Risultati per: Ulcere del piede diabetico: review

Introduction
Domestic violence (DV) is a major public health problem for women around the world, and more commonly for women in Latin American countries (LACs). DV poses a threat to women’s health and can have more severe effects in women at midlife and older (aged 50 and above), including a decline in physical and mental abilities leading to a reduced independence. Low- and middle-income countries, including LACs, are projected to experience the greatest population growth in women at midlife and older worldwide over the next few decades. Current LAC literature about DV in relation to women at midlife and older is predominantly prevalence focused. The objective of this review is to identify what is known about DV among women at midlife and older in LACs.

Methods and analysis
This review will be conducted in accordance with JBI scoping review methodology. This includes a three-step search strategy: first, a search to identify articles from databases in MEDLINE, Scopus and LILACS; then, a second search using all key words and index terms identified from the articles in step one across select databases; and third, screening the reference lists of included studies and reports for additional studies. All studies which focus on DV in LACs among women at midlife and older will be eligible for inclusion, including those related to definitions, frameworks, cultural norms, risk factors, interventions, evaluations, measurement tools, and health and social consequences. Titles, abstracts and full texts will be assessed by two independent reviewers. A data extraction tool will be used, and findings will be presented in a narrative accompanied by diagrams and tables that address the review questions.

Ethics and dissemination
Ethics approval is not required for this review. Findings will be disseminated through a range of traditional approaches, including publication in a peer-reviewed publication and conference presentations.

Trial registration
This review has been registered with Open Science Framework https://doi.org/10.17605/OSF.IO/SZMF7.

Objectives
To examine the effectiveness of exercise interventions to improve long COVID symptoms and the tolerance of exercise interventions among people with long COVID.

Design
Systematic review.

Data sources
Medline via EBSCOhost, Embase via OVID and CENTRAL via the Cochrane Library up to 28 February 2023.

Eligibility criteria for selecting studies
Inclusion criteria were: (1) participants with long COVID, as defined by study authors; (2) random assignment to either an exercise intervention or a comparison group and (3) a quantitative measure of at least 1 of the 12 core long COVID outcomes. Exclusion criteria were: (1) signs or symptoms not reasonably attributable to prior SARS-CoV-2 infection; (2) pre-exposure or postexposure prophylaxis for COVID-19 or the prevention of long COVID symptoms and (3) interventions where the primary exercise component is breathing or respiratory muscle training.

Data extraction and synthesis
Two reviewers independently extracted data, and studies were narratively synthesised.

Results
Eight studies were included. Follow-up periods ranged from 2 to 28 weeks (mean=8.5 weeks). Sample sizes ranged from 39 to 119 (mean=56). All studies were in adults (mean age=49.9 years) and both sexes (mean female proportion=53.9%). Four studies were at low risk of bias, two were unclear and two were high. The evidence suggests that exercise interventions lead to short-term improvements in dyspnoea, fatigue, physical function and the physical domain of quality of life among people with long COVID. Of the five studies that reported adverse events, rates were low and, when reported, mild. Of the seven studies that reported sufficient relevant information, 1 of 252 participants who received exercise discontinued the intervention due to tolerance-related issues.

Conclusion
Available evidence suggests that exercise interventions may be beneficial and tolerable among some people with long COVID. However, the evidence base consists of a limited number of studies with small sample sizes and short follow-up periods.

The network meta-analysis reveals that saturation SB+TB and SB+saturation TB have no significant difference in csPCa detection between them and SB+TB. Meanwhile, ips-SB+TB and saturation TB are effective biopsy strategies for MRI-positive PCa patients, offering a more targeted approach for detecting csPCa.

TPT decreased the risk of TBD in patients with RD, especially in TB high burden countries/regions. When using isoniazid monotherapy, extending the treatment course might have better protection. TST combined with IGRA might be optimal when screening the TBI. More types of RDs, short-course regimens containing rifamycins and high-quality randomized controlled trials (RCT) should be the focus of future research.

Objectives
Suicidal behaviours are common among medical students, and the prevalence might vary across various regions. Even though various systematic reviews have been conducted to assess the suicidal behaviours among medical students in general, no review has ever explored or carried out a sub-analysis to show the burden of suicidal behaviours among Bangladeshi medical students.

Design
This is a systematic review and meta-analysis of prevalence studies among Bangladeshi medical students. The review applied truncated and phrase-searched keywords and relevant subject headings for study identification using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines.

Data sources
PubMed (Medline), Scopus, PsycINFO and Google Scholar databases were searched between January 2000 and May 2024.

Eligibility criteria for selecting studies
The designed study included cross-sectional, case series, case reports and cohort studies of Bangladeshi medical students reporting suicidal behaviours (suicidal ideation, suicidal planning or suicidal attempts). Only freely accessible, full-text articles in English were included for analysis.

Data extraction and synthesis
Study screening, data extraction and methodological assessment were performed by two independent reviewers. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool. A random-effects meta-analysis model was conducted to pool prevalence rates, complemented by narrative synthesis. Heterogeneity was assessed using the I 2 statistic.

Results
Data were obtained from 6 eligible studies, including 1625 medical students (691 male) of Bangladesh. The pooled prevalence of lifetime suicidal behaviours was 25%, for suicidal ideation (95% CI: 14% – 37%, I 2=91%; p

Introduction
Cancer affects not only patients but also their families, increasing the risk of stress-related illnesses among family members. Despite the development of various support interventions, family members continue to report unmet support needs, largely due to the limited implementation of these interventions into routine care or their lack of relevance to family needs. Co-design approaches, which involve stakeholders in the development process, are recommended to enhance both implementation and relevance. This scoping review aims to map the available evidence on co-design approaches in family interventions within oncology, examining key themes, methodologies and outcomes of interventions.

Methods and analysis
This scoping review will be conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews checklist and the Joanna Briggs Institute framework. The review will follow five stages: identifying the research questions, retrieving relevant studies, selecting studies, charting data and collating, summarising and reporting the results. The research will focus on co-design approaches in family interventions in oncology, exploring activities involved, barriers encountered and their impact on outcomes. A comprehensive search was conducted in EMBASE, MEDLINE, Scopus, CINAHL and PsycINFO databases in August 2024, with no date restrictions, and articles will be selected based on predefined inclusion criteria. Study selection will be performed independently by two reviewers, with disagreements resolved by a third. All reviewers will carry out the data extraction. Data will be analysed using descriptive content analysis and presented through narrative summaries, tables and diagrams to highlight study characteristics and research aims. The findings will inform future research and practice, offering insights into co-design strategies in family interventions in oncology.

Ethics and dissemination
Ethical approval is not needed as this scoping review does not involve collecting data from human participants. The results produced from this review will be submitted to a scientific peer-reviewed journal for publication and will be presented at scientific meetings.

Trial registration details
https://doi.org/10.17605/OSF.IO/2RWB9.

Objective
Previous research on interprofessional learning in primary healthcare has been focused on students’ learning in the encounter with the patient. However, the research is limited, and a review of the experiences of patients, students, and supervisors of interprofessional learning in primary healthcare is lacking. The focus of this scoping review is to describe the current knowledge and also to identify knowledge gaps.

Design
A scoping review in which blocks of keywords and synonyms were used for achieving a high level of subject precision together with a qualitative thematic analysis for the presentation of the results.

Data sources
Publications from 2012 to 2024 were searched for in the PubMed, CINAHL and ERIC databases.

Eligibility criteria for selecting studies
Peer-reviewed studies with a qualitative design describing the experiences of patients, students and supervisors of interprofessional learning in primary healthcare were included.

Data extraction and synthesis
The articles were retrieved, stored and reviewed in a shared online folder. All the authors participated in the scoping review. The decisions on inclusion/exclusion were made after a systematic, multidisciplinary team approach, which involved all the authors in the discussions to reach a consensus.

Results
The results showed that interprofessional learning helped the students to focus on the patient and that the students broadened their perspectives when working together. The results showed that supervisors planned for interprofessional learning by setting aside time for the students to get to know each other. The supervisors confirmed that interprofessional learning contributed to the primary healthcare employees remaining abreast with high professional standards, with updated knowledge, more resources and the implementation of several organisational changes.

Conclusions
Interprofessional learning contributed to a patient-centred approach that provided new insights and expanded knowledge for students in professional training. More research is needed to understand how interprofessional learning between different professions can be developed.

Introduction
The disparities and risk trajectories experienced by people who use drugs (PWUD) highlight the critical need for equity-oriented strategies. Pharmacy staff (pharmacists, pharmacy technicians and assistants) make essential contributions to public health, and their role in the response to the drug overdose crisis can be understood as an extension of their public health role. Their involvement in overdose prevention strategies, such as take-home naloxone programmes and prescribed opioid medication management, has been documented. Still, their role in harm reduction services for PWUD has yet to be mapped. This gap has led to challenges when implementing harm reduction services in pharmacy-related settings. This review aims to summarise literature that focuses on the implementation of harm reduction services for PWUD provided by pharmacy staff.

Methods and analysis
This scoping review will adhere to the Arksey and O’Malley framework for conducting scoping reviews. The electronic databases MEDLINE, Embase, CINAHL, Web of Science Core Collection, SCOPUS and Google Scholar were searched on 4 June 2024, using terms related to pharmacy staff, PWUD and harm reduction services. This review will consider peer-reviewed literature in English, Spanish and French focused on describing or evaluating the implementation of harm reduction services for PWUD by pharmacy staff. Two independent reviewers will screen titles and abstracts and conduct the full-text screening to determine eligibility. Findings will be presented as a narrative summary and supported by tabular and graphical formats. Knowledge partner engagement will guide all steps in this study.

Ethics and dissemination
Formal ethical approval is not required, as primary human or animal data will not be collected. A manuscript summarising the results will be written and submitted to a peer-reviewed journal for publication. Other outlets for dissemination will include local presentations and conference presentations.

Trial registration details
Open Science Framework (https://osf.io/vn6ht).

Objective
A multidisciplinary team is essential to providing high-quality, patient-centred care. However, its effectiveness can be either hindered or facilitated by various factors, such as the need for rapid decision-making, which may compromise patient outcomes despite individual efforts. The aim of this study is to synthesise the factors that may act as barriers and facilitators to the work of multidisciplinary teams in managing labour within acute care settings.

Design
A systematic qualitative review and meta-synthesis was conducted following the five-step methodology proposed by Sandelowski et al.

Data source
Three databases (Medline, Embase and Scopus) were systematically searched without time restrictions up to 25 May 2024.

Eligibility criteria for selecting studies
Qualitative studies exploring perspectives, experiences and other similar factors were included. These studies were assessed for methodological quality using the Critical Appraisal Skills Programme.

Data extraction and synthesis
The reviewers independently searched, screened and coded the results of the included studies. Data were synthesised using the method proposed by Thomas and Harden.

Results
Seventeen studies were included in the meta-synthesis. Four key dimensions emerged, reflecting both the barriers and the facilitators of multidisciplinary team performances: (1) organisational variables, (2) individual variables, (3) collaborative variables and (4) role variables. A total of 36 variables were identified, which could function as barriers (n=6; eg, high staff turnover), facilitators (n=6; eg, strong listening skills) or both (n=24; eg, team climate), depending on the context.

Conclusions
This meta-synthesis identifies specific barriers and facilitators and variables that can act as both. Understanding these factors enables targeted interventions to enhance the performance of multidisciplinary teams in clinical practice, particularly in acute care settings.

PROSPERO registration number
CRD42022297395.

Introduction
This scoping review synthesises the existing literature on racial and ethnic disparities in the utilisation of continuous glucose monitors (CGMs) among adults and children with diabetes in the USA. The primary objective is to describe the extent and nature of these disparities, with the broader goal of informing future research and interventions to address health inequities.

Methods and analysis
Guided by the Joanna Briggs Institute methodological framework, this review will systematically search PubMed, Embase and Scopus for relevant studies. Included studies will focus on individuals diagnosed with type 1 or type 2 diabetes in the USA. Selection criteria will prioritise studies reporting demographic factors, CGM usage patterns and associated health outcomes. The primary outcome is the extent of racial and ethnic disparities in CGM utilisation. Data synthesis will use the National Institute on Minority Health and Health Disparities Framework (NIMHD) to uncover patterns of CGM utilisation among racial–ethnic groups. The NIMHD facilitates a multilevel examination of the factors influencing CGM initiation, continued use and attrition by integrating individual, interpersonal, community and societal level influences. This comprehensive approach provides a nuanced understanding of the barriers and facilitators shaping CGM usage across diverse populations. By applying the NIMHD framework, this review aims to identify existing disparities, uncover gaps in the literature and offer direction for future research and interventions.

Ethics and dissemination
As this study involves a review of previously published literature and does not involve human subjects research, institutional review board approval will not be pursued. Findings will be disseminated through peer-reviewed publications, conference presentations and lay summaries.

Literature review registration number
https://doi.org/10.17605/OSF.IO/RGW6M.

Stroke, Ahead of Print. BACKGROUND:Robotic rehabilitation, which provides a high-intensity, high-frequency therapy to improve neuroplasticity, is gaining traction. However, its effectiveness for upper extremity stroke rehabilitation remains uncertain. This study comprehensively reviewed meta-analyses on the effectiveness of upper extremity robot-assisted therapy in patients with stroke.METHODS:We combined results from 396 randomized controlled trials (RCTs) in 16 meta-analyses and conducted a new meta-analysis using nonoverlapping RCTs and 6 additional RCTs published after 2024. Duplicate studies were removed, all data were from RCTs, and a random-effects model resolved heterogeneity. Effects were analyzed by comparing robot-assisted therapy with conventional therapy at the same dose and as an add-on to conventional therapy.RESULTS:Compared with conventional therapy, the effect of robot-assisted therapy on the Fugl-Meyer assessment was summarized as a significant standardized mean difference (SMD) of 0.29 (95% CI, 0.14–0.44; number of individual RCTs reanalyzed, 100 RCTs), and the additional effect of robot-assisted therapy was an SMD of 0.42 (95% CI, 0.23–0.61; 16 RCTs). However, these Fugl-Meyer assessment improvements did not meet the minimum clinically important difference thresholds identified in previous studies: 12.4 for subacute and 3.5 for chronic stroke. For activities of daily living, only the additional effect was significant by SMD of 0.35 (95% CI, 0.17–0.54; 26 RCTs), muscle strength was significant by SMD of 0.46 (95% CI, 0.22–0.70; 31 RCTs), and spasticity was not significant by SMD of −0.25 (95% CI, −0.55 to 0.06; 25 RCTs).CONCLUSIONS:Robot-assisted therapy shows statistically significant improvements in motor recovery as measured by the Fugl-Meyer assessment in patients with stroke, both at the same dose and as an add-on to conventional therapy; however, these improvements do not meet the minimum clinically important difference. These benefits are consistent across different stages of stroke recovery, different types of robotic devices, duration of intervention, and training sites. However, the heterogeneity of included studies in patient population, stroke severity, intervention protocol, and robot type limits generalizability. High-quality trials are needed to better define the value of robot-assisted therapy across various devices and strategies.

Stroke, Ahead of Print. The devastating physical, emotional, and social effects of stroke can disrupt all aspects of life for the stroke survivor. Ensuring that survivor and caregiver needs are met after a stroke is essential in ongoing care to ensure optimal quality of life. Despite health care professionals making significant strides in poststroke symptom management, education, and rehabilitative support, the common poststroke symptom of sexual dysfunction is rarely addressed. Multiple barriers across health care settings and systems have contributed to this gap. The purpose of this article is to provide evidence that supports the importance of addressing sexual health by health care providers with the stroke survivor and their partner as they transition through the recovery process. We have the following recommendations to optimize care and quality of life for stroke survivors: (1) comprehensive sex education must include information on healthy sex and sexuality for people with neurological disabilities; (2) rehabilitation programs offered in postacute settings should include a structured culturally sensitive interprofessional sexual rehabilitation component that addresses sexuality of the stroke survivor in collaboration with their intimate partners; (3) sexual rehabilitation programs should be tailored for each person based on a thorough assessment of the person’s health literacy and learning needs; and (4) the American Heart Association should develop an extensive toolkit for health care providers and survivors that is easily and readily available to the public. Health care providers, survivors, and their partners have a stake in optimal stroke recovery. Sexuality and sexual function are important quality of life indicators thus conversations addressing issues must be included as part of the recovery process. This discussion is best initiated by a health care provider to address system barriers and misconceptions across care transitions. Likewise, survivors and their partners must be encouraged to take ownership to address sexuality issues and initiate the conversation with their health care partners to achieve full recovery.

PCMC is sub-optimal globally, particularly in the domain of communication and autonomy. There are also inequities in PCMC driven by various sociodemographic and health systems-related factors. Interventions to improve women’s experiences and to address the inequities are therefore needed.

Introduction
Data are limited on the impact of stigma (stigma associated with HIV and/or stigma related to old age (ageism) or both) on linkage to the HIV care cascade among older persons (aged 50 years and older) in sub-Saharan Africa (SSA). Studies have documented the prevalence and determinants of HIV testing, antiretroviral therapy (ART) use and viral load suppression among older people in Africa. However, there is a need to conduct a systematic review to synthesise the findings on the impact of stigma on the HIV care cascade among older people in SSA. The objective of this systematic review is to collate the findings on the impact of stigma on the HIV care cascade among older people aged 50 years and older in SSA. The major research question is: what is the impact of stigma on the HIV care cascade among older persons aged 50 years and older in SSA?

Methods and analysis
We will search MEDLINE via PubMed, Web of Science Collection, Academic Search Premier from the EBSCO platform, Cochrane Central, JBI EBP, Global Health, Social Policy and Practice and Health Management Information Consortium for articles published in English from 2000 to June 2024. The search strategy will include variations of the following terms: HIV, HIV cascade, HIV testing, HIV care or linkage to care, retention in care, viral suppression, older persons, stigma, HIV-related stigma, age-related stigma, ageism, discrimination and intersectional stigma. In terms of study characteristics, the following will be included: epidemiological studies/observational studies/randomised controlled trials and qualitative studies on the HIV care cascade (ie, HIV testing, linkage to care, retention and viral suppression). We will restrict eligibility by focusing on the older population (older persons aged 50 years and older living with HIV) in SSA. The planned limits include timing (2000–2024), geographical coverage (SSA), language (English), copyright (open access publications) and age of the population (50 years and older). The primary and secondary outcomes are drawn from the HIV care cascade, including HIV testing, linkage to care, retention in care and adherence to ART.

Ethics and dissemination
Ethics approval is not needed since this is a systematic review based on published data. Dissemination will be done by submitting scientific articles to academic peer-reviewed journals. We will also present the results at relevant conferences and meetings.

PROSPERO registration number
CRD42024534675.

Introduction
Methods to adopt artificial intelligence (AI) in healthcare clinical practice remain unclear. The potential for rapid integration of AI-enabled technologies across healthcare settings coupled with the growing digital divide in the health sector highlights the need to examine AI use by health professionals, especially in allied health disciplines with emerging AI use such as physiotherapy, occupational therapy, speech pathology, podiatry and dietetics. This protocol details the methodology for a scoping review on the use of AI-enabled technology in sectors of the allied health workforce. The research question is ‘How is AI used by sectors of the allied health workforce to improve patient safety, quality of care and outcomes, and what is the quality of evidence supporting this use?’

Methods and analysis
The review will follow the Joanna Briggs Institute scoping review guidelines. Databases will be searched from 17 to 24 March 2025 and will include PubMed/Medline, Embase, PsycINFO and Cummulative Index to Nursing and Allied Health Literature databases. Dual screening against inclusion criteria will be applied for study selection. Peer-reviewed articles reporting primary research in allied healthcare published in English within the last 10 years will be included. Studies will be evaluated using the Quality Assessment with Diverse Studies tool. The review will map the existing literature and identify key themes related to the use of AI in the disciplines of physiotherapy, occupational therapy, speech pathology, podiatry and dietetics.

Ethics and dissemination
No ethics approval will be sought, as only secondary research outputs will be used. Findings will be disseminated through peer-reviewed publication and presentations at workshops and conferences.

Trial registration number
Open Science Framework Protocol Registration https://osf.io/r7t4s

Introduction
The clinical environment is recognised to influence learning for healthcare professionals, with the described challenges likely extenuated in low- and middle-income countries that are tackling resource limitations. There is limited research on factors influencing learning in clinical environments in low- and middle-income countries, with no scoping review on this topic published to date. This review will identify the key factors described to shape learning in clinical environments for healthcare professionals in low- and middle-income countries.

Methods and analysis
A scoping review will be performed according to Joanna Briggs Institute (JBI) methodology and reported following Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. Databases to be searched include MEDLINE (Ovid), Embase (Elsevier), CINAHL (EBSCO), Web of Science, ERIC (Education Resources Information Center) and Global Health (CABI) from 1990 to present with no language restriction. Following abstract and full-text screening by two independent reviewers, data will be extracted by two independent reviewers and presented in diagrammatic or tabular form, accompanied by a narrative summary. Results will be summarised using quantitative and qualitative analyses. Data will be organised using the components of the clinical learning environment to present factors shaping learning, described challenges, outcomes of interventions and reported recommendations for improvement.

Ethics and dissemination
Ethics approval is not required. Findings will be disseminated through conference presentations and publication in a scientific journal. Results will be used to inform future studies exploring stakeholder perspectives on clinical learning in paediatric oncology in low- and middle-income countries.

Trial registration details
This protocol was registered on Open Science Framework on 5 September 2024; https://osf.io/ysedk.