Risultati per: Ulcere del piede diabetico: review

Introduction
Studies based on health claims data (HCD) have been increasingly adopted in medical research for their strengths in large sample size and abundant information, and the Taiwan National Health Insurance Research Database (NHIRD) has been widely used in medical research across disciplines, including dementia. How the diagnostic codes are applied to define the diseases/conditions of interest is pivotal in HCD-related research, but the consensus on the issue that diagnostic codes most appropriately define dementias in the NHIRD is lacking. The objectives of this scoping review are (1) to investigate the relevant characteristics in the published reports targeting dementias based on the NHIRD, and (2) to address the diversity by a case study.

Methods and analysis
This scoping review protocol follows the methodological framework of the Joanna Briggs Institute Reviewer’s Manual and the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. The review will be performed between 1 March and 31 December 2022 in five stages, including identifying the relevant studies, developing search strategies, individually screening and selecting evidence, collecting and extracting data, and summarising and reporting the results. The electronic databases of MEDLINE, EMBASE, CENTRAL, CINAHL, and PsycINFO, Airiti Library Academic Database, the National Health Insurance Administration’s repository, and Taiwan Government Research Bulletin will be searched. We will perform narrative syntheses of the results to address research questions and will analyse the prevalence across the included individual studies as a case study.

Ethics and dissemination
Our scoping review is a review of the published reports and ethical approval is not required. The results will provide a panorama of the dementia studies based on the NHIRD. We will disseminate our findings through peer-reviewed journals and conferences, and share with stakeholders by distributing the summaries in social media and emails.

Introduction
There are 53 million caregivers in the USA providing informal care for individuals with chronic illnesses. These caregivers contribute significantly to the healthcare system, yet they may experience adverse consequences due to caregiving, including financial burden. The purpose of this scoping review is to fill a research gap on understanding the nature and effect of financial interventions for family caregivers.

Methods and analysis
This study will use the Arksey and O’Malley scoping review framework to systematically search for articles in MEDLINE, PubMed, CINAHL Complete, Cochrane Library, PsycINFO, Dissertations & Theses Global, and Web of Science during April 2022. Articles published from 1997 to the present will be included for the review. Data from articles will be extracted and summarised for financial intervention nature, scope, measurement, effect and health system context.

Ethics and dissemination
This study does not include human subjects; therefore, no ethical review will be undertaken. Findings will be disseminated in scholarly journals and at caregiving and ageing conferences, such as the Gerontological Society of America.

Objectives
In this study, we aim to analyse the relationship between educational attainment and all-cause mortality of adults in the high-income Asia Pacific region.

Design
This study is a comprehensive systematic review and meta-analysis with no language restrictions on searches. Included articles were assessed for study quality and risk of bias using the Joanna Briggs Institute critical appraisal checklists. A random-effects meta-analysis was conducted to evaluate the overall effect of individual level educational attainment on all-cause mortality.

Setting
The high-income Asia Pacific Region consisting of Japan, South Korea, Singapore and Brunei Darussalam.

Participants
Articles reporting adult all-cause mortality by individual-level education were obtained through searches conducted from 25 November 2019 to 6 December 2019 of the following databases: PubMed, Web of Science, Scopus, EMBASE, Global Health (CAB), EconLit and Sociology Source Ultimate.

Primary and secondary outcome measures
Adult all-cause mortality was the primary outcome of interest.

Results
Literature searches resulted in 15 345 sources screened for inclusion. A total of 30 articles meeting inclusion criteria with data from the region were included for this review. Individual-level data from 7 studies covering 222 241 individuals were included in the meta-analyses. Results from the meta-analyses showed an overall risk ratio of 2.40 (95% CI 1.74 to 3.31) for primary education and an estimate of 1.29 (95% CI 1.08 to 1.54) for secondary education compared with tertiary education.

Conclusion
The results indicate that lower educational attainment is associated with an increase in the risk of all-cause mortality for adults in the high-income Asia Pacific region. This study offers empirical support for the development of policies to reduce health disparities across the educational gradient and universal access to all levels of education.

PROSPERO registration number
CRD42020183923.

Introduction
Stroke is the second leading cause of death and morbidity across the globe. In low-income and middle-income countries (LMICs), it has become an overwhelming burden over the past few decades. This burden is escalating at a much greater pace compared with that of high-income countries. It is considered the most frequent cause of adult disability that affects the quality of life. ‘Prevention’ is one of the key components to combating stroke. In this regard, community-based interventions can play a vital role in improving population-level health and well-being. Considering the escalating trend of stroke in LMICs, this systematic review aims to map the available community-based interventions in preventing stroke and to conduct further analysis regarding the effectiveness of the identified interventions.

Methods and analysis
We have searched Medline, Web of Science and Scopus using a comprehensive search strategy in October 2021. Two reviewers will independently perform screening, data extraction and risk of bias (ROB) assessment. The ROB assessment and applicability of results of eligible studies will be performed using the Cochrane ROB tool for assessing randomised controlled trials and the ROBANS (Risk Of Bias Assessment tool for Non-randomised Studies) to assess non-randomised studies. A random-effect model meta-analysis will be used to calculate pooled results and to obtain weighted OR and risk ratio of incidence of stroke along with corresponding 95% CI.

Ethics and dissemination
The results will be disseminated through publishing in a peer-reviewed journal and public presentations at relevant national and international conferences. Ethical approval is not required as this is a systematic review of publicly available data.

PROSPERO registration number
CRD42021283670.

Objective
To determine intervention effects and synthesise qualitative research that explored women with or at high risk of kidney disease experiences of shared decision-making in relation to their reproductive health, family planning options and pregnancy.

Design
A systematic review of interventions and a qualitative evidence synthesis.

Data sources
We searched Cochrane, CINAHL, MEDLINE, Scopus, ProQuest, Elsevier, PubMed, ScienceDirect and Web of Science.

Eligibility criteria
Shared decision-making interventions and qualitative studies related to reproductive health involving women with or at high risk of kidney disease published from 1980 until January 2021 in English (clinical settings, global perspective).

Data extraction and synthesis
Titles were screened against the inclusion criteria and full-text articles were reviewed by the whole team. Framework synthesis was undertaken.

Results
We screened 1898 studies. No evidence-based interventions were identified. 18 qualitative studies were included, 11 kidney disease-specific studies and 7 where kidney disease was a common comorbidity. Women frequently felt unprepared and uninformed about their reproductive options. Conversations with healthcare professionals were commonly described as frustrating and unhelpful, often due to a perceived loss of autonomy and a mismatch in preferences and life goals. Examples of shared decision-making were rare. Kidney disease exacerbated societal expectations of traditional gender roles (eg, wife, mother, carer) including capability to have children and associated factors, for example, parenting, (sexual) relationships, body image and independent living (including financial barriers to starting a family). Local interventions were limited to types of counselling. A new health system model was developed to support new interventions.

Conclusion
There is a clear need to establish new interventions, test those already in development and develop new clinical guidance for the management of women with or at high risk of kidney disease in relation to their reproductive health, including options to preserve fertility earlier. Other health conditions with established personalised reproductive care packages, for example, cancer, could be used to benchmark kidney practice alongside the new model developed here.

Objectives
The objective of this study was to determine the level of type 2 diabetes (T2DM) and hypertension (HTN) in Vietnam and to assess the trend and recommend the future direction of prevention research efforts.

Design
We searched scientific literature, databases including PubMed, EMBASE, CINHAL and Google Scholar; grey literature and reference lists for primary research published, nation database websites between 1 January 2000 and 30 September 2020. We adapted the modified Newcastle Ottawa Scale for assessing the quality of the study, as recommended by the Cochrane Collaboration.

Results
In total, 83 studies met our inclusion criteria, representing data of approximately 239 034 population of more than 15 years of age in Vietnam. The findings show that prevalence rates varied widely across studies, from 1.0% to 29.0% for T2DM and 2.0% to 47.0% for HTN. For the total study period, pooled prevalence of T2DM and HTN in Vietnam for all studies was 6.0% (95% CI: 4.0% to 7.0%) and 25% (95% CI: 19% to 31%), respectively. Prevalence rate of both T2DM and HTN was higher among the male population compared with female counterpart.

Conclusion
There is evidence of a rising trend of HTN and T2DM prevalence in Vietnam. Future research should focus on the major drivers, incidence and prognosis of T2DM and HTN. Policy approaches should base upon the trends of T2DM and HTN in Vietnam over the last 20 years and pay more attention on the effective interventions to combat T2DM and HTN. In our study, we included both English and Vietnamese language articles and seems that majority of the articles came from Vietnamese language.

PROSPERO registration number
CRD42020182959.

Stroke, Ahead of Print. BACKGROUND:High level evidence for direct oral anticoagulants (DOACs) in patients with cerebral venous thrombosis is lacking. We performed a systematic review and meta-analysis to assess the efficacy and safety of DOACs versus vitamin K antagonists in patients with cerebral venous thrombosis.METHODS:This systematic review was registered in PROSPERO (CRD42021228800). We searched MEDLINE (via Ovid), EMBASE, CINAHL, and the Web of Science Core Collection between January 1, 2007 and Feb 22, 2022. Search terms included a combination of keywords and controlled vocabulary terms for cerebral venous thrombosis, vitamin K antagonists/warfarin, and DOACs. We included both randomized and nonrandomized studies that compared vitamin K antagonists and DOACs in 5 or more patients with cerebral venous thrombosis. Where studies were sufficiently similar, we performed meta-analyses for efficacy (recurrent venous thromboembolism and complete recanalization) and safety (major hemorrhage) outcomes, using relative risks (RRs).RESULTS:Out of 10 665 records identified, we screened 254 as potentially eligible. Nineteen studies (16 observational studies [n=1735] and 3 randomized controlled trials [n=215]) met the inclusion criteria. All 3 randomized controlled trials had some concerns, and all 16 observational studies had at least moderate risk of bias. When compared with vitamin K antagonist treatment, DOAC had comparable risks of recurrent venous thromboembolism (relative risk [RR], 0.85 [95% CI, 0.52–1.37], I2=0%), major hemorrhage (RR, 0.70 [95% CI, 0.40–1.21], I2=0%), intracranial hemorrhage (RR, 0.58 [95% CI, 0.30–1.12]; I2=0%), death (RR, 1.14 [95% CI, 0.54–2.43], I2=1%), and complete venous recanalization (RR, 0.98 [95% CI, 0.87–1.11]; I2=0%).CONCLUSIONS:This systematic review and meta-analysis suggest that in patients with cerebral venous thrombosis, DOACs, and warfarin may have comparable efficacy and safety. Given the limitations of the studies included (low number of randomized controlled trials, modest total sample size, rare outcome events), our findings should be interpreted with caution pending confirmation by ongoing randomized controlled trials and large, prospective, observational studies.

Introduction
Ageing entails a variety of physiological changes that increase the risk of chronic non-communicable diseases. The prevalence of these diseases leads to an increase in the use of health services. The care models implemented by health systems should provide comprehensive long-term healthcare. We conducted this systematic review to determine whether any model of care for older persons have proven to be effective.

Methods
A systematic review of literature was carried out to identify randomised clinical trials that have assessed how effective a care model for older patients with chronic diseases. A searches electronic databases such as MEDLINE, Turning Research Into Practice Database, Cochrane Library and Cochrane Central Register of controlled Trials was conducted from January 1966 to January 2021. Two independent reviewers assessed the eligibility of the studies. Interventions were identified and classified according to the taxonomies developed by the Cochrane Effective Practice and Organisation of Care and Cochrane Consumers and Communication groups.

Results
Of the 4952 bibliographic references that were screened, 577 were potentially eligible and the final sample included 25 studies that evaluated healthcare models in older people with chronic diseases. In the 25 care models, the most frequently implemented interventions were educational, and those based on the provision of healthcare. Only 22% of the outcomes of interventions were identified as being effective, whereas 21% were identified as being partially effective; thus, more than 50% of the outcomes were identified as being ineffective.

Conclusions
It was not possible to determine a care model as effective. The interventions implemented in the models are variable. The most effective outcomes were focused on improving the patient–healthcare professional relationship in the early stages of the intervention. The interventions addressed in the studies were similar to public health interventions as their main objectives focused on promoting health. Most studies were of low methodological quality.

Objectives
Decision aids (DAs) for clients in home and community care can support shared decision-making (SDM) with patients, healthcare teams and informal caregivers. We aimed to identify DAs developed for home and community care, verify their adherence to international DA criteria and explore the involvement of interprofessional teams in their development and use.

Design
Systematic review reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data sources
Six electronic bibliographic databases (MEDLINE, Embase, CINAHL Plus, Web of Science, PsycINFO and the Cochrane Library) from inception to November 2019, social media and grey literature websites up to January 2021.

Eligibility criteria
DAs designed for home and community care settings or including home care or community services as options.

Data extraction and synthesis
Two reviewers independently reviewed citations. Analysis consisted of a narrative synthesis of outcomes and a thematic analysis. DAs were appraised using the International Patient Decision Aid Standards (IPDAS). We collected information on the involvement of interprofessional teams, including nurses, in their development and use.

Results
After reviewing 10 337 database citations and 924 grey literature citations, we extracted characteristics of 33 included DAs. DAs addressed a variety of decision points. Nearly half (42%) were relevant to older adults. Several DAs did not meet IPDAS criteria. Involvement of nurses and interprofessional teams in the development and use of DAs was minimal (33.3% of DAs).

Conclusion
DAs concerned a variety of decisions, especially those related to older people. This reflects the complexity of decisions and need for better support in this sector. There is little evidence about the involvement of interprofessional teams in the development and use of DAs in home and community care settings. An interprofessional approach to designing DAs for home care could facilitate SDM with people being cared for by teams.

PROSPERO registration number
CRD42020169450.

Objectives
When resources are strained during communicable disease outbreaks, novel palliative care interventions may be required to optimally support people who use substances with life-limiting illnesses. Therefore, we asked the question, ‘what is known about communicable disease outbreaks, palliative care and people who use substances?’, such as palliative care interventions that can improve the quality of life of patients with life-limiting illnesses.

Design
We conducted a scoping review that involved comprehensive searches in six bibliographic databases from inception to April 2021 (Medline ALL (Medline and Epub Ahead of Print and In-Process and Other Non-Indexed Citations), Embase Classic+Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trial, PsycInfo all from the OvidSP platform, Scopus from Elsevier) and grey literature searches. We included English and French records about people ≥18 years old with life-limiting illnesses who use substances during communicable disease outbreaks. We identified, summarised and presented the findings about palliative care interventions in figures, tables and narrative descriptions.

Results
We identified 32 records about palliative care interventions for people who use substances during communicable disease outbreaks. The majority focused on palliative care for people who use substances with AIDS during HIV epidemics (n=27, 84.4%), and approximately half were published in the USA (n=15, 46.9%). Most common substances used were alcohol (n=18, 56.3%), opioids (n=14, 43.8%) and cocaine (n=10, 31.3%). Four groups of palliative care interventions were identified: (1) symptom management (n=20, 62.5%), (2) psychosocial support (n=15, 46.9%), (3) advance care planning (n=8, 25.0%) and (4) healthcare provider training (n=6, 18.8%).

Conclusions
Beyond studies on HIV epidemics, there is limited knowledge about palliative care interventions for people who use substances during communicable disease outbreaks. Research and guidance are needed about how best to provide palliative care to this population with complex needs including in resource-limited countries.

Protocol
Buchman DZ, Ding P, Lo S, et al. Palliative care for people who use substances during communicable disease epidemics and pandemics. BMJ Open 2021; 11: e053124

Introduction
COVID-19 is a global pandemic caused by the SARS-CoV-2 virus. Although most COVID-19 cases are asymptomatic or mild, a significant number of patients experienced adverse outcomes. In addition, studies have shown that cardiac abnormalities are associated with increased mortality in hospitalised patients with COVID-19. This finding sets a precedent for the potential use of ECG tracing as an indicator of patient mortality and morbidity. This study aims to determine associations between the 12-lead ECG findings and various clinical outcomes of hospitalised patients with COVID-19, measured as incidence of endotracheal intubation, intensive care unit (ICU) admission and mortality rate.

Methods and analysis
An electronic literature search will identify all potentially relevant articles using specific databases and websites. The search will be limited to studies published from December 2019 to May 2021. In addition, studies will include hospitalised patients with COVID-19 with normal and abnormal 12-lead ECG findings assessed for clinical outcomes, including the incidence of endotracheal intubation, ICU admission and mortality rate. The risk of bias in individual studies will be evaluated using the Quality in Prognostic Studies tool or the Cochrane risk of bias tool. A meta-analysis will be conducted if at least two studies indicate a prognostic factor’s effect. Moreover, subgroup and sensitivity analyses will be performed accordingly to address heterogeneity. Reporting the review results will comply with the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. The quality of evidence generated will be assessed using the Grades of Recommendation, Assessment, Development and Evaluation system.

Ethics and dissemination
This study has been exempted from ethics review. There will be no patient or public involvement in this study. Furthermore, the findings will be disseminated via conferences, seminars, symposia and congresses on top of peer-reviewed journals.

PROSPERO registration number
CRD42021257155.

Objective
Compliance with COVID-19 prevention measures limits infection occurrence and spread in healthcare settings. According to research conducted in Ethiopia, compliance with COVID-19 preventative strategies is inconsistent among healthcare providers. This systematic review and meta-analysis aimed to estimate the national pooled proportion of healthcare workers (HCWs) who adhere to COVID-19 preventive measures and associated factors with good compliance.

Design
A systematic review and meta-analysis of all identified studies with cross-sectional study design.

Data sources
A comprehensive search was conducted in PubMed/MEDLINE, POPLINE, HINARI, Science Direct, Cochrane Library databases and Google Scholar search engines from January 2020 to September 2021.

Data extraction and synthesis
This review included all observational studies conducted in Ethiopia that reported the proportion of compliance with COVID-19 preventive measures and associated factors among HCWs. Two independent authors assessed the methodological quality of studies using Joanna Briggs Institute’s meta-analysis of statistical assessment and review instrument. The effect estimates for pooled proportion and pooled OR (POR) were determined.

Results
From retrieved 611 original studies, 21 studies were included in the meta-analysis with a total of n=7933 HCWs. The pooled proportion of good compliance with COVID-19 preventive measures among HCWs was 49.7% (95% CI: 42.3% to 57.1%). Being male (POR=2.21, 95% CI: 1.52 to 3.21), service years ( >3 years) (POR=2.65, 95% CI: 1.94 to 3.64), training (POR=2.30, 95% CI: 1.78 to 2.98), positive attitude (POR=3.14, 95% CI: 1.66 to 5.94) and good knowledge (POR=2.36, 95% CI: 1.92 to 2.89) were factors significantly associated with good compliance towards COVID-19 preventive measures.

Conclusion
Our study indicated that approximately one in every two HCWs had good compliance with COVID-19 preventive measures. There must be more emphasis on providing further training sessions for the HCWs to improve their compliance with COVID-19 preventative measures.

Objective
To establish the prevalence of long-term and serious harms of medical cannabis for chronic pain.

Design
Systematic review and meta-analysis.

Data sources
MEDLINE, EMBASE, PsycINFO and CENTRAL from inception to 1 April 2020.

Study selection
Non-randomised studies reporting on harms of medical cannabis or cannabinoids in adults or children living with chronic pain with ≥4 weeks of follow-up.

Data extraction and synthesis
A parallel guideline panel provided input on the design and interpretation of the systematic review, including selection of adverse events for consideration. Two reviewers, working independently and in duplicate, screened the search results, extracted data and assessed risk of bias. We used random-effects models for all meta-analyses and the Grades of Recommendations, Assessment, Development and Evaluation approach to evaluate the certainty of evidence.

Results
We identified 39 eligible studies that enrolled 12 143 adult patients with chronic pain. Very low certainty evidence suggests that adverse events are common (prevalence: 26.0%; 95% CI 13.2% to 41.2%) among users of medical cannabis for chronic pain, particularly any psychiatric adverse events (prevalence: 13.5%; 95% CI 2.6% to 30.6%). Very low certainty evidence, however, indicates serious adverse events, adverse events leading to discontinuation, cognitive adverse events, accidents and injuries, and dependence and withdrawal syndrome are less common and each typically occur in fewer than 1 in 20 patients. We compared studies with

Objectives
Young adults report disproportionality greater mental health problems compared with the rest of the population with numerous barriers preventing them from seeking help. Peer support, defined as a form of social-emotional support offered by an individual with a shared lived experience, has been reported as being effective in improving a variety of mental health outcomes in differing populations. The objective of this scoping review is to provide an overview of the literature investigating the impact of peer support on the mental health of young adults.

Design
A scoping review methodology was used to identify relevant peer-reviewed articles in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines across six databases and Google/Google Scholar. Overall, 17 eligible studies met the inclusion criteria and were included in the review.

Results
Overall, studies suggest that peer support is associated with improvements in mental health including greater happiness, self-esteem and effective coping, and reductions in depression, loneliness and anxiety. This effect appears to be present among university students, non-student young adults and ethnic/sexual minorities. Both individual and group peer support appear to be beneficial for mental health with positive effects also being present for those providing the support.

Conclusions
Peer support appears to be a promising avenue towards improving the mental health of young adults, with lower barriers to accessing these services when compared with traditional mental health services. The importance of training peer supporters and the differential impact of peer support based on the method of delivery should be investigated in future research.

Introduction
The prevalence of heart failure (HF) is increasing. Exercise-based cardiac rehabilitation (CR) reduces mortality and further improves the prognosis of patients with HF. However, the effect of different modes of CR delivery on HF remains unclear. Thus, the purpose of this study is to find out the relative efficacy and safety of different modes of CR delivery for individuals with HF using a network meta-analysis.

Methods and analysis
We will perform a systematic review and network meta-analysis of randomised controlled trials which compare different modes of exercise-based CR delivery for patients with HF. Databases including Embase, Medline, the Cochrane Central Register of Controlled Trials and Web of Science will be searched up to May 2022. The primary outcomes will focus on the functional capacity and the health-related quality of life (hr-QOL). Functional capacity will be evaluated by peak oxygen consumption (mL/kg/min) and 6 min walking test (metres). The Minnesota Living with Heart Failure questionnaire, Short Form-36, Psychometric properties of the Kansas City cardiomyopathy questionnaire and EuroQol five dimensions questionnaire will serve as measures of hr-QOL. As secondary outcomes, we will assess hospital admissions (all-cause and cardiac) and all-cause mortality, which required a minimum follow-up of 6 months, as well as adverse events during exercise training. The risk of bias for individual studies will be evaluated according to the Cochrane Handbook. The quality of evidence will be assessed by the Grading of Recommendations, Assessment, Development and Evaluation approach.

Ethics and dissemination
This study does not require ethics approval as it is based on published trials. Results of this systematic review and network meta-analysis will be submitted to a peer-reviewed journal for future publication.

Trial registration number
CRD42021278351.

Introduction
A major development in solid malignancy treatment is the application of immune checkpoint inhibitors (ICIs), which have produced durable responses and increased survival rates. However, the therapeutic effect of ICIs has great heterogeneity in patients with cancer. We propose a systematic review to evaluate the predictive value of tumour mutation burden (TMB) on efficacy of ICIs.

Methods and analysis
A systematic literature search will be conducted in the PubMed, OVID, Web of Science, Embase and Cochrane Central Register of Controlled Trials Library databases up to 31 May 2022. We will compare the efficacy of ICIs between TMB high group and TMB low group in terms of the HRs of overall survival (OS) and progression-free survival (PFS), and the OR of the objective response rate/overall response rate (ORR). The HRs of PFS and OS, and the OR of ORR, will be measured by an inverse variance weighted fixed effects model (I2≤50%) or a DerSimonian-Laird random effects model (I2 >50%). In addition, subgroup analysis, sensitivity analysis, heterogeneity analysis and publication bias will be conducted. We plan to conduct a subgroup analysis on age, sex, area, number of patients (high/low TMB), cancer type, tumour size, stage, line of therapy, TMB sequencing method, type of immunotherapy and follow-up period.

Ethics and dissemination
Ethical approval and informed consent are not needed, as the study will be a literature review and will not involve direct contact with patients or alterations to patient care. This systematic review is anticipated to be finished in December 2023, and the results will be published in a peer-reviewed journal.

PROSPERO registration number
CRD42021262480.