Risultati per: Il dolore neuropatico: review

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.

Background
Sustained viral suppression is critical not only for ensuring long and healthy livelihoods among the people who are living with Human immunodefficiency virus (HIV), but it is also crucial for prevention of new infections of HIV perinatally and to HIV negative sexual partners through unsafe sex. Available data, however, suggest that some of the patients who are on antiretroviral therapy (ART) fail to maintain the suppressed state once they have achieved it, with others reporting subsequent episodes of viral rebound following resuppression. The association of depression, social issues including day-to-day routine and stigma with poor adherence inadvertently calls for the formulation of intervention strategies that are patient centric. The proposed systematic review and meta-analysis study will identify studies of intervention strategies that are in place to address viral suppression and viral rebound among HIV positive patients who are on ART.

Methods and analysis
The proposed study will conduct a systematic search of peer-reviewed articles through PubMed, Scopus and EBSCOhost databases. Data collection will occur in March 2025. The reviewers will include studies if they were published in South Africa, between 2013 and 2024, and if they were observational in design and written in English. Identified articles will be exported onto Rayyan software where processes of de-duplication and screening by two independent reviewers will be performed. A meta-analysis of data will be conducted on Stata 17 software using the random effects model. The results will be generated in a table and displayed graphically in a forest plot which will indicate type of study, type of intervention, point effect size and the corresponding 95% CI, weight per cent contributed by each study to the pooled estimate, pooled estimate and the 95% CI and measures of heterogeneity. Sensitivity analysis will be performed to identify the source of heterogeneity. Publication bias will be assessed by funnel plot and the Egger’s asymmetry test.

Ethics and dissemination
The study protocol has obtained ethical clearance from the ethics committee of Sefako Makgatho Health Sciences University (SMUREC/H/31/2024:PG). As this will be a systematic review study, involving no human participants, informed consent will not be required. However, for integrity, the findings will be prepared and disseminated widely through peer-reviewed publication and in various media, including conferences, congresses or symposia.

PROSPERO registration number
CRD42024532244.

Objective
A systematic analysis was conducted to investigate the association between tinnitus incidence and daily dietary patterns.

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

Data sources
The PubMed, Embase, Web of Science and Cochrane Library databases were searched from their inception to 25 May 2024.

Eligibility criteria for selecting studies
We included observational studies from peer-reviewed English-language journals that examined tinnitus presence or severity in adults aged 18 years or older, including associated prevalence estimates.

Data extraction and synthesis
Data extraction was independently conducted by two evaluators, who assessed research bias using the Agency for Newcastle-Ottawa Scale and applied evidence classification criteria for aggregate grade strength assessment. This study adhered to the guidelines of the Preferred Reporting Project (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and Meta-Analysis of Epidemiological Observational Studies, as well as the PROSPERO Registry protocols. A mixed-effect model combined maximum adjusted estimates, with heterogeneity measured using the I2 statistic. Sensitivity analysis validated the robustness of the analysis, and publication bias was assessed qualitatively and quantitatively.

Results
A total of 10 retrospective studies were identified and included in this analysis, with the last eight studies incorporated into the meta-analysis. Fifteen dietary factors were examined. Fruit intake, dietary fibre, caffeine and dairy product consumption were negatively correlated with tinnitus incidence (OR=0.649 (95% CI 0.532, 0.793), p

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

International and prominent national guidelines frequently lack recommendations for adverse event management or had non-specific recommendations. Research on prevention and management of common and serious adverse events should be a priority for improving the patient’s experience and the outcomes of tuberculosis treatment.

Background
Sexual and reproductive health (SRH) programmes and services aim to prevent complications of pregnancy and childbirth, unintended pregnancies, unsafe abortions, complications caused by sexually transmitted infections, including HIV, sexual violence and impacts from avoidable cancer.

Objective
To systematically identify published economic evaluations of SRH programmes and services, assess the methods used and analyse how costs and outcomes are estimated in these studies.

Settings
Low- and middle-income countries.

Design
Systematic review and narrative synthesis.

Methods
Eight databases were searched, including EMBASE, MEDLINE, Scopus, Health Technology Assessment, Web of Science, PsycINFO, National Health Service Economic Evaluation Database (NHS EED) and African Journals Online (AJOL) from 1998 to December 2023. The inclusion and exclusion criteria were developed using the Population, Intervention, Comparator, Outcome and Study Design framework. The review included economic evaluations alongside randomised trials and economic studies with modelling components. Study characteristics, methods and results of economic evaluations were extracted and tabulated. The quality of the studies was assessed using the Consensus Health Economic Criteria list and Philips checklists for trial-based and model-based studies, respectively. The review followed the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the results were synthesised narratively in line with Centre for Reviews and Dissemination guidance.

Results
7575 studies were screened and categorised. 20 studies were included in the review. The studies assessed the cost-effectiveness and costs of SRH programmes and services from an individual, healthcare or societal perspective. The main SRH programme considered was contraceptive services. The main outcome measures reported were disability-adjusted life years, quality-adjusted life years, couple years of protection and pregnancies averted. Most of the studies did not indicate the costing approach used, and many of the studies evaluated direct medical costs only. Most of the study designs were model-based with significant heterogeneity between the models. The review showed that many studies did not fulfil all of the requirements for a high-quality economic evaluation. 1 out of the 20 studies reviewed considered equity.

Conclusions
The review revealed heterogeneity in approaches to evaluating the costs and outcomes of SRH programmes. These methodological limitations may have implications for their use by public health decision-makers to inform optimal decision-making.

PROSPERO registration number
CRD42023435241.

Background
There is developing evidence of excess mortality among people with mental disorders. This protocol presents the methodology to undertake a systematic review to definitively examine the current evidence on the risk of all-cause and cause-specific mortality in people with mental disorders (mood, anxiety, substance use, eating, personality and psychotic disorders) compared with populations without mental disorders in broadly representative studies of general populations worldwide. In addition, we seek to understand whether the excess mortality has increased further over time, and if the COVID-19 pandemic exacerbated the excess mortality in people with mental disorders.

Methods
A systematic review of cohort studies will be conducted. The search strategy to yield peer-reviewed (in Medline Complete, CINAHL Complete, Embase and APA PsycInfo) and published grey literature will be developed in consultation with a liaison librarian. A preliminary scope of peer-reviewed literature in Medline Complete using the EBSCOhost platform was conducted on 20 November 2023. Epidemiological cohort or case-control studies will be eligible if they examine (1) diagnoses of mental disorders (according to the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases classification systems) and (2) risk of all-cause and/or cause-specific mortality. A critical appraisal of the included studies will be undertaken. A synthesis of the findings will include the characteristics of the included studies, critical appraisal and a summary of the key findings in texts and visually in tables. Where appropriate, meta-analyses and subgroup analyses will be performed.

Ethics and dissemination
This study is exempt from ethics approval, as it does not include identifiable human data. The outcomes of the proposed review will be shared in national/international conferences, published in a peer-reviewed journal and disseminated to new and existing networks.

PROSPERO registration number
CRD42023477494.

Objectives
To identify themes relating to clinician acceptability of digital health intervention (DHIs) in the perioperative setting.

Design
Systematic review and narrative synthesis applying an inductive-deductive framework synthesis approach.

Data sources
Medline, Embase and Cumulative Index to Nursing and Allied Health Literature for studies published between inception and 6 March 2023.

Eligibility criteria
Studies with qualitative data on clinician perceptions of DHIs in the context of adult perioperative care.

Data extraction and synthesis
Included studies were coded inductively by a single reviewer. Codes were organised into themes based on conceptual similarities. Collaborative discussions with a second and third reviewer enabled higher-order interpretations and the emergence of subthemes. Themes and subthemes were systematically mapped onto the seven constructs of the theoretical framework of acceptability (TFA).

Results
A total of 3234 publications were identified, of which 18 were selected for inclusion. DHIs studied included telemedicine platforms, mobile health applications, website-based programmes and electronic health record (EHR)-integrated software. The most commonly reported TFA construct was perceived effectiveness, followed by affective attitudes, opportunity costs, ethicality, burden, intervention coherence and self-efficacy.

Conclusions
Clinicians’ acceptance of DHIs is primarily driven by perceived effectiveness. Optimism about the potential for DHIs to enhance care is often overshadowed by concerns about patient safety, privacy and opportunity costs. As clinicians are key gatekeepers in DHI adoption, these perspectives have a significant impact on the long-term integration of these technologies into perioperative care. Cocreation of DHIs with clinicians is required to address implementation barriers, enhancing their utilisation and uptake in the long term.

PROSPERO registration number
This review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with a protocol accessible on PROSPERO (registration number: CRD42023403205).

Introduction
In England, increasing numbers of young people seek help from emergency healthcare services, such as ambulances and emergency departments, after they self-harm. One contributing factor is a lack of meaningful and available community-based alternative sources of support for self-harm. It is not clear what helps young people in this context, how or why. This research aims to understand which resources are available in the emergency setting for young people (aged ≤25 years) who self-harm in England, and how and why they produce their intended and unintended effects.

Methods and analysis
A realist review is a theory-driven interpretive approach to evidence synthesis. It provides realist logic of inquiry to produce an explanatory analysis of how and why resources work, for whom and in what circumstances. This review has two key components; one will identify the resources available in England for young people who self-harm in the emergency setting, the other will identify initial programme theories from the international literature. The review will closely follow Pawson’s five iterative stages: (1) clarifying scope, (2) evidence search, (3) article selection, (4) data extraction and organisation, and (5) evidence synthesis. Published and grey literature will be reviewed and included. Three key stakeholder groups will be involved throughout the review process, namely two patient and public involvement (PPI) groups (one for young people, one for parents and carers) and an interdisciplinary group of healthcare professionals.

Ethics and dissemination
Ethical approval is not required for this review. Results will be reported according to Realist And Meta-narrative Evidence Synthesis: Evolving Standards publication and quality standards. Findings will be disseminated via a peer-reviewed publication in a scientific journal, conference presentations, a study website, an animated video shared via social media and other avenues identified by our PPI groups.

PROSPERO registration number
CRD42025638539.

Objectives
Medical education profoundly impacts patients, students, educators and public resources. However, the economic dimensions necessary for informed decision-making remain underexplored. This systematic review examines how economic evaluations are conducted and reported in undergraduate medical education (UME) literature and assesses their quality.

Design
Systematic review.

Data sources
Medline, Embase, Web of Science, Cochrane, ERIC, Google Scholar and the CEVR CEA databases were searched on 13 September 2024.

Eligibility criteria
Eligible studies evaluated interventions within UME and reported (incremental) costs and effects, employing any method such as cost-effectiveness analysis, cost-minimisation analysis or decision-analytic modelling.

Data extraction and synthesis
Key data, including study characteristics, evaluation type, perspective, intervention details, sensitivity analyses, cost and effect measures, outcomes, expressions of cost-effectiveness and adherence to economic reporting guidelines, were extracted. Quality was assessed using the CHEQUE tool, and the findings were synthesised qualitatively.

Results
Of 6559 studies identified, 21 met the inclusion criteria. Most studies reported costs and effects post-hoc within effectiveness trials, with only one decision-analytic modelling study identified. Evaluated domains included instructional methods, skills training, selection and student health. All but one study adopted a payer (university) perspective, and nearly all focused on short-term outcomes. Sensitivity analyses were rarely performed, and no study achieved full quality scores.

Conclusions
Economic evaluations in UME are scarce and often of limited methodological rigour. A shift towards comprehensive, prospective evaluations is needed to address long-term outcomes, societal perspectives and methodological robustness. Such efforts will enable better resource allocation, enhance the impact of medical education and contribute to a sustainable educational landscape.

PROSPERO registration number
CRD42023478907.

Objective
The study aims to identify self-care practices related to diabetic foot care and determine their predictors among diabetes mellitus (DM) patients in Ethiopia.

Design
Systematic review and meta-analysis.

Data sources
Data were collected from PubMed/MEDLINE, ScienceDirect, Google Scholar and grey literature sources. Databases were searched from inception to August 2024.

Eligibility criteria
Observational studies (including cross-sectional, case–control, cohort and survey designs) reporting diabetic foot self-care practices and their predictors among DM patients in Ethiopia. Our inclusion criteria encompassed articles published in English, and we considered studies conducted in both healthcare institutions and community settings.

Data extraction and synthesis
Microsoft Excel was used for data extraction and summary, while the analysis was performed with R software V.4.3.2. The overall pooled prevalence of diabetic foot self-care practices and their predictors were estimated using a random-effects model. Publication bias was assessed both graphically, using funnel plots, and statistically, with tests such as Egger’s regression test. The reviewers systematically assessed potential bias in individual studies using the Newcastle–Ottawa Quality Assessment Scale, and the certainty of evidence was assessed by Grade of Recommendations Assessment, Development and Evaluation (GRADE). Subgroup analysis was carried out to minimise random variations in the estimates from the primary studies.

Results
The pooled prevalence of good diabetic foot self-care practice in Ethiopia was 51% (95% CI: 41% to 61%; I²=98%, p≤0.001). Factors associated with diabetic foot self-care practices among diabetic patients included knowledge of foot care (adjusted OR (AOR)=2.42; 95% CI: 1.20, 3.62), being female (AOR=1.23; 95% CI: 1.02, 1.98) and rural residency (AOR=1.23; 95% CI: 1.02, 1.98). Both Egger’s test (p=0.4430) and Begg’s test (p=0.501) indicated no significant evidence of publication bias. Regarding the certainty of evidence, the overall GRADE rating is categorised as low.

Conclusions
The overall prevalence of good diabetic foot self-care practices among DM patients in Ethiopia is relatively high. Residence, sex and knowledge of foot care were identified as key predictors of effective foot self-care practices in this population. To enhance diabetic foot self-care in Ethiopia, it is crucial to strengthen education on foot care. Tailored interventions should be developed specifically for men and rural residents to improve their diabetic foot self-care practices.

Introduction
Over the last 20 years, the pharmacist’s role in healthcare has evolved, moving towards patient-centred care, collaboration and medication therapy management. Patient engagement in research is similarly being recognised as a transformative approach to healthcare due to its positive impact on outcomes and research relevance. However, patient engagement in pharmacy practice research is nascent. Therefore, we present a protocol for a scoping review to map the current state of patient engagement in pharmacy practice research, identifying its extent, range, nature, barriers, facilitators, impacts and gaps.

Methods and analysis
This protocol was developed in collaboration with persons with lived experience (PWLE). The scoping review will be conducted using established methodological frameworks and guided by the Best Practice Guidance and Reporting Items for the Development of Scoping Review Protocols and the Guidance for Reporting Involvement of Patients and the Public (GRIPP2) checklists. A comprehensive search involving three large databases, Medline (Ovid; 1946–Present), Embase (Ovid; 1974–Present) and Scopus (Elsevier), grey literature sources, forward and backward reference checking and consultation will be completed to retrieve the relevant literature. We will include published and unpublished research related to pharmacy practice that adopts patient engagement in research approach. Full-text screening will occur to determine eligibility for inclusion. Data will then be charted using a comprehensive extraction form. Qualitative data will be synthesised using basic qualitative content analysis, and quantitative data will be analysed using descriptive statistics. Regular meetings with PWLE and the research team will guide data analysis, interpretation and dissemination.

Ethics and dissemination
Ethics approval was not required for this protocol as we did not collect participant data. Findings may be disseminated through peer-reviewed publications, conference presentations, social media and knowledge user meetings, as informed by the perspectives of PWLE. Knowledge gained from this review will inform the development of strategies that support patient engagement, advance pharmacy practice research and have the potential to improve health outcomes and patient experiences.

Objective
To assess the acknowledgement and mitigation of sex bias within studies using supervised machine learning (ML) for improving clinical outcomes in rheumatoid arthritis (RA).

Design
A systematic review of original studies published in English between 2018 and November 2023.

Data sources
PUBMED and EMBASE databases.

Study selection
Studies were selected based on their use of supervised ML in RA and their publication within the specified date range.

Data extraction and synthesis
Papers were scored on whether they reported, attempted to mitigate or successfully mitigated various types of bias: training data bias, test data bias, input variable bias, output variable bias and analysis bias. The quality of ML research in all papers was also assessed.

Results
Out of 52 papers included in the review, 51 had a female skew in their study participants. However, 42 papers did not acknowledge any potential sex bias. Only three papers assessed bias in model performance by sex disaggregating their results. Potential sex bias in input variables was acknowledged in one paper, while six papers commented on sex bias in their output variables, predominantly disease activity scores. No paper attempted to mitigate any type of sex bias.

Conclusions
The findings demonstrate the need for increased promotion of inclusive and equitable ML practices in healthcare to address unchecked sex bias in ML algorithms.

PROSPERO registration number
CRD42023431754.

Studio promettente per nuovi trattamenti non farmacologici

Our evidence-based predictive model offers a robust tool for estimating the risk of seizure recurrence in pediatric patients with epilepsy after ASM withdrawal, aiding clinicians in personalized treatment decisions. While this tool enhances personalized treatment decisions in epilepsy management, its predictive thresholds require external validation across diverse clinical settings and populations to ensure broad clinical applicability.