Prevalence of anabolic steroid users seeking support from physicians: a systematic review and meta-analysis

Objectives
To estimate the overall prevalence of androgenic-anabolic steroids (AAS) users seeking support from physicians. Secondary objectives are to compare this prevalence in different locations and among subpopulations of AAS users, and to discuss some of the factors that could have influenced the engagement of AAS users with physicians.

Design
Systematic review and meta-analysis.

Data sources
MEDLINE, PsycINFO, Web of Science and SciELO were searched in January 2022.

Eligibility criteria
Quantitative and qualitative studies reporting the number of AAS users who sought support from physicians, with no restrictions of language or time of publication.

Data extraction and synthesis
Two independent reviewers extracted data and assessed the quality of studies, including publication bias. A random-effects meta-analysis was performed to estimate the overall prevalence of AAS users seeking support from physicians, followed by pooled prevalence rates by studies’ location and the subpopulation of AAS users.

Results
We identified 36 studies published between 1988 and 2021, involving 10 101 AAS users. The estimated overall prevalence of AAS users seeking support from physicians is 37.12% (95% CI 29.71% to 44.52%). Higher prevalence rates were observed in studies from Australia (67.27%; 95% CI 42.29% to 87.25%) and among clients of the needle and syringe exchange programme (54.13%; 95% CI 36.41% to 71.84%). The lowest prevalence was observed among adolescent AAS users (17.27%; 95% CI 4.80% to 29.74%).

Conclusion
Our findings suggest that about one-third of AAS users seek support from physicians, with remarkable differences between locations and subpopulations of AAS users. Further studies should investigate the factors influencing the engagement of AAS users with physicians.

PROSPERO registration number
CRD42020177919.

Leggi
Luglio 2022

Experiences and outcomes of Gypsy, Roma and Traveller women in pregnancy: a scoping review protocol

Introduction
Gypsy, Roma and Traveller communities are subjected to a specific form of racism fuelled by deep-seated prejudice and stereotypes. These groups have historically been the victims of school segregation, forced assimilation policies, hate speech and hate crimes.
Persecution and displacement have resulted in high rates of unemployment, reduced access to education and poorer health in general, which places these groups at significantly increased risk of poverty. In pregnancy, they are at increased risk of adverse obstetric outcomes. There is a gap in the literature surrounding the experiences and outcomes of pregnant women within this group. A scoping review was chosen as the appropriate methodology to identify what is known about the experiences and outcomes of pregnant women in these communities.

Methods and Analysis
The Levac et al guideline on conducting a scoping review will be followed. This six-step approach includes identification of the research question, identification of relevant studies, selection of studies, charting of data, summary of results and consultation with experiential experts. A comprehensive search of the following electronic databases from 1980 to 2021 will be conducted: CINAHL, Embase, MEDLINE, Scopus and Web of Science. Relevant grey literature and reference lists will also be searched. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) tool will be used.

Ethics and dissemination
Ethical approval was not required for this protocol as all literature within this scoping review are publicly available. To facilitate dissemination of findings, the research team will present the findings to key stakeholders working with Gypsy, Roma and Traveller communities.

Leggi
Luglio 2022

Charting current evidence on the health and non-health benefits and equity impacts of pandemic/epidemic individual-level economic relief programmes: a scoping review protocol

Introduction
The emergence of a regional or global scale infectious disease outbreak often requires the implementation of economic relief programmes in affected jurisdictions to sustain societal welfare and, presumably, population health. While economic relief programmes are considered essential during a regional or global health crisis, there is no clear consensus in the literature about their health and non-health benefits and their impact on promoting equity. Thus, our objective is to map the current state of the literature with respect to the types of individual-level economic relief programmes implemented during infectious disease outbreaks and the impact of these programmes on the effectiveness of public health measures, individual and population health, non-health benefits and equity.

Methods and analysis
Our scoping review is guided by the updated Arksey and O’Malley scoping review framework. Eligible studies will be identified in eight electronic databases and grey literature using text words and subject headings of the different pandemic and epidemic infectious diseases that have occurred, and economic relief programmes. Title and abstract screening and full-text screening will be conducted independently by two trained study reviewers. Data will be extracted using a pretested data extraction form. The charting of the key findings will follow a thematic narrative approach. Our review findings will provide in-depth knowledge on whether and how benefits associated with pandemic/epidemic individual-level economic relief programmes differ across social determinants of health factors.
This information is critical for decision-makers as they seek to understand the role of pandemic/epidemic economic mitigation strategies to mitigate the health impact and reduce inequity gap.

Ethics and dissemination
Since the scoping review methodology aims to synthesise evidence from literature, this review does not require ethical approval. Findings of our review will be disseminated to health stakeholders at policy meetings and conferences; published in a peer-review scientific journal; and disseminated on various social media platforms.

Leggi
Luglio 2022

Systematic review of spontaneous reports of myocarditis and pericarditis in transplant recipients and immunocompromised patients following COVID-19 mRNA vaccination

Objectives
To determine whether spontaneous reporting rates of myocarditis and pericarditis differed in immunocompromised patients compared with the whole population overall, and in terms of demographics, vaccine dose and time-to-onset.

Design
Systematic review of spontaneously reported data from the European Union/European Economic Area (EU/EEA), the USA and the UK.

Data sources
EudraVigilance (EU/EEA), Vaccine Adverse Event Reporting System (VAERS; USA) and the Medicines and Healthcare products Regulatory Agency (UK) spontaneous reporting databases were searched from date of vaccine launch to 1 December 2021.

Eligibility criteria
Publicly available spontaneous reporting data for ‘myocarditis’ and ‘pericarditis’ from EU/EEA and USA following COVID-19 messenger RNA vaccines. Reports with comorbidities or concurrent medication indicative of transplantation, HIV infection or cancer (‘immunocompromised’ population) were compared with each overall database population.

Data extraction and synthesis
Two researchers extracted data. Spontaneously reported events of myocarditis and pericarditis were presented for immunocompromised populations for each data source, stratified by age, sex, dose and time-to-onset (where available). Seriousness of each event was determined according to the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) Guideline E2A definition. Proportional reporting ratio (PRR) was calculated.

Results
There were 178 reports of myocarditis and pericarditis among immunocompromised individuals overall. Seriousness was comparable between the immunocompromised and overall populations in both databases. No trends in age or sex were observed among immunocompromised individuals. Most reports followed a second vaccine dose and occurred within 14 days. The frequency of reporting was similar to the wider population (PRR=1.36 (95% CI=0.89 to 1.82) for VAERS population).

Conclusions
Myocarditis and pericarditis following COVID-19 vaccination are very rare, and benefits of COVID-19 vaccination continue to outweigh any perceived risks. Reporting rates of myocarditis and pericarditis were similar in immunocompromised individuals, however defining characteristics differed compared with the whole population; therefore, continued monitoring of adverse events following vaccination remains vital to understand differences between population subgroups.

Leggi
Luglio 2022

Ethical challenges in palliative sedation of adults: protocol for a systematic review of current clinical practice guidelines

Introduction
This study aims to identify the full spectrum of ethical challenges of all forms of palliative sedation for adults as presented in current clinical practice guidelines (CPGs) and to determine whether CPGs specify ethical challenges of this therapy for patients with cancer and non-cancer and, if so, how exactly they do this. To the best of our knowledge, no studies have yet investigated this topic. The purpose is purely descriptive; our aim is not to make any kind of normative judgements on these challenges. Nor is our aim to assess the quality of the CPGs.

Methods and analysis
We will perform a systematic review of CPGs on palliative sedation for adults via five electronic databases, grey literature search tools, citation tracking and contact with palliative care experts. Current CPGs accredited by an international, national or regional authority, published in English, German, French, Italian or Polish, from 2000 to the date of the search, will be subjected to content analysis at the textual, linguistic and thematic levels.

Ethics and dissemination
This is a protocol for a systematic review and no human will be involved in this research. Therefore, ethics approval and consent to participate are not applicable to this context. This study protocol is reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis for Protocols criteria and registered on PROSPERO. Moreover, the integral version of this study protocol is published as a preprint on Research Square. The results of this study will be actively disseminated through peer-reviewed journals and books, international, national and local conference presentations, social media and media in general.

Leggi
Luglio 2022

Occupational outcomes of people with multiple sclerosis: a scoping review

Objectives
To update the knowledge on the occupational outcomes associated with multiple sclerosis (MS), systematically examine the extent, scope and nature of the pre-existing literature and identify research gaps in the existing literature.

Design
Scoping review.

Data sources
A comprehensive database search of PubMed/MEDLINE, Scopus, SciVerse ScienceDirect and Web of Science was performed. There were no time limits.

Eligibility criteria
We included any peer-reviewed original article reporting the occupational outcomes of people with MS between the ages of 18 and 65 years. We excluded those off-topic and with insufficient information.

Methods
This review was conducted following the Joanna Briggs Institute recommendations and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for scoping review checklist. Screening, reading of full-texts and data extraction was performed in a standardised way by expert reviewers from 14 July 2021 to 31 October 2021. We provided a narrative synthesis and an overview of findings.

Results
The initial systematic search yielded 104 228 results. After removing duplicates and applying the exclusion criteria, 403 articles were included in the review. In total, the studies evaluated 492 062 subjects with MS. One hundred fifty-four (38.2%) articles were published in the last 5 years, mostly from Europe and North America (50.9% and 33.0%, respectively). Concerning the occupational outcomes, studies mostly addressed unemployment (311, 77.2%), early retirement (120, 29.8%), disability pension (117, 29.0%), sick leave (77, 19.1%), the indirect cost of MS (74, 18.4%) and work characteristics (57, 14.1%). The results were categorised into seven subtopics: ‘Changes in work and occupational status due to MS’, ‘work-related socio-economic consequences of MS’, ‘risk factors for unfavourable occupational outcomes’, ‘reported barriers to employment’, ‘reported job accommodations and vocational rehabilitation strategies’, ‘job satisfaction, stigma, and disclosing the diagnosis in the workplace’ and ‘rating clinical scales’.

Conclusions
There are several issues that deserve further in-depth study by the scientific community in order to improve the occupational outcomes of people with MS.

Leggi
Luglio 2022

Mental health services in response to the COVID-19 pandemic in high-income countries: protocol for a rapid review

Introduction
The COVID-19 pandemic has caused disruptions to mental health services, forcing the rapid implementation of alternative ways of delivering services alongside a greater immediate, and continuously growing, demand across those services. The care and level of mental health service provided are felt to be inadequate to respond to the increasing demand for mental health conditions in the time of the pandemic, leading to an urgent need to learn from service change and consequences to inform solutions and plans to support the NHS postpandemic plan in the UK. This rapid review aims to understand the changes in mental health services during the pandemic and summarise the impact of these changes on the health outcomes of people with mental health conditions.

Methods and analysis
Cochrane CENTRAL, MEDLINE, Embase and PsycInfo will be searched for eligible studies with key terms indicating mental health AND COVID-19 AND health services. Peer-reviewed empirical studies aiming to investigate or describe new models of care, services, initiatives or programmes developed or evolved for patients (aged 18 years or over) with mental health in response to COVID-19, published in the English language and undertaken in a high-income country defined by Organisation for Economic Co-operation and Development (OECD) member will be included. Studies reporting views of the general public, letters of opinion to peer-review journals, editorial or commentaries will be excluded. Study selection and data extraction will be undertaken independently by two reviewers. Evidence will be summarised narratively and in a logic model.

Ethics and dissemination
Ethics approval is not required for this review. A list of interventions/services/models of care delivered to people with mental health conditions will be grouped as ‘Do’, ‘Don’t’ and ‘Don’t know’ based on the evidence on effectiveness and acceptability. The results will be written for publication in an open-access peer-reviewed journal and disseminated to the public and patients, clinicians, commissioners, funders and academic conferences.

PROSPERO registration number
CRD42022306923.

Leggi
Giugno 2022

Gross and applied anatomy pedagogical approaches in occupational therapy education: protocol for a scoping review

Introduction
Historically, dissection is considered the ‘gold standard’ for teaching foundational anatomy to student occupational therapists. However, many programmes no longer have access to gross anatomy laboratory resources, as it is considered too costly. To address this limitation, applied anatomy instructors have developed innovative novel approaches to teach gross and applied anatomy to student occupational therapists, including live/surface anatomy, medical imaging, and more recently, computer-aided instruction. The types of different anatomy pedagogical approaches used and their impact on learning outcomes in occupational therapy education are unclear. The purpose of this scoping review is to map the types of musculoskeletal gross and applied anatomy pedagogical approaches used in occupational therapy curricula.

Methods and analysis
Using Arksey and O’Malley’s (2005) six-stage scoping review framework, approximately 304 different search combinations will be searched across five electronic library databases (ie, MEDLINE, Embase, CINAHL, AMED and ERIC) from their inception to December 2021, in addition to conducting consultation exercises with relevant stakeholders. After title/abstract and full-text screening, included articles will be charted, collated and summarised.

Ethics and dissemination
This study will not involve human or animal subjects. Therefore, research ethics approval is not required. The proposed scoping review will help the research, institutional and clinical rehabilitation communities to better understand the types of musculoskeletal gross and applied anatomy pedagogical approaches used to foster, build and promote musculoskeletal foundational knowledge in occupational therapy education. This could potentially inform the future physical medicine course curricula in occupational therapy programmes. The findings of this review will be disseminated to occupational therapy instructors, occupational therapists, researchers and organisations offering occupational therapy programmes (eg, Universities).

Leggi
Giugno 2022

Protocol for a systematic review on routine use of antibiotics for infants less than 6 months of age with growth failure/faltering

Introduction
Antibiotics have been used as an adjunct in treating children with severe acute malnutrition 6–59 months of age; however, the data for infants less than 6 months are scarce. The WHO recently started guideline development for preventing and treating wasting, including growth failure/faltering in infants less than 6 months. This systematic review commissioned by WHO aims to synthesise evidence from current literature on the effectiveness of antibiotics for infants less than 6 months of age with growth failure/faltering.

Methods and analysis
We will conduct a systematic review and meta-analysis for studies that assessed the effect of antibiotics in the treatment of infants with growth faltering. We will search multiple electronic databases. We will include randomised control trials and non-randomised studies with a control arm. The study population is infants less than 6 months of age with growth failure. The intervention group will be infants who received no antibiotics or antibiotics other than recommended in 2013 guidelines by WHO to treat severe acute malnutrition in children. The comparison group will be infants who received antibiotics according to the 2013 guideline by WHO. We will consider the following outcomes: mortality, clinical deterioration, antimicrobial resistance, recovery from comorbidity, adverse events, markers of intestinal inflammation, markers of systemic inflammation, hospital-acquired infections, non-response. We will use the meta-analysis to pool the studies where applicable. We will use the Grading of Recommendations Assessment, Development, and Evaluation approach to reporting the overall evidence quality for an outcome.

Ethics and dissemination
This is a systematic review and will not involve contact with a human subject. The findings of this review will be published in a peer-review journal and will guide the WHO’s recommendation for the use of antibiotics in infants less than 6 months of age with growth failure.

PROSPERO registration number
CRD42021277073.

Leggi
Giugno 2022

Risk factors for fear of falling in stroke patients: a systematic review and meta-analysis

Objective
Even though 32%–83% for fear of falling (FoF) in patients with stroke, very little is known about the predictors of the problems. Therefore, we systematically reviewed the literature on risk factors for FoF in patients with stroke.

Design
A systematic review and meta-analysis

Data sources
PubMed, Embase, Cochrane Library database, Web of Science, CINAHL, PsycINFO, Grey literature and other relevant databases for related publications were searched (from inception to 17 July 2021).

Results
Eight studies involving 1597 participants were selected to analyse risk factors for patients with stroke with FoF. The quality of all included studies was assessed and categorised as medium or high quality. Review Manager V.5.3 merged the OR value and 95% CI of the potential risk factors. Meta-regression and Egger’s test were performed by Stata V.15.1. The risk factors for FoF in patients with stroke were women (OR=2.13, 95% CI 1.47 to 3.09), impaired balance ability (OR=5.54; 95% CI 3.48 to 8.81), lower mobility (OR=1.12; 95% CI 1.05 to 1.19), history of falls (OR=2.33; 95% CI 1.54 to 3.53) and walking aid (OR=1.98; 95% CI 1.37 to 2.88), anxiety (OR=2.29; 95% CI 1.43 to 3.67), depression (OR=1.80; 95% CI 1.22 to 2.67), poor lower limb motor function (OR=1.14; 95% CI 1.00 to 1.29) and physically inactiveness (OR=2.04; 95% CI 1.01 to 4.12). Measurement of heterogeneity between studies was high for all outcomes (I2=0%–93%), indicating that the substantial interstudy heterogeneity in estimated proportions was not attributed to the sampling error. Sensitivity analysis (leave-one-out method) showed that the pooled estimate was stable.

Conclusion
This meta-analysis indicated that female population, impaired balance ability, lower mobility, history of falls and walking aid in patients with stroke might be at greater risk for FoF. Future studies are recommended to determine other risk factors specific to patients with stroke.

Leggi
Giugno 2022

Mapping outcomes for recovery of consciousness in studies from 1986 to 2020: a scoping review protocol

Introduction
Historically, heterogeneous outcome assessments have been used to measure recovery of consciousness in patients with disorders of consciousness (DoC) following traumatic brain injury (TBI), making it difficult to compare across studies. To date, however, there is no comprehensive review of clinical outcome assessments that are used in intervention studies of adults with DoC. The objective of this scoping review is to develop a comprehensive inventory of clinical outcome assessments for recovery of consciousness that have been used in clinical studies of adults with DoC following TBI.

Methods and analysis
The methodological framework for this review is: (1) identify the research questions, (2) identify relevant studies, (3) select studies, (4) chart the data, (5) collate, summarise and report results and (6) consult stakeholders to drive knowledge translation. We will identify relevant studies by searching the following electronic bibliographic databases: PubMed, Scopus, EMBASE, PsycINFO and The Cochrane Library (including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials and Cochrane Methodology Register). Criteria for article inclusion are published in the English-language, peer-reviewed studies of interventions aimed at facilitating recovery of consciousness among adults ( > 18 years) with DoC following a severe TBI, published from January 1986 to December 2020. Articles meeting inclusion criteria at this stage will undergo a full text review. We will chart the data by applying the WHO International Classification of Functioning, Disability and Health Framework to identify the content areas of clinical outcome assessments. To support knowledge translation efforts, we will involve clinicians and researchers experienced in TBI care throughout the project from conceptualisation of the study through dissemination of results.

Ethics and dissemination
No ethical approval is required for this study as it is not determined to be human subjects research. Results will be presented at national conferences and published in peer-reviewed journals.

Trial registration number
CRD42017058383.

Leggi
Giugno 2022

Evidence base of economic evaluations of workplace-based interventions reducing occupational sitting time: an integrative review

Objective
To review the evidence on the economic evaluations of workplace-based interventions that are designed to reduce prolonged periods of occupational sitting.

Design
An integrative review.

Data sources
The search was conducted in 11 databases, including PubMed, Scopus, PsychINFO, NHS-EED, Cumulative Index to Nursing and Allied Health Literature (CINAHL), ProQuest, Cochrane library, Sportdiscus, Research Paper in Economics (RePeC), the International Health Economic Association (IHEA) and EconLit. The databases were searched for articles published from inception to January 2022. Subsequent citation searches were also conducted in Google Scholar. The items of the Consensus Health Economic Criteria (CHEC) checklist were used for quality appraisal of the included studies.

Results
This review included five randomised control trails, including 757 office-based workers in high-income countries. The median quality appraisal score based on the CHEC items was 14 points (a range of 9–18). The mean duration of interventions was 33 weeks (a range of 4–52 weeks). Overall, the studies reported economic benefit when implemented to reduce occupational sitting time but no effect on absenteeism. From the societal perspective, the interventions (eg, the use of a sit–stand desk) were cost-effective.

Conclusion
The economic impact of workplace interventions implemented to reduce occupational sitting time is evident; however, the existing evidence is limited, which precludes strong conclusions. Cost-effectiveness is not often evaluated in the studies exploring workplace interventions that address occupational sitting time. Workplace interventions are still in the development and testing phase; thus, the challenge for future studies is to include economic evaluation of interventions addressing sedentary behaviour in workplaces.

PROSPERO registration number
CRD42021226275.

Leggi
Giugno 2022

How do electronic risk assessment tools affect the communication and understanding of diagnostic uncertainty in the primary care consultation? A systematic review and thematic synthesis

Objectives
To conduct a systematic review and synthesise qualitative research of electronic risk assessment tools (eRATs) in primary care, examining how they affect the communication and understanding of diagnostic risk and uncertainty. eRATs are computer-based algorithms designed to help clinicians avoid missing important diagnoses, pick up possible symptoms early and facilitate shared decision-making.

Design
Systematic search, using predefined criteria of the published literature and synthesis of the qualitative data, using Thematic Synthesis. Database searches on 27 November 2019 were of MEDLINE, Embase, CINAHL and Web of Science, and a secondary search of the references of included articles. Included studies were those involving electronic risk assessment or decision support, pertaining to diagnosis in primary care, where qualitative data were presented. Non-empirical studies and non-English language studies were excluded. 5971 unique studies were identified of which 441 underwent full-text review. 26 studies were included for data extraction. A further two were found from citation searches. Quality appraisal was via the CASP (Critical Appraisal Skills Program) tool. Data extraction was via line by line coding. A thematic synthesis was performed.

Setting
Primary care.

Results
eRATs included differential diagnosis suggestion tools, tools which produce a future risk of disease development or recurrence or calculate a risk of current undiagnosed disease. Analytical themes were developed to describe separate aspects of the clinical consultation where risk and uncertainty are both central and altered via the use of an eRAT: ‘Novel risk’, ‘Risk refinement’, ‘Autonomy’, ‘Communication’, ‘Fear’ and ‘Mistrust’.

Conclusion
eRATs may improve the understanding and communication of risk in the primary care consultation. The themes of ‘Fear’ and ‘Mistrust’ could represent potential challenges with eRATs.

Trial registration number
CRD219446.

Leggi
Giugno 2022

Web-based interventions for pregnant women with gestational diabetes mellitus: a systematic review and meta-analysis protocol

Introduction
Gestational diabetes mellitus (GDM) is one of the most prevalent diseases during pregnancy, which is closely associated with many short-term and long-term maternal and neonatal complications and can incur heavy financial burden on both families and society. Web-based interventions have been used to manage GDM because of the advantages of high accessibility and flexibility, but their effectiveness has remained inconclusive. This systematic review and meta-analysis aims to comprehensively investigate the multidimensional effectiveness of web-based interventions for pregnant women with GDM, thereby aiding implementation decisions in clinical settings.

Methods and analysis
This systematic review protocol strictly adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. Six electronic databases (PubMed, Web of Science, Cochrane Central Register of Controlled Trials, Embase, CINAHL and PsycINFO) will be comprehensively searched from their inception to 26 January 2022 to identify randomised controlled trials and controlled clinical trials regarding the efficacy of web-based interventions for pregnant women with GDM on glycaemic control, behavioural outcomes, cognitive and attitudinal outcomes, mental health, maternal and neonatal clinical outcomes, and medical service utilisation and costs. Two reviewers will independently conduct the study selection, data extraction and quality assessment. The methodological quality of included studies will be assessed using the Effective Public Health Practice Project assessment tool. The overall meta-analyses for each of the interested outcomes will be performed if the outcome data are sufficient and provides similar effect measures, as well as subgroup analyses for glycaemic control indicators based on the different types of intervention format, interactivity and technology. We will conduct a qualitative synthesis for studies that cannot be quantitatively synthesised.

Ethics and dissemination
Ethics approval is not required for this review as no human participants will be involved. The results will be disseminated via a peer-reviewed journal or an academic conference.

PROSPERO registration number
CRD42022296625.

Leggi
Giugno 2022

Antipsychotic prescribing practices and patient, family member and healthcare professional perceptions of antipsychotic prescribing in acute care settings: a scoping review protocol

Introduction
Antipsychotic medications are commonly prescribed off-label in acutely ill patients for non-psychiatric clinical indications such as delirium or insomnia. New prescription initiation of antipsychotics in acute care settings increases the proportion of patients discharged home on antipsychotics without approved clinical indication. Long-term use of antipsychotics is associated with increased risk of sudden cardiac death, falls and cognitive impairment. An understanding of acute care off-label antipsychotic prescribing practices and healthcare professional, patient and family perceptions related to antipsychotic prescribing and deprescribing is necessary to facilitate in-hospital deprescribing initiatives.

Methods and analysis
We present the protocol for a scoping review following the methodology proposed by Arksey and O’Malley and the Scoping Review Methods Manual by the Joanna Briggs Institute. We will search five databases including MEDLINE, EMBASE, CINAHL, PsycINFO and Web of Science from inception to 3 July 2021 (ie, planned search date). We will include both peer-reviewed and non-peer-reviewed qualitative and quantitative studies to identify antipsychotic prescribing practices, and to describe healthcare professional, patient and family perceptions towards antipsychotic prescribing and deprescribing in the acute care setting. Protocols, systematic and scoping reviews will be excluded. Two reviewers will calibrate and perform study screening and data abstraction for quantitative and qualitative outcomes of eligible studies. Quantitative outcomes will include study identifiers, demographics and descriptive statistics of antipsychotic prescribing practices. Qualitative synthesis describing perceptions on antipsychotic prescribing practices will include deductive thematic analysis with mapping of themes to the domains of the Theoretical Domains Framework, a 14-domain behaviour and behaviour change framework.

Ethics and dissemination
No ethical approval will be required for this study as only data from published studies in which informed consent was obtained by primary investigators will be retrieved and analysed. The results of this scoping review will inform integrated knowledge translation initiatives aimed at in-hospital antipsychotic medication deprescribing.

Leggi
Giugno 2022

Examining the impact of social stressor stimuli in eliciting physiological reactivity in children and adolescents with autism spectrum disorder: a systematic review and meta-analysis protocol

Introduction
Stress is not experienced the same by everyone. Some individuals, such as individuals with autism spectrum disorder (ASD), are at risk of heightened sensitivity to stress responses. ASD is a neurodevelopmental disorder commonly characterised by deficits in social communication and social interaction. Among different stressor stimuli, social stressors are particularly worth our attention due to the social and communication challenges inherent in ASD. This study aims to systematically evaluate different social stressor stimuli in eliciting physiological reactivity in ASD, focusing on the children and adolescent population.

Methods and analysis
We designed a study protocol for this study and submitted it to PROSPERO for systematic review registration. Any studies with children and adolescents with ASD between the ages of 0 and 18 in clinical and community settings will be included. All types of social stressor interventions will be included. The outcome of interest will include studies with physiological activity of the participants being measured, for example, measures related to autonomic functioning, electrodermal functioning and cortisol level. The primary literature sources will be across four electronic databases: MEDLINE, Embase, PsycInfo and CINAHL in August 2021. The second source of literature will be across grey literature, including ProQuest Dissertations & Theses Global and across clinical trial registries in August 2021. Hand searching of references will be performed on the reference lists of all included studies. Two volunteers pursuing postgraduate-level studies will independently search and screen potential studies for eligibility. Finally, all references considered by hand searching will be reviewed by two researchers. The methodological quality of the research will be assessed by adopting the quality assessment used by a previous study. The assessment consists of four primary categories: descriptive validity, internal validity, external validity and statistical conclusion validity.

Ethics and dissemination
No ethical approval is required for this study. Results will be disseminated through conferences and publications in relevant peer-reviewed journals.

PROSPERO registration number
CRD42021244039.

Leggi
Giugno 2022