Risultati per: Progressi nel trattamento della psoriasi: review

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

Objectives
Obesity and overweight significantly impact public health. The benefits of water aerobics (WAs) have been shown in obesity and overweight people, but the effects of WAs on body composition improvement are still unclear.

Design
Systematic review and meta-analysis.

Data sources
A systematic literature search was conducted on 16 November 2024, across the PubMed MEDLINE, Ovid MEDLINE, Embase, Scopus, Web of Science and the Cochrane Library.

Eligibility criteria for selecting studies
Only randomised controlled trials (RCTs) were included, which were independently screened by two researchers. All RCTs on WAs that evaluated the anthropometric and body composition parameters of overweight and obesity subjects were included. Eligible studies were reported following the Reporting Items for Systematic Reviews and Meta-Analysis statement.

Data extraction and synthesis
All process were independently screened by two researchers (ZD, HZ). A fixed-effects or random-effects model was chosen based on the heterogeneity of the studies. The risk of bias in the included studies was assessed using the Risk of Bias V.2.0 tool, and sensitivity and subgroup analyses were conducted for outcome indicators. The quality of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.

Results
A total of 10 studies involving 286 participants were included. Sensitivity analyses were performed for percent body fat (PBF) with high heterogeneity, and the results were robust. WAs were able to reduce body weight (BW) (weighted mean differences (WMD)=–2.69, 95% CI –4.10 to –1.27, p

Annals of Internal Medicine, Ahead of Print.

A systematic review of randomized clinical trials involving about 15 500 participants without diabetes found that all 12 of the identified glucagon-like peptide-1 (GLP-1) receptor agonists led to decreased body mass, waist circumference, and blood pressure. Of the 3 commercially available agents—liraglutide, semaglutide, and tirzepatide—the latter resulted in the greatest weight loss, with participants reporting up to an 18% change in body weight after nearly 17 months.

Circulation, Volume 151, Issue 10, Page 716-732, March 11, 2025. Albuminuria—increased urine albumin excretion—is associated with cardiovascular mortality among patients with diabetes, hypertension, chronic kidney disease, or heart failure, as well as among adults with few cardiovascular risk factors. Many authors have hypothesized that albuminuria reflects widespread endothelial dysfunction, but additional work is needed to uncover whether albuminuria is directly pathologic or causative of cardiovascular disease. Urinary albumin-to-creatinine ratio is an attractive, unifying biomarker of cardiovascular, kidney, and metabolic conditions that may be useful for identifying and monitoring disease trajectory. However, albuminuria may develop through unique mechanisms across these distinct clinical phenotypes. This state-of-the-art review discusses the role of albuminuria in cardiovascular, kidney, and metabolic conditions; identifies potential pathways linking albuminuria to adverse outcomes; and provides practical approaches to screening and managing albuminuria for clinical cardiologists. Future research is needed to determine how broadly and how frequently to screen patients for albuminuria, whether it is cost-effective to treat low-grade albuminuria (10–30 mg/g), and how to equitably offer newer antiproteinuric therapies across the spectrum of cardiovascular-kidney-metabolic diseases.

Introduction
The transition from the neonatal intensive care unit (NICU) to home is a critical period for families with preterm or medically complex infants and is often marked by stress, anxiety and the challenge of managing complex medical regimens. Virtual programmes such as mobile health applications and telehealth interventions have emerged as promising tools to support families during this transition. These programmes aim to provide continuous education and support after discharge. This scoping review will map the existing evidence on virtual interventions supporting families during the NICU-to-home transition and identify their delivery methods and reported outcomes.

Methods and analysis
This protocol outlines a scoping review methodology, as described by Arksey and O’Malley and further improved by Levac et al. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review will be used as a guiding framework for scoping reviews. A comprehensive search will be conducted in six databases: PubMed, Scopus, Web of Science, Embase, CINAHL and PsycINFO. Studies will be included if they (1) focus on virtual programmes supporting families of preterm or medically complex infants, (2) involve transitional care during discharge from the NICU to home and (3) are primary studies. Grey literature, as well as secondary and tertiary literature will be excluded. Data will be charted and analysed to summarise the delivery methods, target populations and outcomes reported.

Ethics and dissemination
No ethical approval is required for this study. The findings will be disseminated through publications in peer-reviewed journals and presentations to the relevant stakeholders.

Trial registration number
This scoping review protocol is registered in the Open Science Framework (https://doi.org/10.17605/OSF.IO/HWVZJ).

Objectives
Diabetes is a growing global health concern. International guidelines recommend referral to diabetes prevention programmes (DPPs) for those at high risk of type 2 diabetes. However, many of those eligible to participate in DPPs are not referred. Healthcare workers (HCWs) are pivotal to the referral processes. This study aimed to identify, appraise and synthesise barriers and facilitators to referral to DPPs from the perspective of HCWs.

Design
Systematic review using the best-fit framework synthesis.

Data sources
MEDLINE, Embase, CINAHL, PsychINFO, Web of Science and Scopus were searched from January 1997 to July 2023.

Eligibility criteria
Qualitative, quantitative and mixed methods primary studies exploring HCWs’ perspectives of barriers and facilitators to referral to DPPs.

Data extraction and synthesis
One author screened, extracted and appraised the literature while a second author independently verified at least a 20% sample at each stage. Quality was assessed using the Mixed Methods Appraisal Tool. The best-fit framework approach was used to synthesise the evidence with the Theoretical Domains Framework as the a priori framework.

Results
Of 9998 studies identified, 31 met the inclusion criteria, with a further six identified from reference and citation searching. Barriers and facilitators were coded to 11 of the 14 TDF domains and to another category ‘Expectation of Patient Barriers’. The most frequently occurring domains for both barriers and facilitators were Environmental Context and Resources, Expectation of Patient Barriers and Knowledge. HCWs felt that clear easy referral pathways to the programmes and additional staff or resources were essential to improve referral. HCWs’ were concerned that attending the DPP would place a (time and/or financial) burden on their patients which left them conflicted about referral. HCWs lacked knowledge of the effectiveness, availability and accessibility of DPPs.

Conclusions
Future strategies to improve referral to DPPs should include clear referral pathways and the resourcing of referral. Strategies are also needed to build awareness of DPPs and to address concerns among HCWs about their patients.

Introduction
Mild cognitive impairment (MCI) and dementia impose a significant burden on individuals and their caregivers. Dyadic psychosocial education, which treats care recipients and their caregivers as a pair of active participants, has the potential to improve health outcomes for people with cognitive impairment and their caregivers. However, the results of recent studies on this subject are contradictory. We aim to evaluate the effectiveness of dyadic psychosocial education for people with MCI or dementia and their informal caregivers.

Methods and analysis
Six databases will be searched. We will include all randomised controlled trials that compare dyadic psychosocial education to usual care. The risk of bias will be assessed using the Cochrane Risk-of-Bias Assessment Tool (V.2). Meta-analyses, subgroup analyses and sensitivity analyses will be performed using Stata V.15.1. A narrative synthesis will be conducted if quantitative analysis is not feasible.

Ethics and dissemination
This study and subsequent systematic review will not collect individual-level data and, therefore, do not require ethics committee approval. Peer-reviewed publications will disseminate the study results.

PROSPERO registration number
CRD42024497554.

Objectives
Women diagnosed with BRCA1/2 mutations face significantly elevated lifetime risks of breast and ovarian cancer. Due to the distinctive biopsychosocial implications of a BRCA diagnosis, the care trajectory for these women is highly personalised, yet their care needs frequently remain unmet. The aim was to provide a first overview of the evidence of women’s experiences with person-centred care (PCC) within BRCA care and their needs for further PCC implementation.

Design
A scoping review, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, was conducted.

Data sources
Medline, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, CINAHL Plus and Google Scholar were searched for literature published between January 2004 and February 2024.

Eligibility criteria
Peer-reviewed, primary studies on BRCA and PCC using quantitative, qualitative and mixed-methods designs were eligible. The criteria were iteratively refined to include publications based on samples that were >80% female and >80% BRCA positive.

Data extraction and synthesis
Titles and abstracts were screened with ASReview, a validated AI-driven tool. Data on PCC evidence and needs were extracted based on the eight Picker Principles of PCC and synthesised by describing themes within each principle.

Results
Of the 3801 articles identified as potentially relevant, 18 were included in the review. PCC needs were more prevalent than evidence of their implementation. Most of women’s positive experiences with PCC focused on ‘clear information, communication and support for self-care’, while limited to no evidence existed for other principles. The highest needs were found for increased ‘emotional support, empathy and respect’, ‘attention to physical and environmental needs’, and ‘clear information, communication and support for self-care’. All articles reported demands for more holistic, yet personalised care, though PCC was not mentioned explicitly.

Conclusions
This review suggests a person-centred approach is relevant to improving the standard of BRCA care for women. The first evidence of women’s experiences with PCC demonstrates how care delivered with sensitivity and respect for individual backgrounds can support women throughout their BRCA trajectory. Yet, substantial unmet needs remain among female BRCA carriers, highlighting the importance of further research and PCC implementation to enhance the quality of postdiagnostic care.

Introduction
Breast cancer is the fifth-leading cause of cancer-related mortality in women globally. Asia has a lower overall incidence of breast cancer compared with global incidence rates. Unique dietary habits observed in South Asians contribute significantly to low incidence rates. This review aims to explore the literature on the association between dietary habits and breast cancer among South Asian women.

Methods and analysis
A systematic search will be conducted using electronic databases MEDLINE, EMBASE, CINAHL, Web of Science and Scopus. Additional articles will be searched in Google Scholar and a reference list of the selected articles. Review questions will be framed into different components according to the PICOS (population, intervention, comparator, outcomes, studies) framework. Women above 18 years of age who are diagnosed with breast cancer in the South Asian region will be the population of interest. Only the studies reported in the English language will be included. Both title and abstract screening and full-text screening will be done by two independent reviewers. The quality of included studies will be assessed using the Joanna Briggs Institute critical appraisal tools. Based on the findings, a random-effects meta-analysis will be performed if outcomes are homogeneous, or a narrative synthesis will be conducted if outcomes are heterogeneous.

Ethics and dissemination
This study does not require ethics approval, as it is based on published documents. The findings of this study will be shared with a broader audience through scientific channels including publication in open-access journals and presentations at both national and international forums.

PROSPERO registration number
CRD42023464682.

Introduction
The incidence of severe natural disasters has been increasing worldwide. The residents of long-term care facilities (LTCFs) are particularly vulnerable to such events. Therefore, promoting disaster preparedness among LTCF stakeholders is urgent. However, the optimal preparedness process remains unclear. To close this gap, we use a realist review (RR) to promote an understanding of under what circumstances and what works for promoting the disaster preparedness among LTCF stakeholders and develop theories for the process.

Methods and analysis
RR will be guided by the Realist and Meta-Narrative Evidence Synthesis: Evolving Standard. The following five steps will be employed: (1) literature review and search for evidence, (2) study selection, (3) data extraction, (4) data synthesis and (5) development of the initial programme theory (IPT). Evidence will be searched using MEDLINE, CINAHL, PsycINFO, Web of Science, Cochrane Library, Scopus and ICHUSHI (a Japanese database). Grey literature and citation tracking will also be used. Documents of any design or publication type will be included. The study selection, coding and synthesis will be conducted independently by two authors. An IPT will be developed in the Context–Mechanism–Outcome configuration to understand how to promote disaster preparedness among LTCF stakeholders. The developed IPT will be verified by experts or stakeholders to enhance its validity.

Ethics and dissemination
Ethical approval will not be required because this is a review of published literature. The results will be disseminated at scientific conferences and peer-reviewed journals. The developed IPT will be used in subsequent research and iteratively tested or refined to better explain under what circumstances and what works for promoting disaster preparedness among LTCF stakeholders.

Registration details
This protocol has been registered at the Open Science Framework https://doi.org/10.17605/OSF.IO/J4TU6.

Introduction
Paracetamol, the most used analgesic medicine in the world, is considered a safe treatment, but when overdosed, it can be fatal. Evidence suggests that despite sales legislations, paracetamol overdose still accounts for around 100 000 accident and emergency visits and 50 000 hospital admissions per year in the UK. This systematic review aims to describe the possible factors linked to paracetamol overdoses (intentional and/or accidental) in the adult and child populations in the UK and the subgroups of the population that are at higher risk and identify any preventative interventions.

Methods and analysis
This review will be carried out in accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidance. Literature searches will be performed using six bibliographic databases: MEDLINE via PubMed, EMBASE, SCOPUS, PsycINFO, the Cochrane Library and PROSPERO register. Grey literature and social media will also be searched, and article reference lists are reviewed. Studies included will be in English with populations in the UK from 1998 onwards, experiencing paracetamol overdose (intentional or accidental), with no age restriction. Title and abstract screening and full-text review of included articles will be performed by two independent reviewers (with a third member to resolve disagreement). The risk of bias will be assessed using the JBI critical appraisal checklist. The quality of any systematic reviews included will be assessed using the AMSTAR 2 tool or the Mixed Methods Appraisal Tool (MMAT), as appropriate. It is anticipated to adopt a narrative synthesis of the findings via a thematic analysis. Meta-analysis and subgroup analysis will be considered if data are available.

Ethics and dissemination
Ethics approval is not required for this work since no data will be collected. Results will be disseminated through a peer-reviewed publication and local as well as national conference presentations; and a range of creative and inclusive methods and formats to inform and educate patients and the community.

PROSPERO registration number
CRD42024555406.

Objectives
Cough occurring in patients with renal cell carcinoma (RCC) was first described in 1935 and is a frequently discussed symptom on patient forums. We aimed to systematically review the available evidence to explore the prevalence and risk factors for persistent cough in patients diagnosed with RCC to establish whether cough could be a presenting symptom of RCC.

Design
This epidemiological systematic review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement 2020.

Data sources
Medline, Embase, Science Citation Index, The Cochrane Library, ClinicalTrials.gov and the WHO trials register were searched without language restrictions until 1 June 2023.

Eligibility criteria for selecting studies
We included articles of all study designs reporting cough in patients (18 years or older) with RCC attributed to the disease itself or to treatment.

Data extraction and synthesis
Data from included articles was extracted using a preprepared and piloted form, and quality assessment was conducted independently by two authors. The risk of bias was assessed in studies other than case reports or case series using the critical appraisal instrument for studies reporting prevalence data. Narrative techniques were used for data analysis and, where appropriate, meta-analysis using a fixed-effects model was performed.

Results
Of 509 studies screened, 105 full-text articles were assessed, with 46 papers subsequently excluded, resulting in 59 analysed in depth. There were 105 patients with RCC reported as having a cough due to the disease itself within 30 case reports and 8 case series. When present, most coughs were described as persistent and dry in nature. The cause of cough was attributed to various aetiologies including pulmonary and endobronchial metastasis and paraneoplastic syndromes. Studies reporting patients with RCC developing a cough because of systemic treatment were heterogeneous. Two studies with 238 patients on temsirolimus and 230 on interferon-α (IFN-α) were suitable for meta-analysis using a fixed-effects model. Patients on temsirolimus were more likely to develop a cough than those on IFN-α (OR 1.95 with a 95% CI of 1.05 to 3.63, overall effect Z=2.12 (p=0.03), I2=0%).

Conclusion
Cough can occur in patients with RCC, as part of the disease pathogenesis, as an adverse effect of systemic treatment or due to unrelated causes such as pre-existing conditions (eg, asthma). Further research is required to determine the true prevalence and cause and to assess whether cough could be a presenting symptom for RCC.

PROSPERO registration number
CRD42022302962.

Objectives
There is a need to better inform clinicians and decision-makers in primary or community care settings on selecting the appropriate point-of-care tests (POCTs) for screening purposes (as a part of the NHS Health Check Programme). Here we provide an overview of the published analytic validity and diagnostic accuracy studies on POCTs for measuring blood lipids that are available on the UK market to determine whether they meet the accuracy specifications based on the 1995 US National Cholesterol Education Program (NCEP) recommendations.

Design
Rapid review of analytical validity and diagnostic accuracy studies.

Data sources
On 12 May 2023, Medline and Embase were searched. Google Scholar was manually scrutinised to identify additional studies. Key article reference lists were also hand-searched.

Eligibility criteria
We included analytical validity and diagnostic accuracy studies that compared POCT to laboratory testing (or another POCT) performance for measuring at least total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C).

Data extraction and synthesis
Identified studies were independently reviewed by two researchers using standardised methods of screening. Where necessary, conflicts were resolved by a third reviewer. Title and abstract as well as full texts were screened using prespecified inclusion and exclusion criteria. The quality of identified studies was assessed using QUADAS-2 for diagnostic accuracy studies and a modified quality appraisal tool for studies of diagnostic reliability (QAREL) for analytical validity studies. We assessed the quality of analytical and diagnostic accuracy studies and compared the accuracy of the POCTs for TC, triglyceride (TG), HDL-C and low-density lipoprotein cholesterol (LDL-C) against NCEP standards for mean per cent bias, coefficient of variation or total error. We narratively synthesised analytical and clinical validity evidence from retrieved studies.

Results
This study examined analytical and diagnostic accuracy evidence for the selected POCTs. Through the review of 22 studies, 6 POCTs were identified. All retrieved studies were analytical validity assessments, while five of them also reported diagnostic accuracy information. The majority of evidence focused on Cholestech LDX, CardioChek PA and Accutrend Plus. Evidence of between and within-study heterogeneity was found. Precision measures often showed systematic differences between the POCT and reference standards. Most devices, except for Elemark, met at least one NCEP standard for either TC, TG, HDL-C, or LDL-C.

Conclusions
We found that evidence for two of the devices mostly met the requirements of the NCEP standard of evidence for bias and precision and could be recommended to general practitioners to use in the NHS Health Check programme. These were the Cholestech LDX and the Cobas b101 system.

Introduction
Several studies have addressed the use of pressure injury preventive measures and bundles for hospitalised patients. However, there is a gap in research regarding the use of pressure injury preventive measures and bundles in the home environment. This scoping review aims to identify, explore and map the international literature on pressure injury preventive measures and bundles in the home and community environments.

Methods and analysis
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will be used to guide the reporting of this scoping review. The Joanna Briggs Institute guide will inform the methods. A modified version of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols will be used to guide the reporting of this scoping review protocol. An initial search was carried out in July 2024. The search will be conducted in electronic databases such as LILACS, SciELO, Scopus, PubMed, Embase, CINAHL, Cochrane Library and Web of Science. The search will be restricted to studies in English, Portuguese and Spanish, with no time restriction. Additional literature will be retrieved by reviewing the reference lists of the selected studies based on their titles. Two independent reviewers will carry out the data extraction process. Essential details, including the author, references and findings pertinent to the review questions, will be collected. The findings will be displayed through graphs, tables and figures, supplemented by a narrative summary.

Ethics and dissemination
As this review will be conducted using secondary data, ethical approval is not required. Results will be shared with the international scientific community through conference presentations and publication in a high-impact journal.

Study registration
This scoping review was registered with the Open Science Framework registry (osf.io/m5gvn) on 8 August 2024.

Objective
This study aimed to systematically evaluate published predictive models for dental caries in children and adolescents.

Design
A systematic review and meta-analysis of observational studies.

Data sources
Comprehensive searches were conducted in PubMed, Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Embase, China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database (VIP) and SinoMed for relevant studies published up to 18 January 2024. The search focused on caries prediction models in children and adolescents.

Eligibility criteria
Eligible studies included observational research (cohort, case–control and cross-sectional designs) that developed risk prediction models for dental caries in children and adolescents aged ≤18 years. Each model was required to include a minimum of two predictors. Studies were excluded if they were not available in English or Chinese, primarily focused on oral microbiome modelling, or lacked essential details regarding study design, model construction or statistical analyses.

Results
A total of 11 studies were included in the review. All models demonstrated a high risk of bias, primarily due to inappropriate statistical methods and unclear applicability resulting from insufficiently detailed presentations of the models. Logistic regression, random forests and support vector machines were the most commonly employed methods. Frequently used predictors included fluoride toothpaste use and brushing frequency. Reported area under the curve (AUC) values ranged from 0.57 to 0.91. A combined predictive model incorporating six caries predictors achieved an AUC of 0.79 (95% CI: 0.73 to 0.84).

Conclusions
Simplified predictive models for childhood caries showed moderate discriminatory performance but exhibited a high risk of bias, as assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Future research should adhere to PROBAST guidelines to minimise bias risk, focus on enhancing model quality, employ rigorous study designs and prioritise external validation to ensure reliable and generalisable clinical predictions.

PROSPERO registration number
CRD42024523284.