may reduce this risk. However, challenges related to the successful implementation of diabetes prevention programmes after GDM exist. Our objective is to map the components of the effective implementation of diabetes prevention programmes after GDM. We also plan to connect the available evidence on the effective implementation of diabetes prevention programmes to the Consolidated Framework for Implementation Research.

Methods and analysis
We will conduct a scoping review following Levac’s adaptation of Arksey and O’Malley’s framework for scoping reviews. We will report it according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Using a peer-reviewed search strategy, we will search Medline, Embase, PsycInfo and Emcare for primary studies describing the effective implementation of diabetes prevention programmes after GDM. Study selection will be completed in DistillerSR by two independent reviewers. Data will be extracted by one reviewer and verified by a second reviewer for accuracy using data extraction forms in DistillerSR.

Ethics and dissemination
Ethics approval was not required. Study results will be published in a peer-reviewed journal and presented at relevant conferences.

Study registration details
This scoping review protocol was registered with Open Science Framework (OSF; preregistration, 15 April 2024; registration ID: 10.17605/OSF.IO/MPNQD).

Annals of Internal Medicine, Ahead of Print.

This systematic review to support a 2025 US Preventive Services Task Force Recommendation Statement summarizes published evidence on the benefits and harms of interventions to support breastfeeding.