Risultati per: Il dolore neuropatico: review

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.

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.

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
Embodied conversational agents (ECAs) are computer-based dialogue systems designed to simulate face-to-face interactions by incorporating human-like physical attributes. Their capacity to establish and maintain an empathic relationship in patient interactions positions them as innovative tools that facilitate shared decision-making (SDM). To systematically synthesise the existing evidence concerning the development and application of ECAs in promoting SDM, this protocol delineates a scoping review designed to identify and present the available evidence within this domain. Specifically, the protocol outlines a review that will concentrate on the key features of ECAs in the context of SDM, including their appearance, dialogue mechanisms and emotional models, within the framework, as well as their implementation and evaluation in clinical settings.

Methods and analysis
The framework established by Arksey and O’Malley will be employed to guide the scoping review process. This protocol outlines the systematic retrieval of seven databases, including PubMed, EMBASE, PsycINFO, Web of Science, the Cumulative Index to Nursing and Allied Health Literature, Institute of Electrical and Electronics Engineers (IEEE) Xplore Digital Library and Association for Computing Machinery (ACM) Digital Library. The search strategy has been developed and will be conducted across each database, from its inception to September 2024. Two researchers will conduct literature screening and data extraction independently. The results will be systematically organised and presented through narrative abstracts, tables and/or figures.

Ethics and dissemination
Ethical approval is not necessary for this review, as it uses data that have been previously collected. Furthermore, the obtained results will be reported in a peer-reviewed journal.

Trial registration number
Open Science Framework Registries (https://doi.org/10.17605/OSF.IO/BN3CM).

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.

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.