Risultati per: Il dolore neuropatico: review

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.

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
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.

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.

Objectives
To quantify access to health services during the COVID-19 pandemic and measure the change in use between the prepandemic and the pandemic periods in a population with assessment of psychological distress or diagnosis of mental disorders.

Data sources
We developed and piloted a search syntax and adapted it to enter the following databases from 1 January 2020 to 31 March 2023: PubMed/MEDLINE, PsycINFO, Web of Science, Epistemonikos and the WHO International Clinical Trials Registry Platform. We reran the searches from the end of the original search to 3 December 2024.

Design
We systematically screened titles, abstracts and full texts of retrieved records.

Eligibility criteria
We included observational studies on any populations and regions, covering health services such as doctor visits, hospital admissions, diagnostic examinations, pharmaceutical therapies and mental health (MH) services. Only studies using validated scales to assess psychological distress or mental disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders were included.

Data extraction and synthesis
We extracted data using a purposefully designed form and evaluated the studies’ quality with the Newcastle-Ottawa Scale. We measured the incidence rate (IR) of access to health services and the IR ratio (IRR) between the prepandemic and the pandemic periods. We calculated contacts days and catchment areas in the different periods. We used the random effects DerSimonian-Laird inverse-variance model and calculated heterogeneity with statistics I² and ². We computed pooled IR and pooled IRR and tested the hypothesis of no variation (IRR=1).

Results
We retrieved 10 014 records and examined the full text of 580 articles. We included 136 primary studies of which 44 were meta-analysed. The IR of access to services during the pandemic was 2.59 contact months per 10 000 inhabitants (IR=2.592; 95% CI: 1.301 to 5.164). We observed a reduction of 28.5% in the use of services with negligible differences by age group and type of services (IRR=0.715; 95% CI: 0.651 to 0.785). We observed significant differences in effect sizes across studies (2=5.44; p

Introduction
Sedentary behaviours are a prevalent issue among university students worldwide. The negative impact of low physical activity (PA) levels among university students on mental and physical health is well-documented. Regular PA is linked to numerous health benefits and protects against non-communicable diseases. While group-based physical activity (GBPA) interventions show promise, their effectiveness in increasing PA levels among university students remains uncertain. This review aims to identify, evaluate and elucidate the key determinants of successful GBPA interventions tailored to this population.

Methods and analysis
We will search articles from PubMed, Web of Science, SPORTDiscus via EBSCOhost, Africa-Wide, PsycInfo and Cumulative Index to Nursing and Allied Health Literature. We will perform article screening, data extraction and quality assessment of eligible studies in duplicate. The risk of bias in individual studies will be assessed using the Cochrane Collaboration tool for randomised control trials, Risk Of Bias In Non-randomised Studies – of Interventions for non-randomised interventional studies and Risk of Bias in Non-randomised Studies – of Exposure. We will conduct a narrative synthesis of the findings. If there is homogeneity of primary outcomes, we will perform a meta-analysis to appraise evidence across studies. The Grading of Recommendations Assessment, Development and Evaluation will be used to synthesise the quality of evidence across studies.

Ethics and dissemination
Ethical approval is not required for this systematic review protocol; we will analyse published primary studies. Findings will be published in a peer-reviewed journal and presented at conferences.

PROSPERO registration number
CRD42024553196.

Introduction
Gender-affirming care (GAC) includes interventions aimed at supporting an individual’s gender identity. Canada is experiencing an increase in referrals for GAC, higher than any other health service; therefore, there is a need for a systematic approach to health outcome measurement to effectively evaluate care. This review aims to analyse health outcome measurement in Canadian GAC, focusing on what is measured, how it is measured and associated barriers and enablers.

Methods
A comprehensive search was conducted in MEDLINE, Embase, PsycINFO, Scopus and CINAHL, up to 26 December 2023. Inclusion criteria were original articles involving transgender or gender-diverse (TGD) patients receiving gender-affirming care in Canada.

Results
A total of 4649 articles were identified with 64 included, representing 6561 TGD patients. Most studies were conducted in Ontario (52%), British Columbia (19%) and Quebec (11%). The most common forms of GAC provided were hormonal (36%) and surgical (27%). Barriers to outcome measurement include that most studies (61%) did not use patient-reported outcome measures (PROMs). When PROMs were used, most did not capture gender-related constructs (eg, gender dysphoria). Barriers to accessing care included stigma, discrimination, lack of clinician knowledge, geographic, socioeconomic and institutional barriers.

Conclusion
This review reveals gaps in outcome measurement for GAC, particularly underutilisation of PROMs and inconsistent outcome measurement and reporting. There is a need to systematically implement PROMs, including those measuring gender-related constructs, to promote patient-centred care. This review provides evidence-based recommendations for improving health outcomes for TGD individuals in Canada.

Introduction
Family caregivers play an indispensable role in the care of solid organ transplant patients, undertaking a wide range of tasks from basic daily care to complex medical management. However, these responsibilities come with substantial challenges, placing additional strain on caregivers who bear significant physical, emotional, financial and social burdens, along with numerous unmet support needs. Currently, the exploration of challenges and support needs among family caregivers in the caregiving process is limited to primary research, lacking a synthesised and comprehensive understanding of the issues. Therefore, the aim of this scoping review is to summarise the available evidence to accentuate the diverse challenges encountered by family caregivers and to identify their specific supportive needs, while also pinpointing the areas of research that have yet to be explored.

Methods and analysis
Following the Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews, this review will be conducted. The initial search of PubMed to identify keywords was conducted on 16 November 2024. Additionally, Web of Science Core Collection, ProQuest, Scopus, CINAHL (EBSCOhost), China National Knowledge Infrastructure (CNKI) and China Wan Fang database will be systematically searched for relevant literature. No language or date restrictions will be applied. Two reviewers will independently screen the articles based on title, abstract and full text. Data extraction and analysis of results will be presented in tables or graphs.

Ethics and dissemination
Ethical approval is not necessary for this scoping review. The study findings will be published in open-access journals after peer review. These findings will provide information for healthcare providers to alleviate the plight of family caregivers and to pave the way forward towards more resilient caregiver support systems.

Objectives
This systematic review examines prehospital and in-hospital delays in acute stroke care in Indonesia.

Design
Systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data sources
We conducted a thorough search across 11 databases, ClinicalTrials.gov registries and three preprint repositories up until October 2024.

Eligibility criteria
Studies that examined risk variables associated with hospital delays in the treatment of acute stroke in Indonesian individuals were included.

Data extraction and synthesis
Two reviewers each carried out the data extraction and risk-of-bias evaluation separately. The quality of the study was evaluated using the Risk of Bias in Non-randomised Studies of Exposures tool. The ‘combining p values’ approach and albatross plots were used to synthesise the findings.

Results
A total of 27 studies with 3610 patients were included. Key factors contributing to prehospital delays included low educational level (p=0.014, 6 studies), low socioeconomic status (p=0.003, 5 studies), cultural beliefs affecting decision-making (p