Search Results for: Il dolore neuropatico: review

The Review titled “A Person-Centered Approach to Supplemental Oxygen Therapy in the Outpatient Setting: A Review,” published online April 7, 2025, contained 3 instances of the same error in the section The Evidence. The correct threshold for severe resting desaturation is 88% or less. This article has been corrected online.

This systematic review and meta-analysis identifies reports of systematic reviews that included retracted studies in their meta-analyses, and assesses the impact of these retracted studies on the results.

To the Editor We read with great interest the recent study by Na et al on social determinants of health (SDOH) and suicide-related outcomes. This comprehensive review provides valuable insights into the role of SDOH in suicide risk, highlighting key factors that merit public health and policy attention. However, we believe that further discussion on methodological and theoretical aspects could strengthen the study’s implications.

This Review proposes a person-centered framework to improve independence and quality of life for people using supplemental oxygen and summarizes supplemental oxygen evidence and landscape in the outpatient setting.

Mission Statement: To advance the equitable, person-centered, and evidence-based practice of internal medicine through publication of scientifically rigorous, innovative, and inclusive research, review, and commentary that informs dialogue and action with clinical, public health, and policy impact.

In Reply We thank Mermel for his thoughtful and careful review of our Teachable Moment article, “The Harm of Inappropriate Central Line Blood Cultures in Clinical Practice.” We agree that whether a positive central line culture reflects a bloodstream infection, colonization, or a false-positive result requires accounting for the outcome of each blood culture obtained. In our case, we reported that the initial central line blood culture grew coagulase-negative Staphylococcus, yet the initial and repeated peripheral cultures had negative results. As only 1 of the 2 initial blood cultures revealed infection, the positive result was limited to the central line culture, and subsequent cultures revealed negative results. This suggests colonization of the catheter hub or lumen or a false-positive result due to a skin contaminant. Coupled with an alternative explanation for the patient’s fever (ie, community-acquired pneumonia), the infectious diseases consultant did not disregard the possibility of a catheter-related bloodstream infection; rather, as stated in our initial report, they determined the risk to be low. Last, we agree that alcohol end caps are an important strategy to reduce false-positive results drawn from central lines, along with careful skin and catheter disinfection. Unfortunately, such strategies do not eliminate the risk of a false-positive result, supporting our conclusion to limit central line blood culture specimens in clinical practice to specific indications: inability to obtain peripheral blood cultures, suspected catheter-related bloodstream infection in the absence of another recognized source of infection, and neutropenic fever.

Objectives
The increased use of Community Health Services (CHS) is central to UK policy visions of moving more care out of hospital to reduce pressure across the healthcare system and, in particular, the demand on secondary care, hospital services. CHS are under-researched, and little is known about how they can best contribute towards this aim. The National Health Service (NHS) in England has recently undergone a significant reorganisation, with an increased emphasis on collaborative service delivery. In the aftermath of this reorganisation, the objective of this study was to explore how commissioners and providers of CHS think about the need for services and how decisions are made about the commissioning and allocation of resources in order to facilitate out-of-hospital care.

Design
A qualitative, semi-structured interview study with participants from four case study sites in England. Semi-structured interviews were conducted virtually and transcripts analysed using a reflexive thematic approach.

Setting
Adult CHS, which included two sites with CHS providers embedded in acute hospital Trusts, one standalone CHS Trust and a CHS provider collaborative. Sites were selected for both geographical (two sites in the north of England and two in the South) and organisational model diversity.

Participants
40 participants were interviewed across all four case study sites (site A, n=10; site B, n=17; site C, n=10; and site D, n=3). To be included in the study, participants were required to have a management role in providing or commissioning adult CHS and/or their understanding of this at strategic level within the Integrated Care Systems.

Results
Themes from current literature on commissioning (organisation, assessing needs, service design and development, contracting and funding, and performance management and support) were used to structure the data. Participants from all sites reported that the reorganisation of the NHS away from Clinical Commissioning Groups to Integrated Care Boards has resulted in confusion around the commissioning function, with a lack of clarity about current roles and responsibilities. All sites were undertaking some form of service review. However, participants highlighted the fact that current population health and CHS service data do not adequately support proactive planning of services to meet rising demand. CHS find it particularly difficult to evidence their contribution to hospital avoidance. Current block contract funding models also limit the extent to which CHS can provide the flexible services required if hospital admission is to be avoided. We also found some tension around the implementation of additional hospital avoidance services (eg, ‘virtual wards’) which did not necessarily integrate with or complement core CHS services.

Conclusions
Our focus on the commissioning of CHS has highlighted the fact that the new collaborative approach to service design and delivery embodied by the creation of Integrated Care Boards has led to some confusion around decision-making. In addition, the lack of appropriate data and the funding and contractual model used to procure CHS impacts their ability to contribute to the policy agenda of treating more people in the community. These factors should be addressed if CHS are to fulfil ambitions of preventing hospital admissions.

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.

A new systematic review suggests that NIV might benefit some patients.

Objectives
To assess whether treatment with drugs that activate the Wnt pathway leads to an increased risk of cancer.

Design
Systematic review reported using Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) reporting guidelines.

Data sources
PubMed, Embase and the Cochrane Library were searched through 1 November 2024.

Eligibility criteria
All primary research articles reporting clinical studies, including observational and experimental studies, were included in this review. All studies were eligible for inclusion if they included the exposure of interest, that is, compounds which have been described to activate the Wnt pathway, and the outcome of interest, that is, cancer prevalence. No language restrictions were performed.

Data extraction and synthesis
This study was reported according to the PRISMA reporting guidelines. The search string, objectives, and study protocol methods were defined before the study was initiated.

Results
A total of 48 studies investigating drugs that activate the Wnt pathway (valproic acid, lithium, cimetidine, olanzapine, clozapine, haloperidol) were included in this systematic review. The results from this systematic review show that, at least for the included compounds in the currently used systemic dosage, cancer prevalence does not significantly increase.

Conclusions
The current study found that the use of drugs that activate the Wnt pathway was not associated with an increased risk of cancer. As a promising agent in the regenerative therapy field, further research into Wnt activation as a treatment option should be explored.

PROSPERO registration number
CRD42021286193.

Objectives
Entrustable professional activities (EPAs) have been used in undergraduate and graduate medical education and in other health professions for a long time. They are regarded as a suitable way for bridging the gap between competency-based education and actual work tasks in the workplace. In nursing education, EPA development started later, and it is unclear which EPAs have been developed and implemented yet. This scoping review aims to identify which EPAs have been developed in nursing education, which of these have even been implemented and what the empirical evidence supports any effects of implementation.

Design
Scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

Data sources
MEDLINE and EMBASE via OVID, CINAHL and ERIC via EBSCOhost were searched for the period 1 January 1995 to 31 December 2023.

Eligibility criteria
Publication period from the first mention of EPAs in 1995 to 2023, no language restrictions, all types of literature if they had a clear mention of EPAs, all academic nursing education fields, EPAs had to be mentioned in the title or abstract.

Data extraction and synthesis
Screening was conducted in a two-stage process with two authors. 13 suitable articles were included which describe either the development, implementation or assessment of EPAs.

Results
Results indicated that EPAs have been developed in 16 areas of nursing education, including special areas such as palliative care or emergency/intensive care. The activities health status assessment, care measures, leadership/management, diagnoses, care plans and protocols, emergency care measures and participation in diagnostics and/or therapy were described most often. In 4 out of 13 cases, EPAs were implemented. Described evidence indicated that the use of EPAs improved critical thinking, promoted flexibility in teaching and led to a mindset change.

Conclusions
EPAs are increasingly developed and implemented in nursing education. There seem to be overlaps between EPAs mainly covering the steps of the nursing care process.

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.

Introduction
Multiple sclerosis (MS) is an immune-mediated neurological disorder that affects one million people in the USA. Up to 50% of patients with MS experience depression, yet the mechanisms of depression in MS remain underinvestigated. MS is characterised by white matter lesions, suggesting that brain network disruption may underlie depression symptoms. Studies of medically healthy participants with depression have described associations between white matter variability and depressive symptoms, but frequently exclude participants with medical comorbidities and thus cannot be extrapolated to people with intracranial diseases. The purpose of this current study is to investigate how brain network disruption underlies depression by learning from the example of MS.

Methods and analysis
We will obtain structured clinical and cognitive assessments from 250 participants with MS and prospectively evaluate white matter disease burden as a predictor of depressive symptoms. White matter lesion burden will be quantified by identifying streamlines within white matter fascicles that intersect lesions along any portion of their trajectory, classifying these streamlines as injured, and calculating the total volume of injured streamlines to serve as the metric of disease burden.

Ethics and dissemination
Ethics approval was obtained from The University of Pennsylvania Institutional Review Board (protocol #853883). The results of this study will be presented at scientific meetings and conferences and published in peer-reviewed journals.

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

Background
Patients and their caregivers incur significant financial burden from health care costs, but the financial burden often does not consider additional impacts from non-monetary burdens.

Objectives
Examine the extent to which non-monetary burdens have been investigated and identify the methods and instruments used to collect non-monetary burdens through a systematic scoping review.

Methods
Scoping review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and Joanna Briggs Institute guidance for scoping reviews.

Data sources
PubMed, CINAHL, EconLit and Web of Science were searched from 1 January 2013 to 7 November 2023. The search identified 950 articles.

Data extraction and synthesis
A dual independent review of titles, abstracts and full texts was conducted for inclusion, and data were extracted using DistillerSR software; 166 articles met the inclusion criteria.

Results
The included studies suggest three overarching categories of non-monetary burdens: material, psychological or psychosocial and coping behaviour. Within each of these categories, the literature has identified subcategories of burdens that vary in the extent to which they have been studied. This review also identifies 29 instruments used to collect non-monetary burdens from patients and caregivers across the included studies, of which 19 were validated. Many of these instruments were used in a single study.

Conclusions
The findings help illustrate the gaps in the literature on non-monetary burdens for patients and caregivers and provide a starting point for further investigation of this topic as well as implications for policy. Future research may reference the instruments highlighted in this study to help develop new instruments for capturing non-monetary burdens to better reflect the patient and caregiver experiences with financial toxicity due to medical expenses. Collecting more comprehensive data will provide a better understanding of the range and the extent of the non-monetary burdens faced by patients and caregivers. It will also increase the evidence to support new or existing targeted programmes and policies to help patients and caregivers better cope with these non-monetary burdens.

Introduction
Systemic racism exposes Black and Latinx adolescents to a range of traumatic stressors that increase the risk for long-term emotional and behavioural health (EBH) problems. Researchers have theorised that critical consciousness (CC)—awareness of societal inequities and engagement in action to promote social justice—may serve as a protective factor that promotes youth well-being. There are few rigorous longitudinal research studies, however, that examine the development of CC among adolescents, the association over time of CC with EBH and the potential of CC to protect against harmful effects of race-related stress. This longitudinal study, Resilience in a Stressful Era (RISE), addresses these gaps using a mixed methods approach with Black, Latinx and White adolescents in Baltimore.

Methods and analysis
We plan to enrol up to 650 Black, Latinx and White adolescents ages 14–19 who reside in Baltimore, Maryland. The recruitment will include outreach through youth-serving organisations, community events, youth networks, social media, snowball sampling and re-contacting adolescents who participated in a prior study (R01HD090022; PI: Mendelson). Participants will complete online questionnaires assessing exposure to pandemic- and race-related stress, CC and EBH twice per year over 4 years as they transition into early adulthood. Using an explanatory sequential mixed methods approach, in-depth interviews exploring the development and impact of CC will be conducted with a subset of participants selected based on their CC scores and, separately, their caregivers. A Youth Advisory Board comprised of adolescents who are representative of our target study population will be developed to provide input on the study and its implementation. Growth mixture modelling and latent variable modelling will be used to analyse quantitative data. Themes identified through qualitative analyses will expand the understanding of quantitative findings.

Ethics and dissemination
All study procedures were approved by the Johns Hopkins Bloomberg School of Public Health Institutional Review Board. Findings will be disseminated through publications in peer-reviewed journals and presentations at academic conferences. We will also communicate research findings with study participants and disseminate findings to the Baltimore community, such as developing briefs for the Baltimore City Health Department and/or hosting a town hall meeting for Baltimore families.