Risultati per: Benefici e rischi del trattamento farmacologico per il diabete di tipo 2: review

Objective
To synthesise the role of digital technologies in epidemic control and prevention, focussing on Ebola and COVID-19.

Design
A scoping review.

Data sources
A systematic search was done on PubMed, HINARI, Web of Science, Google Scholar and a direct Google search until 10 September 2024.

Eligibility criteria
We included all qualitative and quantitative studies, conference papers or abstracts, anonymous reports, editorial reports and viewpoints published in English.

Data extraction and synthesis
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist was used to select the included study. Data analysis was performed using Gale’s framework thematic analysis method, resulting in the identification of key themes.

Results
A total of 64 articles that examined the role of digital technology in the Ebola and COVID-19 pandemics were included in the final review. Five main themes emerged: digital epidemiological surveillance (using data visualisation tools and online sources for early disease detection), rapid case identification, community transmission prevention (via digital contact tracing and assessing interventions with mobility data), public education messages and clinical care. The identified barriers encompassed legal, ethical and privacy concerns, as well as organisational and workforce challenges.

Conclusion
Digital technologies have proven good for disease prevention and control during pandemics. While the adoption of these technologies has lagged in public health compared with other sectors, tools such as artificial intelligence, telehealth, wearable devices and data analytics offer significant potential to enhance epidemic responses. However, barriers to widespread implementation remain, and investments in digital infrastructure, training and strong data protection are needed to build trust among users. Future efforts should focus on integrating digital solutions into health systems, ensuring equitable access and addressing ethical concerns. As public health increasingly embraces digital innovations, collaboration among stakeholders will be crucial for effective pandemic preparedness and management.

Objectives
To map the scope of available evidence on relationships between multimorbidity patterns and functioning among adults in low- and middle-income countries (LMICs), and describe methods used.

Design
Scoping review guided by a five-step methodological framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews reporting guidelines.

Data sources
PubMed/MEDLINE, Scopus, EBSCOhost (CINAHL) and Cochrane databases were searched from January 1976 to March 2023, plus reference lists of included studies.

Eligibility criteria for selecting studies
Peer-reviewed full-text articles or conference proceedings of any design, published in English or Afrikaans, involving adults ( >18 years) with multimorbidity living in LMICs. Studies had to refer to associations between multimorbid patterns of co-occurrence and functioning. Multimorbidity was defined as the coexistence of ≥2 diseases, including any combination of non-communicable, infectious and mental health conditions.

Data extraction and synthesis
Data were extracted independently by two reviewers using a piloted form. Findings were synthesised according to methodological approaches, multimorbidity-pattern epidemiology, evidence gaps/limitations and recommendations for future research. The International Classification of Functioning, Disability and Health framework was used to classify functional problems.

Results
Nine studies (total sample size: 62 003) were included, mainly from upper-middle-income Asian countries. Key methodological inconsistencies were identified in defining and operationalising multimorbidity, conditions included in determining patterns, statistical methods for pattern determination and functioning outcome measures. Five main multimorbidity pattern domains emerged: Cardio-Metabolic and Coronary Atherosclerotic, Musculoskeletal, Respiratory and Digestive/Visceral, Degenerative, and Mental Health-Related. Mobility limitations, instrumental activities of daily living, self-care and bowel/bladder problems were consistently linked to all pattern domains.

Conclusions
The limited and geographically skewed body of literature, along with methodological inconsistencies, hampers a comprehensive understanding of multimorbidity patterns and associations with functioning in LMICs. Future research should explore context-specific multimorbidity definitions, employ transparent methodologies, use standardised measures and incorporate diverse samples to inform tailored interventions and policies.

Mahesarajah S, El Asmar ML, Irwin R, et al. Impact of the COVID-19 pandemic on psychotropic prescribing: a systematic review BMJ Open 2024;14:e076791. doi: 10.1136/bmjopen-2023–0 76 791
The article is updated since it was first published. The below mentioned sections have been updated:
Results- Changes in antipsychotic prescribing rates, line 21 and 22, page no. 8.
Results – Changes in antidepressant prescribing rates, line 20, page no. 8.
Discussion – Discussion of findings and implications of selected studies, line 33, page no. 9.
Table 2- Result, last paragraph.

Objective
To identify effective policies and non-policy interventions preventing youth vaping behaviour initiation and assess their effectiveness by the level of intrusiveness and subpopulations.

Design
This systematic rapid review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data sources
Searches on MEDLINE and APA-PsycINFO for studies published between January 2019 and November 2023.

Eligibility criteria
Observational, intervention or mixed-method studies and quantitative systematic reviews/meta-analyses measuring the impact of interventions on youth (6–18 years) who never vaped or who had experimentally vaped.

Data extraction and synthesis
A predesigned form was used to extract data. To classify interventions by levels of intrusiveness, we used the PLACE Research Lab Intervention Ladder Policy Analysis Framework. We applied PROGRESS-Plus (Place of residence, Race/ethnicity/culture/language, Occupation,Gender/sex, Religion, Education, Socioeconomic status, Social capital, and additional context-specific factors) for an equity analysis. Methodological quality was assessed using the Effective Public Health Practice Project Quality Assessment Tool.

Results
20 studies were included: 45% were experiments or quasiexperiments, 85% reported data from the USA, 65% were non-policy interventions and 40% and 35% measured susceptibility and attitudes and behaviours related to vaping, respectively. Considering the level of intrusiveness, 45% of the studies provided information and 25% eliminated choices. Overall, the certainty of evidence was low. The effectiveness of interventions regarding their level of intrusiveness varied by each outcome. No clear pattern was found between the level of intrusiveness and intervention effectiveness, suggesting that overall, the studied interventions positively changed youth vaping behaviours. Some interventions had positive effects on multiple outcomes. Equity-related findings suggested that younger youth may be less responsive to the interventions. Recommendations for action are provided.

Conclusions
We suggest that combining multiple interventions targeting different levels of intrusiveness and outcomes may be more effective in preventing youth vaping behaviours. Also important is to tailor programmes to younger youth to better meet their needs.

Objectives
Kangaroo mother care (KMC) is high impact for survival of low birth weight neonates, but there are few rigorous evaluations of duration required for impact. We conducted a scoping review of KMC duration measurement methods and assessed their validation.

Design
Scoping review in accordance with Joanna Briggs Institute guidance for conducting scoping review.

Data sources
MEDLINE, Embase, Cochrane Library, PsycINFO, African Index Medicus, Latin American and Caribbean Health Sciences Literature, ClinicalTrials.gov, International Clinical Trials Registry Platform, International Standard Randomised Controlled Trial Number Registry, Medrxiv and OpenGrey were searched through November 2022.

Eligibility criteria for selecting studies
Publications with primary data on KMC duration were included. We excluded short procedural skin-to-skin care studies.

Data extraction and synthesis
Selection and data abstraction were conducted by two independent reviewers. A data charting form based on the variables of interest was used to abstract data.

Results
A total of 213 publications were included, of which 54 (25%) documented a method of measuring KMC duration. Only 20 publications (9%) provided a detailed description of the duration measurement method, and none reported validity. Most studies used caregiver reports (29, 54%) or healthcare worker observations (17, 31%). Other methods included independent observers and electronic monitoring devices.

Conclusion
Only 9% of KMC studies reporting duration documented the measurement method applied, and no studies were found with documented validation of duration measurement methods. Accurate and comparable data on the dose response of KMC will require duration measurement methods to be validated against a gold standard such as an independent observer.

Objective
Multicomponent rehabilitation (MR) could restore functioning in elderly patients after hospitalisation, even beyond geriatrics, but specific evidence seems lacking. This review mapped the evidence on MR in elderly patients following hospitalisation for age-related conditions regarding functioning-related outcomes.

Design
Scoping review.

Data sources
PubMed, Cochrane Library, International Clinical Trials Registry Platform and ClinicalTrials.gov (searched through 24 June 2024).

Eligibility criteria
We included randomised controlled trials (RCT) and controlled cohort studies (CCS) comparing centre-based MR with usual care (medical care excluding exercise training) in patients ≥75 years, hospitalised for age-related cardiac, neurological, oncological and orthopaedic diseases. MR was defined as exercise training and at least one additional component (eg, nutritional counselling), starting within 3 months after hospital discharge. RCTs and CCS were included from inception, without language restriction. Care dependency, physical function, health-related quality of life (HRQL) and activities of daily living (ADL) after ≥6 months follow-up were the outcomes of interest.

Data extraction and synthesis
Four reviewers independently screened titles, abstracts and full texts for inclusion and extracted data. MR components and the typology of outcome assessments used were mapped at the final data synthesis level.

Results
Out of 20 409 records, nine studies were investigated in the final data synthesis. Throughout these studies, disease education was the most frequent MR component besides exercise training, while physical function, HRQL and ADL were commonly assessed outcomes. One RCT (cardiac rehabilitation, 80±0.3 years, MR/usual care n=24/23) fully met the inclusion criteria and reported improvements in physical function (2 months) and in HRQL (2, 8, 14 months post intervention) in MR patients.

Conclusions
Evidence on MR regarding functioning-related outcomes in ≥75-year-old patients is sparse beyond geriatrics. There is an essential need for studies investigating the capabilities of MR in this growing and under-represented patient population.

Trial registration number
OSF (https://doi.org/10.17605/OSF.IO/GFK5C).

Objective
We aim to assess which variables are associated with recruitment failure of obstetrical and gynaecological randomised controlled trials (RCTs), leading to an extension of the study period.

Design
Nationwide study.

Setting
A cohort of RCTs supported by the trial centre of the Dutch Consortium of Obstetrics and Gynaecology.

Population
We included 83 RCTs that recruited patients between 1 March 2003 and 1 December 2023.

Main outcome measures
Main outcome was recruitment target not achieved within 6 months after the preplanned recruitment period. Secondary outcomes were recruitment target not achieved within an extension period of at least 12 months and premature termination of the trial. In all RCTs, we collected information on variables with a potential effect on recruitment failure, recorded at five levels; patient, doctor, participating centre, study organisation and study design.

Results
In total, 46 of 83 RCTs (55%) did not achieve their targeted recruitment within the preplanned study period with a maximal extension period of 6 months. The most relevant variables for recruitment failure in multivariable risk prediction modelling were presence of a no-treatment arm (where treatment is standard clinical practice), a compensation fee of less than 200 per included patient, funding of less than 350 000, while a preceding pilot study lowered this risk.

Conclusions
We identified that the presence of a no-treatment arm, low funding and a low compensation fee per included patient were the most relevant risk factors for recruitment failure within the preplanned period, while a preceding pilot study lowered this risk. Awareness of these variables is important when designing future studies.

Introduction
Individuals experiencing disadvantaged socioeconomic positions (SEPs) may be at increased risk of falls during middle and older age, and these impacts of socioeconomic factors may vary according to the duration, timing and sequencing of exposures across the life course. However, there has not been a recent systematic review of this evidence. This study, therefore, aims to synthesise existing knowledge on the association between SEP across the life course and falls within middle- and older-aged adults.

Methods and analysis
We systematically searched for literature in three academic databases from database inception to 15 March 2024: MEDLINE (Ovid), Embase (Ovid) and PsycInfo (Ovid). The search strategy combined MeSH headings and search terms related to SEP, falls, middle- and older-aged adults and observational studies. Cohort, case-control and cross-sectional studies with mean or median participant age of >40 years, which report on the association between at least one socioeconomic indicator across the life course and one fall outcome and are published in peer-reviewed academic journals were included. No language or geographic restrictions were imposed. Titles and abstracts were screened by one reviewer with 20% of titles and abstracts also screened by a second reviewer. Two reviewers independently screened full texts. Data will be extracted using a standardised Excel template. Using a modified Quality in Prognosis Studies (QUIPS) tool, the risk of bias of included studies will be assessed by one reviewer with 20% of studies also independently appraised by a second reviewer. Meta-analyses will be conducted if sufficient homogeneity between studies permits. Otherwise, a narrative synthesis of results will be undertaken.

Ethics and dissemination
As this is a review of published literature, no ethics approval is required. Findings will be disseminated through a journal article publication, conference presentations and plain-text summaries for public accessibility.

PROSPERO registration number
CRD42024534813.

Introduction
The aim of this scoping review is to connect theoretical research related to stress with practical applications to supervision experiences within allied health professions. Understanding the implications of stress between clinical supervisors and allied health students will allow for better insights to improve supervisory methods within clinical training, stronger mentorship and lead to better quality patient care.

Methods and analysis
This review is conducted according to Joanna Briggs Institute (JBI) methodology for scoping reviews, which includes defining the research question, developing inclusion criteria and searching for, selecting, extracting and analysing the evidence. A literature search will be conducted in MEDLINE (PubMed), CINAHL (EBSCO), ERIC (EBSCO), PsycINFO (EBSCO) and Embase (Elsevier), as well as various grey literature resources. Studies will be included if they focus on undergraduate or graduate allied health students in a clinical setting and allied health clinical educators, and report on outcomes related to stress dynamics between these two populations. Results will pass through title/abstract and full-text screening before data are extracted using a tool developed by the reviewers. Data will be analysed and summarised descriptively and presented in both tabular and narrative formats.

Ethics and dissemination
Ethical approval is not required for this scoping review. Results will be disseminated in peer-reviewed publications and professional conferences.

Trial registration number
The protocol was registered with Open Science Framework on 2 October 2024 (https://doi.org/10.17605/OSF.IO/REK7Z).

Objectives
Coronary heart disease (CHD) is the leading cause of global morbidity and mortality, yet no comprehensive evaluation of its global economic costs exists. We conducted a systematic review with meta-analysis to examine the costs of CHD treatment by region and CHD subtypes, examine whether there are cost difference by sex, and examine costing methodologies.

Design
We conducted a systematic review and meta-analysis of non-randomised studies.

Data sources
We searched Medline, Embase, CINAHL, EconLit and Google Scholar from 1 January 2000 to February 2023.

Eligibility criteria for selecting studies
We included observational studies reporting economic costs of CHD treatment and outcomes for adults that were published in English.

Data extraction and synthesis
Data extraction and quality assessment were independently undertaken by two reviewers. Costs were converted to percentage of gross domestic product (GDP) per capita of corresponding country. A random-effects model was used for meta-analysis using StataSE V.18 to calculate the pooled percentage. Heterogeneity was assessed using the I2 statistic. Meta-regression and bias assessment were performed.

Results
Out of 20 100 records identified, 37 studies (including 2 564 189 individuals) from 22 countries were included in the qualitative synthesis and the quantitative meta-analysis. In most countries, the annual cost of CHD exceeds many times the total health expenditure per capita. The pooled direct annual cost of CHD per patient varied from 4.9% to 137.8% of GDP per capita (Int$ purchasing power parity), with pooled percentage of 21.7% (95% CI 15.3, 28.1) for those with CHD. Slight difference in the annual pooled cost of CHD was observed, with a 2% of GDP per capita higher cost in men (95% CI 0.8, 3.2). Most studies applied a top-down costing approach (n=21).

Conclusions
The review illustrates the expense associated with CHD, which is varied by region and CHD subtypes. The observed cost difference by sex warrants further exploration of sex-specific factors influencing cost disparities. Exploring advanced costing methods such as time-driven activity-based costing can optimise resource allocation and identify opportunities to reduce unnecessary costs and cost disparities.

PROSPERO registration number
CRD42023412044.

Objective
Prior research has identified that people with Parkinson’s reporting lower levels of self-efficacy exhibit worsening motor and non-motor symptomology, reduced quality of life, and self-management. Our key objective was to conduct a scoping review examining the impact of digital health technologies on self-efficacy in people with Parkinson’s.

Design
A scoping review using Arksey and O’Malley’s (2005) framework was undertaken.

Data sources
MEDLINE, Embase, PsychINFO, CINAHL, Web of Science, IEEE Xplore, and Google Scholar principally for grey literature were searched from 1 January 2008 to the 24th of July 2024.

Eligibility criteria for selecting studies
Primary studies which incorporated digital health technologies, measured self-efficacy and had a sample population of people with Parkinson’s were searched.

Data extraction and synthesis
Following identification of potentially eligible records, two independent reviewers undertook title and abstract screening, followed by full-text screening. Data was extracted using our earlier published data extraction sheet which incorporated the Practical Reviews in Self-Management Support (PRISMS) taxonomy, and the template for intervention description and replication (TIDieR) checklist. Data was extracted from a Microsoft Excel spreadsheet and synthesised by describing themes, demographic data and numerical data.

Results
From 33 165 unique records following screening and independent review by two reviewers, 11 eligible records were found. Of these five elevated self-efficacy to a statistically significant level, five did not and one lowered self-efficacy. Of the studies which raised self-efficacy to a statistically significant level, all adopted a multimodal approach with a variety of devices. Thematically, these devices were focused on physical activity, falls/falls prevention, or both. The level of heterogeneity precluded comparisons between studies.

Conclusions
This scoping review identified significant knowledge and evidence gaps in the literature, and the limited number of eligible studies make these findings not generalisable. Future self-management research might benefit from also considering self-efficacy.

Introduction
Primary hypertension (PH) affects over one billion individuals globally, yet less than 30% achieve controlled blood pressure (BP) with medication. Many patients require a combination of multiple medications to reach targets, but adverse effects and financial burdens undermine adherence. Additionally, prehypertension affects 25%–50% of adults, increasing the risk of cardiovascular complications. Early detection and management of prehypertension are crucial for delaying the need for pharmacological interventions. In recent years, clinical guidelines have increasingly emphasised non-pharmacological interventions for PH management. However, the diversity of non-pharmacological therapies and the inconsistencies in efficacy challenge clinical decision-making. This study aims to use network meta-analysis (NMA) to synthesise existing evidence on non-pharmacological interventions for PH, offering updated clinical insights and evidence-based support to optimise treatment strategies. It will also provide recommendations for integrating these interventions into community-based chronic disease management.

Methods and analysis
To identify potentially relevant randomised controlled trials, a reverse search strategy will be employed to ascertain all non-pharmacological interventions for PH. A well-constructed search strategy will be applied across nine academic databases (Web of Science, Embase, PubMed, PsycINFO, CENTRAL, AMED, CNKI, WF and VIP database) and three clinical trial registries (WHO ICTRP, ClinicalTrials.gov and ChiCTR) for studies conducted between 1 January 2014 and 1 August 2024. Two investigators will independently extract information from eligible articles and document reasons for exclusions. The primary outcomes will encompass changes in systolic and diastolic BP. Pairwise and Bayesian NMA will be conducted using ‘meta’ and ‘GeMTC’ package (R 4.4.1). Risk of bias will be assessed using the Risk of Bias 2 tool, and the quality of evidence will be evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation approach.

Ethics and dissemination
As this review involves secondary analysis of previously published data, ethical approval is not required. The results will be published in peer-reviewed journals.

PROSPERO registration number
CRD42023451073.

Introduction
Cultural humility practices are shown to be effective when working with diverse populations in healthcare settings. Research recruitment and retention among minoritised groups are essential to address health inequities. Given the successful application to healthcare settings, cultural humility practices may hold promise for recruiting and retaining minoritised individuals. However, little is known about how these practices may be applied to health research. The objective of this scoping review is to understand the extent to which cultural humility practices are applied to health research and how they may be leveraged to optimise recruitment and retention among minoritised populations.

Methods and analysis
This scoping review will follow the Joanna Briggs Institute methodology for scoping reviews. Databases to be searched will include Medline (Ovid), CINAHL (EBSCOhost), EMBASE (Ovid), PsycINFO (Ovid) and Web of Science Core Collection. Literature from 1993 to 2024 that captures the concept of cultural humility in health research with racial and ethnic or gender and sexual minoritised populations in the USA will be considered. The identified pool of records will be imported to Covidence, an online data management software. At the first screening stage, two independent reviewers will screen for title and abstract relevance. A third reviewer will be recruited to resolve discrepancies, if any. Records achieving consensus will have their full texts screened against the eligibility criteria and included in the final pool. Two tables will be developed to guide the data extraction process. The tabular format will be piloted and agreed on by all research team members. Descriptive content analysis will outline the operationalisation of cultural humility and identify strategies found effective in improving the representation of minoritised populations.

Ethics and dissemination
Ethical approval is not required in line with the scoping review methodology. Dissemination of the findings mapping the cultural humility strategies found effective in health research will be conducted through a peer-reviewed publication.

Trial registration number
Open Science Framework https://osf.io/vra7h.

Introduction
Congenital colour vision deficiency (CVD), known as colour blindness, is a common visual problem affecting around 1 in 12 men and 1 in 200 women. It is known that people who have red-green CVD, the most common phenotype, can have difficulty differentiating colours and this can impact the ability to perform clinical tasks related to patient care. The objective of this scoping review is to understand the extent and type of evidence and the impact on clinical practice and patient safety arising from congenital CVD in healthcare professionals.

Methods and analysis
The scoping review will follow the methodological framework outlined by the Joanna Briggs Institute and by Arksey and O’Malley and we will adhere to the Preferred Reporting Items for Systematic reviews and Meta-Analyses Scoping Reviews checklist. The following databases will be searched: PubMed, MEDLINE, Web of Science, Scopus, Lens.org and the Trip medical database (filtered for low-income countries) with no limit on earliest date and up to 30 November 2024. Grey literature will be identified by planned searches in the Overton Index. All articles related to ‘CVD in healthcare professionals in clinical practice or in training’ will be included. The study will also include other professionals who may be involved in healthcare but are not involved in direct patient-facing activities. It will be limited to congenital CVD and will exclude the impact of visual impairment and acquired CVD.
There will be an initial search to validate the search strategy. Titles and abstracts will be screened to determine eligibility, and the full text will be reviewed using a data extraction framework. Data will be extracted, collated and then mapped and summarised to present the relevant key findings and outcomes from the papers in tabular and visualised form with a narrative synthesis.

Ethics and dissemination
The scoping review does not need ethical approval and will provide an overview of the impact of congenital CVD on clinical practice and patient safety. This will determine the future need and direction of research in this area and identify methodological challenges and opportunities. The results will be published open access in a peer-reviewed journal.

Registration
INPLASY (DOI: 10.37766/inplasy2024.11.0099).

Objective
To map instruments for assessing healthcare professionals’ knowledge, attitudes and practices regarding deprescribing.

Introduction
Deprescribing is essential for improving patient outcomes by managing polypharmacy, reducing fall risks and decreasing medication costs. However, there is a limited exploration of healthcare professionals’ perspectives about deprescribing.

Methods and analysis
Studies involving healthcare professionals directly involved in the medication use process (nurses, pharmacists and physicians) will be included, while those in which it is not possible to identify the professional will be excluded. Any definition of deprescribing, as well as any stage of the deprescribing process, will be included, and those without a clear definition of deprescribing will be excluded. Studies employing instruments for assessing the knowledge, attitudes and practices of healthcare professionals regarding deprescribing, whether validated or not, will be included. Studies focusing on deprescribing algorithms will be excluded. Studies in any healthcare setting will be included. Data will be presented as absolute and relative frequencies, a world heatmap, heatmaps, bar plots or as a word cloud when appropriate.

Ethics and dissemination
The findings from this review will be discussed with stakeholders and healthcare professionals directly involved in deprescribing processes. Additionally, the results will be disseminated through publications and conference presentations.

Protocol registration
https://osf.io/tgjyc/

Objectives
Uterine adenomyosis is a common gynaecological disease that can be debilitating. It is poorly understood and may be overlooked in clinical settings. A research gap exists as there are currently no published scoping reviews on perceptions and experiences early in the illness course. As part of a professional doctorate thesis, the aim of this review is to systematically retrieve and describe available literature, exploring the impact of living with adenomyosis and perceptions of the diagnostic journey.

Design
A scoping review is conducted using JBI methodology.

Data sources
Medline, CINAHL Plus, Web of Science, Google Scholar, Cochrane library, JBI and PROSPERO databases, EThOS online and Google. Searches were made from database inception to July 2023.

Eligibility criteria
The characteristics of the evidence sourced were deliberately broad. Studies exploring the experiences and perceptions of women diagnosed with adenomyosis were considered.

Data extraction and synthesis
Titles and abstracts were initially screened. Subsequently, eligibility was clarified through methods section inspection, and the remaining studies were read in depth. A manual hand-search of references of selected studies was conducted. Prespecified data were extracted, charted and categorised into themes.

Results
Six eligible studies were found, with themes describing impact and burdens, as well as several categories of unsupported needs. No studies specifically focused on perceptions of the diagnostic journey, but some eligible studies made minor reference to this and are included.

Conclusions
This review highlights the profound impact of adenomyosis and is the first to explore the lived experiences and the diagnostic journey. Understanding the burdens of disease in terms of perceptions and lived experience in combination with the experiences of diagnostic interactions is vital to improving diagnostic pathways. Education with improved multidisciplinary collaboration and further qualitative and case study research will be crucial to achieve this goal.

Registration
A priori protocol was registered (https://doi.org/10.17605/OSF.IO/2UDYN) and published (https://doi.org/10.1136/bmjopen-2023-075316).