Risultati per: Il dolore neuropatico: review

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.

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.

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

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.

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

Objectives
Authentic patient and family engagement in child health research is defined as researchers working in partnership with patients and families on all aspects of the research process, including refining the research question, tailoring the intervention, devising study procedures and disseminating study findings. While there is good evidence of a positive impact of patient engagement on the research process, on research teams and on patient partners, there are few empirical data on the impact of patient and family engagement on research quality and dissemination. We conducted a systematic review to compare research quality and dissemination metrics for paediatric randomised controlled trials (RCTs) that engaged patients and families in the research process with trials that did not.

Design
Systematic review using the Cochrane Highly Sensitive Search to identify RCTs.

Data sources
Ovid MEDLINE from 1 January 2011 through to 31 December 2020.

Eligibility criteria
We included RCTs involving children and youth (

Objectives
To explore the barriers to conversations about deceased organ donation among adults living in the UK.

Design
Systematic review with narrative synthesis.

Data sources
PubMed, MEDline via OVID, APA PsycInfo via EBSCO, Web of Science via Clarivate and Scopus via Elsevier, covering studies that were published between January 2006 and December 2023. Searches were conducted on 1 December 2023 and completed on 2 February 2024.

Eligibility criteria
Studies published between January 2006 and December 2023, focusing on barriers to organ donation conversations among adults in the UK. Both qualitative and quantitative studies were included, emphasising cultural and generational factors. Non-English studies and those unrelated to the UK were excluded.

Data extraction and synthesis
Screening and data extraction were conducted by two independent reviewers using a standardised tool. Quality assessment was performed using Joanna Briggs Institute checklists, evaluating study bias. A narrative synthesis approach was used to integrate findings from heterogeneous studies.

Results
11 studies (6 qualitative, 5 quantitative) with a total of 4991 participants were included. Four main thematic barriers emerged: (1) jinx factor—cultural beliefs associating discussion of death with bad luck; (2) generational impact—younger people were more open but cautious of upsetting parents; (3) ethnic disparities in conversations—varied challenges across diverse backgrounds and (4) cues to action—media and personal experiences prompted conversations. Facilitators included culturally tailored communication and community engagement.

Conclusion
Conversations about death and organ donation are often brief and hindered by cultural taboos surrounding death, generational differences in attitudes and the influence of family dynamics. Further research is needed to understand communication patterns better and to tailor interventions that encourage open discussions about organ donation across different ethnic groups.

PROSPERO registration number
CRD42022340315.

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.

Introduction
The number of babies, children and young people with complex care needs (henceforth children with complex care needs (CCCN)) in England has increased in recent decades, and this has also been recognised globally. CCCN may have frequent and lengthy hospital admissions, but during these episodes, their needs are not always met, potentially resulting in suboptimal experiences and outcomes. Despite increased numbers of CCCN accessing acute care and displaying greater complexity, much of the contemporary literature has focused on primary care coordination between health, education and social care. Research specifically focused on CCCN in the acute care setting is largely absent. This realist review aims to understand how optimal experience and outcomes are achieved for CCCN during acute care, in different settings, for whom and why.

Methods and analysis
This realist review will proceed through six steps: (1) clarifying the scope of the review, (2) searching for evidence, (3) data selection and quality appraisal, (4) data extraction, (5) analysis and synthesis and (6) dissemination. We will search Medline, Cumulated Index in Nursing and Allied Health Literature and PsycINFO, alongside grey literature and other sources and will carry out citation tracking. Patient and public involvement and engagement have aided in the development of this protocol and will be maintained through regular consultations with a stakeholder group throughout the review. The review will result in a programme theory which will include context-mechanism-outcome configurations and provide data to support claims of generative causation.

Ethics and dissemination
Ethical approval is not required for this review as it does not involve primary research. The programme theory developed will be disseminated through peer-reviewed publications and relevant conferences. It will subsequently inform the development of an intervention to improve acute care for CCCN.

PROSPERO registration number
CRD42024591231.

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.