Search Results for: Approcci terapeutici per il cancro al seno: review

Objectives
To determine how high performing is defined in relation to a health system and chart the literature on the definitions and key concepts of high-performing healthcare systems.

Design
Scoping review.

Data sources
MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials were searched from inception to July 2024. The grey literature was also searched.

Eligibility criteria
Included studies reported on health systems and high performance to identify explicit definitions, research outcomes and knowledge gaps.

Results
Two reviewers independently screened 5721 citations and 507 full-text articles, resulting in the inclusion of 35 primary articles and 47 companion documents in the review. Three independent definitions for a high-performance health system were identified. 24 research studies reported outcomes on the elements of a high-performing health system (58%), system evaluation (32%) and tool development or validation (10%). Knowledge gaps identified were the lack of a common definition, a lack of common indicators, strategies for moving evidence into policy and practice, and difficulties with comparisons across health systems.

Conclusions
We found limited definitions and a lack of empirical evidence on our topic. There is an opportunity for primary research in the area of health systems and high performance.

Objectives
The aim of this scoping review was to map the nature and extent of the existing literature on mental health interventions for humanitarian volunteers in disaster contexts. The study also explored how the interventions were evaluated.

Design
The methodology of this scoping review followed the extended guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews.

Data sources
Five academic bibliographic databases (PubMed, Embase, Web of Science, EBSCOhost and Google Scholar), grey literature websites (Google Scholar, ProQuest, Policy Commons, etc.) and relevant organisational archives were systematically searched for eligible documents.

Eligibility criteria
Both peer-reviewed and grey literature studies on mental health interventions for humanitarian volunteers in the context of any type of disaster were eligible for inclusion. Research papers that evaluated any such intervention were also included. Documents that targeted professional humanitarian workers or explored physical health conditions or diseases in disaster contexts, letters to the editor, comments, correspondence and research protocols were excluded. There were no restrictions in terms of the date and language of the documents.

Data extraction and synthesis
A systematic search of the targeted databases was conducted from 12 May 2025 to 20 May 2025. Deduplication, screening and full-text evaluation for the selection of documents were done using the online version of Rayyan. Data were collected and recorded into a structured Microsoft Excel sheet. Two researchers individually conducted the selection of the articles and the extraction of data. A third researcher helped to resolve any discrepancies if required.

Results
A total of 2627 documents were retrieved by searching the targeted databases and websites. After matching them with the eligibility criteria, 20 documents were included in the final list. 14 of them were research papers; the rest was organisational literature. All the papers were from 2006 and later, except one that was from 1998. No documents were found from the Middle East, North Africa and Sub-Saharan regions. 10 broad categories of interventions were identified, which were either implemented in the field or suggested in the form of guidelines. Most of the interventions were postexposure and preventive in nature. Psychological first aid was the most widely used intervention in this context, being used by the national societies of the International Federation of Red Cross and Red Crescent Societies. Nine of the documents were research papers evaluating the effectiveness of the interventions using different scales and customised questionnaires. Four of them did not observe any notable effect on the mental health of the participants.

Conclusions
Over the past two decades, the evidence on mental health interventions for humanitarian volunteers has grown. The reviewed literature documented various interventions and guidelines that need further study and testing to both prove and improve their effectiveness. Organisational policies could incorporate and further evaluate these to ensure the psychosocial well-being of volunteers. A review of research papers on intervention effectiveness found heterogeneity in settings, designs, interventions and methods, precluding a systematic review. More research is needed on individual interventions, volunteer perceptions and comparing interventions to identify the most effective ones. Additionally, comparing pre-exposure and postexposure interventions with multimodal systems that support volunteers throughout deployment is recommended.

Objective
A synthesis and appraisal of the recommendations for biomarkers in practice guidelines concerning sepsis is required to consolidate evidence-based practice. We generated an evidence gap map (EGM) on the use of biomarkers for managing adults with sepsis.

Design
Scoping review.

Data sources
MEDLINE, Guidelines International Network, Pan American Health Organization, Trip Database and UpToDate were searched from 2016 to March 2025.

Eligibility criteria
Guidance documents (GD) that searched at least one literature source and provided clinical recommendations for the use of biomarkers for the management (diagnosis and prognosis, including treatment response) of adults with sepsis.

Data extraction and synthesis
Two reviewers independently applied the eligibility criteria and extracted data. We used the AGREE-II (Appraisal of Guidelines for Research and Evaluation) tool to assess the GD quality. GDs that scored ≥50% on the AGREE-II ‘Rigour of development’ domain were considered robust. We also applied the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system to evaluate if the recommendations were strong or conditional.

Results
We found 10 GDs, with only half (4/8) having a robust methodology. There were 31 recommendations concerning biomarkers. Among these, 24 (77.4%) recommendations were about single biomarkers, with lactate (23; 74.2%) and procalcitonin (8; 25.8%) most frequently recommended. Biomarker testing focused on prognosis in 28 (90.3%) recommendations. Overall, 16 (51.6%) recommendations were graded strong and 13 (42.0%) were conditional, which we displayed in an EGM.

Conclusions
The methodology of GDs concerning adult sepsis was poor. Our review calls for more prudent use of biomarkers in specific prognostic scenarios and in combination with standard clinical assessments. Enhancing the methodological quality of future GDs is essential to generate more valid and robust recommendations for optimising patient care.

Introduction
Primary dysmenorrhoea (PD) is the most common gynaecological condition among young women and is associated with significant socioeconomic repercussions. It is unclear which works best for pain relief when pharmacological and non-pharmacological interventions are compared. This systematic review and network meta-analysis (NMA) will aim to compare and rank the effects of pharmacological and non-pharmacological interventions in patients with PD.

Methods and analysis
Randomised controlled trials of pharmacological and non-pharmacological interventions for PD will be identified via a search of the PubMed, Cochrane Library, Web of Science, Embase, Scopus database and Google Scholar search engine until September 2025. The primary outcome will be a change in pain intensity among patients with PD, while the secondary outcomes include health-related quality of life, symptoms of depression and anxiety, and treatment-related adverse events. Two independent reviewers will perform document screening, study selection and data extraction. The methodological quality of the included studies will be assessed using the Cochrane Risk of Bias tool (V.2). The RevMan, Stata and Aggregate Data Drug Information System software will be used to perform a pairwise meta-analysis and Bayesian NMA in a random-effects model. The certainty of the evidence will be rated using the Grading of Recommendations, Assessment, Development, and Evaluation System.

Ethics and dissemination
This systematic review protocol is exempt from ethical approval as it involves analysis of previously published data. The findings of this review will be submitted to peer-reviewed journals.

Trial Registration number
CRD42024543573.

Objectives
Diabetes mellitus (DM) affects over 422 million individuals globally. Diabetic foot ulcers (DFUs) stand out as a challenging complication of DM, affecting up to 34% of individuals with DM. Despite the prevalence of DFUs, clinical trials for DFUs often face slow and insufficient patient recruitment. We aimed to identify key determinants that impact subject recruitment rates in DFU clinical trials.

Design
Systematic review.

Data sources
ClinicalTrials.gov and PubMed were searched to identify DFU clinical studies published from 1 January 1990 to 9 April 2025.

Eligibility criteria
We included English-language publications of clinical trials aimed at healing DFUs that reported enrolment numbers, duration of enrolment and number of study centres.

Data extraction and synthesis
Records were extracted and subjected to two independent rounds of review by five authors (LZ, SP, RN, HL-T, and RK). Data were pooled and analysed using negative binomial regression, Kaplan-Meier methods and Cox proportional hazards models. Study enrolment and site enrolment rates, as well as time to complete study enrolment, were analysed. Between-study heterogeneity was assessed using the likelihood ratio test.

Results
397 trials involving 31 955 participants were included. On average, DFU studies enrolled 4.24 patients per month (median: 1.65). US-based studies had slower recruitment than non-US studies, with a mean enrolment rate of 1.51 patients per site per month (median: 0.58). The average time to complete enrolment was 1.28 years. Studies that employed a higher number of study sites, were conducted outside the USA, studied behavioural or dietary supplement interventions, and began enrolment more recently, were more likely to have a higher enrolment rate. Longer time to complete enrolment was associated with a larger number of study sites, trials involving at least one US site, earlier starting enrolment year, and longer follow-up duration.

Conclusions
These findings have potential practical implications for the design and conduct of future DFU trials.

Introduction
Perinatal complications involving conflicts between maternal and fetal health interests present a unique challenge to health economic evaluations. No comprehensive synthesis exists of how such studies account for dual-patient outcomes. We aim to develop a scoping review protocol to map and critically examine the methodologies in this understudied area.

Methods and analysis
The scoping review will be conducted under the Joanna Briggs Institute (JBI) framework. It will include health economic studies, such as cost-effectiveness, cost utility and decision analysis studies, focusing on clinical conditions during pregnancy where maternal and fetal interests conflict. Cost analysis without effectiveness assessment will be excluded. Using comprehensive search strategies in Medline (Ovid), EMBASE (Elsevier) and Cochrane Library (Wiley), two independent reviewers will screen and identify relevant studies via abstract and full-text review. We will perform data extraction following an adapted form from the Consolidated Health Economic Evaluation Reporting Standards checklist, which includes the content details, such as the type of study, population, intervention, comparator, probability, utility, duration, cost, model types and uncertainty measurements. As we try to explore the impact of the health economic studies in clinical practice, we will include citation metrics of each study and whether the study was cited by practice guidelines and clinical trials in the data extraction. We will also apply the JBI Checklist for Economic Evaluations to assess the reporting completeness in each article. Results will be tabulated by clinical theme and synthesised narratively to highlight patterns in valuation approaches, gaps in current methods and impact on clinical guidelines.

Ethics and dissemination
This study does not require ethical approval as it involves secondary analysis of published data. Findings will be disseminated through peer-reviewed publications, conference presentations and stakeholder engagement activities.

PROSPERO registration number
CRD42024557324

Introduction
In Germany, influenza vaccination rates in at-risk groups are well below the 75% coverage recommended by the WHO. Although it has been shown that general practitioners (GPs) can play a key role in increasing their patients’ willingness to be vaccinated, this potential does not seem to have been fully used. This study aims to uncover factors that motivate GPs to vaccinate their patients against influenza, investigate the role of financial incentives in achieving higher vaccination rates and determine how the daily practice of GPs can be made more vaccination friendly.

Methods and analysis
A mixed-methods approach is employed to reach the research aims. Literature reviews will be conducted to identify factors that motivate GPs to vaccinate against influenza and to identify studies in which preferences are elicited. This is followed by semistructured interviews with GPs (n=6–10). The scoping reviews and interviews serve as a basis for the development of a quantitative survey directed at GPs which includes a discrete choice experiment. The quantitative survey will be sent to a total of 3760 GPs.

Ethics and dissemination
The study will be conducted in accordance with the Declaration of Helsinki. A positive vote has been received from the Ethics Committee of the Medical Association North Rhine (2024259). Study participants will only be included in the study after being given informed consent. Manuscripts will be prepared for the scoping review on motivating factors and after completion of the quantitative survey, which will be submitted to peer-reviewed journals. Interim results and final results of the project will be presented at conferences.

Introduction
Liver cirrhosis accounts for over 10 000 deaths in the UK each year with a total loss of 60 000 quality-adjusted life-years. There is a substantial cost to the NHS of £4.5 billion, with new liver-related decompensation events accounting for the majority of this. Following an acute cirrhosis decompensating event, there is a significant risk of hospital readmission with 90-day readmission rates as high as 53%. Current care in the UK is reactive and patients are often only readmitted when they have presented acutely as an emergency with significant decompensation.

Methods and analysis
CirrhoCare is a prospective, multicentre, randomised controlled trial comparing the CirrhoCare management system with standard-of-care for high-risk cirrhosis patients who have been discharged following an admission with acute decompensation. The CirrhoCare management system comprises a novel digital platform for use in a patient’s home, designed to proactively detect the first signs of new decompensation in patients with established cirrhosis, discharged to the community. This enables a clinician to instigate early community-based care or, if needed, to triage the patient for hospital interventions.
214 patients will be recruited to the CirrhoCare trial from at least 12 UK centres. Patients will be randomised on a 1:1 ratio allocation to the CirrhoCare Management System or standard of care. Participants who are randomised to CirrhoCare will receive a CirrhoCare health kit comprising a smart watch, smart phone with enabled SIM (Subscriber Identity Module) network card, blood pressure monitor, weighing scales and thermometer. Participants will take measurements every morning Monday to Friday and will be followed up for 90 days postdischarge.
The primary objective of this study is to assess the clinical effectiveness of the CirrhoCare digital management system. We hypothesise that its early community-based intervention will reduce the number of unplanned hospital interventions and admissions and prevent liver-related complications when compared with standard-of-care management.

Ethics and dissemination
CirrhoCare is a National Institute for Health and Care Research-funded study (NCT06223893). The study has UK Research Ethics Committee and Health Research Authority (HRA) approvals, with approval granted by the HRA and Health and Care Research Wales committee. The results of this study will be published in peer review journals, disseminated at international conferences as well as established Patient and Public Involvement and Engagement networks.

Trial registration number
ISRCTN11380842.

Objectives
To evaluate the association between left atrial appendage volume (LAAV) and atrial fibrillation (AF) recurrence after catheter ablation (CA) and explore the potential mechanism.

Design
Systematic review and meta-analysis.

Data sources
PubMed, EMBASE, Web of Science and Cochrane Library databases were searched systematically from inception through 28 September 2024 to identify relevant studies.

Eligibility criteria
Observational studies that estimated the association between LAAV and AF recurrence.

Data extraction and synthesis
Two independent investigators screened studies for inclusion and extracted data. Statistical heterogeneity was assessed using the Cochrane Q-test and I², with p 50% indicating significant heterogeneity. This study used a random-effects model to account for potential heterogeneity. The quality of the included studies was assessed using the Newcastle–Ottawa Scale (NOS), Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I tool) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Publication bias was examined through funnel plots and Egger’s test.

Result
Seventeen studies (3078 patients) were included. Meta-analysis of 11 studies suggested that LAAV was significantly associated with the risk of AF recurrence in both univariate (HR 1.06, 95%CI 1.04 to 1.08, p

Objectives
We examined studies that analysed the spatial association of cancers with demographic, environmental, behavioural and/or socioeconomic factors and the statistical methods applied.

Design
Systematic mapping review.

Data sources
Web of Science (SSCI) (search on 28 July 2022), MEDLINE, SocINDEX and CINAHL (search on 4 August 2022), additional searches included grey literature.

Eligibility criteria for selecting studies
(1) Focused on the constituent countries of the UK (England, Wales, Scotland and Northern Ireland) and its major regions (eg, the North West); (2) compared cancer(s) outcomes with demographic, environmental, behavioural and socioeconomic characteristics by applying methods to identify their spatial association; (3) reported cancer prevalence, incidence rates, relative risk or ORs for a risk factor or to an average level of cancer.

Data extraction and synthesis
A standardised data extraction form was developed and for all studies, core data were extracted including bibliographic information, study design, geographical factors analysed, data aggregation level, methods applied and main findings. We described and synthesised the characteristics of the studies using summary tables, charts and graphs.

Results
52 studies were included covering a variety of objectives and geographical scales. These studies considered different types of cancer, with the most common cancer types analysed being blood and lymphoid cell cancers. The most common methods used to assess the association between cancers and geographical level factors were regression analyses, with the majority being Poisson regression, then logistic and linear regression. Studies were usually conducted at ward and local authority level, or by exact point location when distances from putative risk sources were considered. The results were usually presented in plots or as tables, instead of maps.

Conclusion
Our results highlight the lack of consideration of spatially explicit models in the analysed studies, with the risk of having failed the assumption of independence in the data.

PROSPERO registration number
CRD42022349165.

Objective
The aim of this study was to construct a quality evaluation indicator system for extended care in patients with chronic obstructive pulmonary disease (COPD), provide beneficial references for quality evaluation and practice standardisation of extended care.

Design
This study was conducted from April to November 2023. Based on the three-dimensional quality structure model of ‘structure–process–result’, we used literature review and Delphi method to form the quality evaluation indicator system for extended care in patients with COPD and determined the weight of each indicator by analytic hierarchy process (AHP).

Setting
Zhengzhou Central Hospital Affiliated to Zhengzhou University and School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China.

Participants
20 experts from different universities and hospitals in China participated in the study. They all had profound attainments in clinical treatment, nursing and extended care of COPD.

Primary outcome measures
Effective questionnaire response rate, coefficient of expert authority, arithmetic mean, proportion of maximum score, Kendall harmony coefficient, scores of importance, variation coefficient and weight were used to evaluate the quality evaluation indicator system for extended care.

Results
In the two rounds of Delphi expert consultation, the effective questionnaire response rates were both 100%. The coefficients of expert authority were 0.83 and 0.89, respectively. Kendall harmony coefficients were 0.088 and 0.215, respectively. The final formed quality evaluation indicator system for extended care included 3 primary indicators, 10 secondary indicators and 40 tertiary indicators. For each indicator, the variation coefficient was 0.063–0.151 and the weight was 0.001–0.065.

Conclusion
The quality evaluation indicator system for extended care based on mature theoretical basis and scientific method is scientific and reliable. And the weight of each indicator is set reasonably and accurately, which could provide a basis for quality evaluation and continuous quality improvement of extended care.

Introduction
Transporting critically ill patients between medical facilities can be hazardous and costly. Whether by road, fixed-wing aircraft or helicopter, many professional associations have proposed strategies to efficiently and safely transport patients at high risk of instability. Although these strategies have been assessed in some studies, no comprehensive synthesis of their benefits has been conducted to date. The aim of this study is to assess the effect of strategies to improve the safety and costs of interhospital transports for critically ill patients.

Methods and analysis
We will conduct a systematic review according to the Cochrane guidelines. The review will include randomised controlled trials (RCTs), cohort studies and case-control studies assessing the effect of interventions to improve interhospital transports of critically ill patients on safety and costs. We will search multiple electronic databases (PubMed, EMBASE, CINAHL, Web of Science, Cochrane Library) from inception to 6 months prior to the submission of the final manuscript. Screening by title and abstract, full-text screening, data extraction and quality assessment will be performed by two independent reviewers. We will assess the risk of bias with the Cochrane revised tool for RCTs and with the risk of bias in non-randomised studies of interventions tool. If possible, we will calculate pooled effect estimates and 95% CIs to assess the effect of the interventions. We will also assess heterogeneity using the I2 index and rate the certainty of evidence with the Grading of Recommendations Assessment, Development and Evaluation tool and trial sequential analysis.

Ethics and dissemination
Ethics approval is not required for this review. The results of this systematic review will be shared through publication in a peer-reviewed journal, conference presentations and our network of knowledge user collaborators.

PROSPERO registration number
International Prospective Register of Systematic Reviews (CRD42024595080).

Introduction
Severe perinatal asphyxia at term or near term remains a critical public health issue, associated with high risks of neonatal death and hypoxic-ischaemic encephalopathy (HIE). Despite improved clinical guidelines, suboptimal care persists in many cases, and previous audits have demonstrated that up to 50% of asphyxia cases could be associated with suboptimal care. OptiNeoCare is a French study which aims to assess the prevalence and determinants of suboptimal obstetric and neonatal care and evaluate its potential impact on neonatal outcomes.

Materials and methods
This prospective, population-based observational study will include newborns ≥36 weeks’ gestation with severe perinatal asphyxia across 12 French perinatal networks (213 maternity units). Inclusion criteria comprise neonatal death or moderate/severe HIE with confirmed biochemical markers of asphyxia. Data will be collected prospectively from labour wards, transport teams and neonatal intensive care units using an electronic case report form, and the in-situ team will be invited to complete a morbi-mortality review (MMR). Approximately 336 cases will be included over 12 months, with 25% randomly selected for confidential enquiry by two experts. The quality of care will be assessed based on a structured classification of medical errors (diagnostic, therapeutic, preventive and systemic) by a panel of experts including an obstetrician or midwife and a paediatrician. Root cause analysis will identify determinants of suboptimal care. A concordance analysis will compare findings from MMRs and confidential enquiries. Statistical analysis will include multivariable logistic regression to explore associations between care quality and neonatal outcomes.

Ethics and dissemination
Ethical approval was granted by the Ethics Committee for Research in Obstetrics and Gynaecology. Informed non-opposition is required from participants. Results will be shared with participating centres, healthcare professionals and through scientific dissemination.

Trial registration number
ClinicalTrials.gov ID: NCT06322732.

Objectives
This systematic review and meta-analysis investigates the association between statin use and clinical outcomes in non-small cell lung cancer (NSCLC) patients, focusing on the therapeutic potential of statins and their impact on patient prognosis.

Design
The review includes a mix of prospective and retrospective cohort studies and randomised controlled trials to assess the relationship between statin use and NSCLC outcomes. ROBINS-I tool was used for assessing risk of bias, ensuring methodological rigour.

Data sources
A literature search was conducted across several databases, including MEDLINE (PubMed), EMBASE, Web of Science and the Cochrane Central Register of Controlled Trials. The databases were searched from inception to June 2024.

Eligibility criteria
Participants included adult NSCLC patients prescribed statins before or after diagnosis, with no restrictions on sex, age or disease stage. Interventions of interest were statin medications, typically used for hypercholesterolemia, and also investigated for anticancer properties. The primary outcome was overall survival (OS), with secondary outcomes including progression-free survival (PFS), cancer-specific survival and NSCLC recurrence.

Data extraction and synthesis
Data extraction was performed independently by two reviewers. Results were synthesised via a random-effects model, with forest plots illustrating HRs for OS and PFS.

Results
The meta-analysis included 25 studies with 51 536 NSCLC patients. Statin use was associated with improved OS (HR 0.77, 95% CI 0.70 to 0.85). A trend towards improved PFS was observed but did not reach statistical significance (HR 0.87, 95% CI 0.71 to 1.07).

Conclusions
Statin use may improve survival outcomes in NSCLC patients. These findings support the potential therapeutic role of statins in NSCLC management and call for further clinical trials.

PROSPERO registration number
CRD42016047524.

Objectives
To review the available evidence of screening for atherosclerosis in adults in a primary prevention setting with coronary artery calcium scoring (CACS) on the impact on cardiovascular (CV) risk factor control, health behaviour and clinical events.

Design
Systematic review, reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data sources
We searched MEDLINE, Embase and Cochrane Central Register of Controlled Trials through 22 January 2025.

Eligibility criteria
We included randomised controlled trials (RCTs) and prospective cohorts, without language restrictions, comparing adults without cardiovascular diseases undergoing CACS to a control group that either did not undergo CACS or where the participants and physicians were blinded to its result. Outcomes included changes in CV risk factor control, CV therapy, changes in health behaviour at follow-up and clinical events (all-cause and CV mortality and non-fatal CV events).

Data extraction and synthesis
Two independent reviewers extracted data and assessed the risk of bias. Due to substantial heterogeneity among the included studies, a quantitative analysis was not possible.

Results
We identified seven RCTs and one observational study, with participants ranging from 56 to 43 447 with a total of 51 554. Populations were heterogeneous with a mean age range of 42–64 years, % women ranging from 21% to 100% and mean baseline CACS from 1.37 to >100 Agatston units. Interventions following CACS were also heterogeneous, ranging from simply communicating results to participants to initiating statin therapy for detectable CACS. One RCT demonstrated improvement regarding blood pressure (BP) (n=2137; change in systolic BP: CACS: –5 mm Hg; control: –7 mm Hg; p=0.02), several an improvement in blood lipids between groups (five studies, n=3693; eg, low-density lipoprotein (LDL) cholesterol: range –6.0 to –4.9 mg/dL). Results regarding CV medication (seven studies, n=51 104) were more discrepant, with some studies showing a decrease and others an increase in indication for or usage of CV medication. Three trials (n=3338) investigated adherence to CV medication, with only one showing increased adherence to statins (CACS: 63.3%; control: 45.6%; p=0.03). Five trials (n=3692) investigated behavioural changes, with one showing an increased motivation to change lifestyle (CACS: 94%; control: 62.8%; p=0.002) and another a higher adherence in self-reported physical activity (CACS: 96%; control: 59%; p

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