Risultati per: Il dolore neuropatico: review

Jakobsen MI, Schaug JP, Storebø OJ, et al. What is the current scope of research assessing patients’ and clinicians’ perspectives on clozapine treatment? A comprehensive scoping review. BMJ Open 2025;15:e085956. doi: 10.1136/bmjopen-2024-085956 This article was previously published with an error. Few lines in the Abstract and the Conclusion sections have been rephrased to avoid misinterpretation regarding the recommendations for future research. The following sentences have been reworded in the Abstract’s Results section: Three gaps in research were identified: (1) studies exploring clozapine-eligible, yet clozapine-naïve, patients’ attitudes towards clozapine commencement, (2) studies exploring clinicians’ reasons for clozapine withholding and perceived facilitators of clozapine treatment in individual patient-cases and (3) studies on patient and clinician perspectives on clozapine discontinuation, continuation and rechallenge in individual patient cases. The following are the revised sentences in the Conclusions section: This behaviour leaves three distinct gaps in research: (1) studies exploring clozapine-eligible, yet clozapine-naïve, patients’…

Background and objectives
Peer review is ubiquitous in evaluating scientific research. While peer review of manuscripts submitted to journals has been widely studied, there has been relatively less attention paid to peer review of grant applications (despite how crucial peer review is to researchers having the means and capacity to conduct research). There is spirited debate in academic community forums (including on social media) about the perceived benefits and limitations of grant peer review. The aim of our study was to understand the experiences and challenges faced by grant peer reviewers.

Methods
Therefore, we conducted qualitative interviews with 18 members of grant review panels—the Chairs, peer reviewers and Scientific Officers of a national funding agency—that highlight threats to the integrity of grant peer review.

Results
We identified three threats: (1) lack of training and limited opportunities to learn, (2) challenges in differentiating and rating applications of similar strength, and (3) reviewers weighting reputations and relationships in the review process to differentiate grant applications of a similar strength. These threats were compounded by reviewers’ stretched resources or lack of time. Our data also highlighted the essential role of the Chair in ensuring transparency and rigorous grant peer review.

Conclusions
As researchers continue to evaluate the threats to grant peer review, the reality of stretched resources and time must be considered. We call on funders and academic institutions to implement practices that reduce reviewer burden.

Objective
To make healthcare programmes more patient-centred and efficient in light of limited resources, it is crucial to ensure patient satisfaction. There is limited information on the overall level of satisfaction with Human Immunodeficiency Virus/ Acquired Immune deficiency syndromes (HIV/AIDS) treatment and care services in Ethiopia. This meta-analysis aimed to generate a nationwide pooled estimate of the level of satisfaction with HIV/AIDS and associated factors by combining data from primary studies to provide a general overview of the effect across the country, aiming to informed policy decisions.

Design
Systematic review and meta-analysis.

Data source
PubMed, Scopus, Hinari, African journals online and Google Scholar were used to locate published studies.

Eligibility criteria
Observational studies assessing the level of satisfaction with HIV/AIDS care and treatment services and its associated factors among adult people living with HIV/AIDS receiving antiretroviral therapy in Ethiopia were included.

Data extraction and synthesis
Two authors extracted the data using a pre-established data extraction format and exported it to Stata V.17 for analysis. The Cochran-Q and I2 test statistics were used to measure the statistical heterogeneity among included studies. A random-effects meta-analysis model with the Der Simonian-Laird method was used to estimate the pooled effect size of satisfaction with HIV/AIDS care and treatment services with its 95% CI. Small study effects were assessed using Egger’s regression test at a 5% level of significance. A meta-regression analysis and a leave-one-out sensitivity analysis were also conducted.

Results
24 studies were included. The pooled level of satisfaction with HIV/AIDS treatment and care services in Ethiopia was 69.7% (95% CI 63.8, 75.5%) with a significant level of heterogeneity (I2=98.0%; p

Objectives
To summarise and synthesise existing literature on the implementation of decarbonisation actions in general practice, to outline the actions being implemented, factors influencing decarbonisation, identify evidence gaps and questions for future research.

Design
A systematic review and narrative synthesis.

Data sources
MEDLINE, Embase, CINAHL, Web of Science and ProQuest (grey literature) were searched for literature published up to 29 March 2024.

Eligibility criteria for selecting studies
Studies of any design investigating the implementation of decarbonisation actions in general practice.

Data extraction and synthesis
Two reviewers extracted data and conducted quality assessments using a mixed methods appraisal tool. Narrative synthesis was used to analyse findings.

Results
Fifteen studies were included. Studies were primarily from the UK (n=5), followed by Australia (n=3), USA (n=2), Germany (n=2) and one each from France, Switzerland and Israel. Study designs were qualitative (n=7), quantitative (n=7) and one mixed methods. Participants included healthcare staff (n=7), patients (n=5), health stakeholders (n=2) and the general public (n=1). There was evidence of general practices adopting decarbonisation actions such as resource reuse, improved waste management, energy-efficient systems and preventive care to reduce overmedication, with strong leadership and institutional support being crucial for their success. However, barriers such as high costs, resource constraints and limited awareness among clinicians and patients highlighted the need for enhanced communication, education and the structured promotion of initiatives to improve patient and community engagement.

Conclusions
There is limited evidence on the implementation of decarbonisation actions in general practice. A range of factors may impact on the extent to which implementation occurs. Addressing these will be crucial for effectively promoting and scaling decarbonisation actions in general practice. Future research should focus on understanding the role of institutional context, evaluating the real-world impact of interventions on greenhouse gas emissions and exploring patient and community involvement.

PROSPERO registration number
CRD42023470889.

Introduction
Chronic depression represents a common and highly disabling disorder. Several randomised controlled trials (RCTs) investigated the effectiveness of psychological, pharmacological and combined treatments for chronic depression. This is the first overarching systematic review and network meta-analysis (NMA) based on aggregated and individual patient data comparing the efficacy and acceptability of various treatment options for all subtypes of chronic depression. Furthermore, individual demographic and clinical characteristics that predict or moderate therapy outcomes will be investigated.

Methods and analysis
A systematic literature search of the Cochrane Library, MEDLINE via Ovid, PsycINFO, Web of Science and metapsy databases will be conducted from database inception without language restrictions to include all available samples from RCTs that investigated the efficacy of psychotherapy versus pharmacotherapy, or their combination in adult inpatients or outpatients with a primary diagnosis of chronic depression. Exclusively internet-based treatment studies will be excluded. The main outcome is depression severity measured on a continuous observer-rated scale for depression at 6 months post-treatment (range 3–12 months). Two reviewers will independently screen and select eligible studies based on the predefined inclusion and exclusion criteria. Risk of bias will be assessed using version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2). Individual patient data (IPD) will be requested and incorporated in the network when provided, as it is the gold standard of evidence. For studies which do not provide IPD, aggregate data (AD) will be extracted and incorporated in lieu of IPD for the NMA, strengthening the evidence base and leveraging all existing evidence regardless of data availability restrictions. An NMA comparing psychotherapies and a network meta-regression estimating individualised treatment effects of psychotherapy will be implemented assuming a Bayesian framework. All models will be fitted in R with calls to JAGS. Empirical informative prior distributions will be used for model parameters where available, and non-informative priors will be used in cases where empirical priors are not available.

Ethics and dissemination
This IPD-NMA requires no ethical approval. All results will be disseminated as peer-reviewed publication in a leading journal in this field and presented at (inter)national scientific conferences.

PROSPERO registration number
CRD42024526755.

Background
Statins are considered a promising therapy in traumatic brain injury (TBI) because of their role in mediating inflammatory injury and other endothelial properties. Whether they can improve patient outcomes is unknown.

Objectives
To evaluate the effect of statins in critically ill patients with TBI.

Design
Systematic review and meta-analysis of randomised controlled trials.

Eligibility criteria
Trials of adult patients with acute moderate or severe TBI.

Methods
We searched Medline, Embase, Cochrane Central and Web of Science databases for trials comparing the use of any statin with placebo or other interventions. Our primary outcome was the Glasgow Outcome Scale (GOS or GOS extended); secondary outcomes were mortality, intensive care unit (ICU) and hospital length of stay. We used inverse variance random-effects models to calculate risk ratios (RR) and weighted mean differences. We assessed the risk of bias of trials using the Cochrane risk of bias assessment tool and the presence of statistical heterogeneity using the I2 index. Levels of evidence for summary effect measures were evaluated using Grading of Recommendations Assessment, Development and Evaluation methodology.1

Results
Of the 2418 retrieved records, 7 trials met our eligibility criteria. Three studied simvastatin, and four studied atorvastatin. The duration of the intervention ranged from 2 to 10 days, and outcomes were assessed between ICU discharge and 6 months. Five trials were considered at high risk of bias. We observed no statistically significant association between statins and the GOS (RR 0.42; 95% CI, 0.14 to 1.22; two trials; n=84, I2=0%; very low certainty) or mortality (RR 0.59; 95% CI, 0.25 to 1.44; three trials; n=160, I2=0%; very low certainty). No significant effect was observed for ICU length of stay, while hospital length of stay was evaluated in one trial showing shorter duration.

Conclusion
We found no conclusive evidence supporting the use of statins in critically ill adult patients with TBI at this time. Nevertheless, the trials were limited, and wide confidence intervals resulted in significant uncertainty of the findings. A potential benefit cannot be ruled out, underscoring the need for a larger, well-designed trial.

PROSPERO registration number
CRD42023421227.

Introduction
As educators and health professionals, school nurses are in an optimal position to improve and advocate for adolescent reproductive and sexual health. This report outlines a protocol for a systematic review to synthesize evidence on the effects of school nurse-led education interventions and barriers and facilitators to implementing the interventions to improve students’ knowledge, attitudes and behaviours related to sexual and reproductive health in high-income countries.

Methods and analysis
We will develop a protocol to systematically review school nurse-led education interventions aimed at promoting adolescent sexual and reproductive health. This protocol will be based on the methodology of the Cochrane Handbook for Systematic Reviews of Interventions. The search will be conducted in Ovid-MEDLINE, CINAHL, Cochrane Library, Ovid-Embase, PsycINFO, Koreamed and ScienceON using relevant Medical Subject Headings and text words to identify the literature on different types of studies examining school nurse-led sexual and reproductive health education interventions in April 2024. Two independent reviewers will select relevant studies and extract data using a predefined template. We will assess methodological quality using the risk-of-bias tools appropriate for study designs and will resolve discrepancies through discussion with the review team. Where appropriate, we will conduct meta-analyses to estimate the effectiveness of school nurse-led sexual and reproductive health education interventions. Additionally, a qualitative evidence synthesis will be performed for the qualitative research included in the review. Finally, both a quantitative synthesis and a qualitative synthesis will be combined into a secondary synthesis addressing the facilitators and barriers of sexual and reproductive health educational interventions provided by school nurses to adolescents.

Ethics and dissemination
This review will synthesise publicly available resources and does not require ethical approval. The findings will provide insights into how school nurses can improve students’ sexual and reproductive health. The results will be disseminated through peer-reviewed publications, reports and academic conferences.

PROSPERO registration number
CRD42022347625.

Introduction
Cancer remains a major global health challenge, affecting millions annually and ranking as the second leading cause of death worldwide. The complexity of cancer treatment requires an interdisciplinary approach, connecting professionals from various fields to deliver personalised and integrated care. However, structural issues and insufficient interdisciplinary training can impede effective collaboration, which is why effective interprofessional education (IPE) is needed. This protocol depicts the planned procedures for a scoping review that aims to explore the role of IPE in enhancing interdisciplinary collaboration within oncology by mapping and synthesising the implementation, impact and evaluation strategies of patient-centred IPE programmes.

Methods and analysis
This scoping review will be conducted in line with the Joanna Briggs Institute guidelines for scoping reviews. The research team will develop a comprehensive search strategy and apply it to the following databases: CENTRAL, CINAHL, Embase, MEDLINE, PsycInfo, Scopus and Web of Science . Additionally, we will search for grey literature (eg, using OpenDOAR) and contact relevant organisations for pertinent reports. Each database will be searched without date restrictions on 11 September 2024. In the first stage, eligibility criteria will be assessed through a blinded title and abstract screening, followed by a full-text review. The research team will then extract and synthesise data related to the scoping review questions, focusing on implementation, impact and evaluation strategies employed in the included studies.

Ethics and dissemination
As this protocol does not involve collecting primary data, ethical approval is not required. The results of this review will be published in a peer-reviewed journal and disseminated through institutional websites and conferences.

Introduction
Empirical data on the barriers limiting artificial intelligence (AI)’s impact on healthcare are scarce, particularly within the Canadian context. This study aims to address this gap by conducting a scoping review to identify and evaluate AI algorithms developed by researchers affiliated with Canadian institutions for patient triage, diagnosis and care management. The goal is to identify characteristics in the developed AI algorithms that can be leveraged for a better impact.

Methods and analysis
A scoping review will be conducted following the JBI Methodology for Scoping Reviews and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Relevant literature will be identified through comprehensive searches of MEDLINE (PubMed), CINAHL (EBSCO) and Web of Science (Clarivate) databases, combining keywords related to AI, clinical management and the Canadian context. Studies published after 2014, in English or French, that discuss AI algorithms developed for patient triage, diagnosis or care management by researchers affiliated with Canadian institutions will be included. Data from the selected articles will be extracted and analysed descriptively, and findings will be presented in tabular form accompanied by a narrative summary.

Ethics and dissemination
Ethical approval is not required for this study as it involves the review of publicly available literature. The scoping review is expected to be completed by November 2025. The findings will be disseminated through publications in peer-reviewed journals and presentations at conferences focused on AI and healthcare practice.

Introduction
Reversal treatment is commonly used for managing oral anticoagulant (OAC)-associated intracranial haemorrhages. Its effects on mortality are still understudied, particularly in various subtypes of intracranial haemorrhages. This systematic review and meta-analysis aims to synthesise the available data to study the impact of reversal therapies on mortality following various OAC-associated acute intracranial haemorrhages.

Methods and analysis
This protocol follows the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Protocols, and the final review will be reported in accordance with the PRISMA reporting guidelines. This systematic review and meta-analysis will include studies that assess contemporary reversal treatment in comparison to no reversal treatment, in cases of OAC-associated intracranial haemorrhage. Stratification will be performed for the types of bleeding as well as OAC at bleeding onset. Preliminary searches to determine search term inclusions were conducted in May–August 2024 in the electronic databases Embase, PubMed, Scopus and Web of Science without language and publication date restrictions. Randomised controlled studies, non-randomised controlled trials, and observational studies will be considered for the final meta-analysis. Three reviewers (MT, JOS and AB) will screen titles and abstracts, and one reviewer (MT) will subsequently conduct full-text screening.
Risks of bias will be assessed by MT using tools such as Risk of Bias 2, Risk Of Bias In Non-randomised Studies – of Interventions and the Newcastle-Ottawa Scale. Heterogeneity among the study results will be assessed using the I² statistic. If appropriate, a random-effects meta-analysis model will be performed. Subgroup analyses and meta-regression (if applicable) will be performed to assess sources of heterogeneity among (1) intracranial haemorrhage types, (2) OAC drugs and (3) study types, with randomised controlled trials being the primary focus.

Ethics and dissemination
Ethical approval is not needed as this project involves previously published data. We intend to publish the results in a peer-reviewed journal.

PROSPERO registration number
CRD42024556420.

Introduction
Pulmonary complications frequently occur as comorbidities in individuals with transfusion-dependent thalassaemia (TDT). Despite their clinical significance, the existing literature lacks a systematic review and meta-analysis examining the prevalence and risk factors for pulmonary dysfunction in this patient cohort. Therefore, we propose to conduct a systematic review and meta-analysis to report the prevalence and associated risk factors of pulmonary dysfunction in TDT patients.

Methods and analysis
This systematic review and meta-analysis will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. We will search PubMed, EMBASE, the Cochrane Library, Scopus and Web of Science to identify English-language literature from the inception of each database up to 31 May 2024. We will include studies that involve TDT patients and report on the method of pulmonary function assessment, the proportion of pulmonary dysfunction and the analysis of risk factors for pulmonary dysfunction. The study designs included will be cohort, case-control and cross-sectional studies. Exclusions will apply to studies on non-TDT or patients with other diseases, reviews, case reports and animal experiments, as well as duplicated published studies, studies without full-text availability or studies from which raw data cannot be extracted. The screening process, including title, abstract and full texts, will be conducted independently by two reviewers. Data extraction will be performed following standardised protocols. The quality of the included studies will be assessed using the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality criteria. The meta-analysis will be conducted using Stata 14.0 and Review Manager (RevMan) 5.4 software, incorporating subgroup analyses, heterogeneity assessments and publication bias evaluations to ensure the robustness and reliability of the findings.

Ethics and dissemination
As the data for this systematic review and meta-analysis are sourced exclusively from previously published literature, there is no requirement for ethical approval. The dissemination of the results will occur through publication in a peer-reviewed scholarly journal and presentations at relevant scientific conferences.

PROSPERO registration number
CRD42024504353.

Our review highlights the potential for the use of AI algorithms applied to retina images, particularly CFP, to screen, predict, or diagnose the various microvascular and macrovascular complications of diabetes. However, we identified few studies with longitudinal data and a paucity of randomized control trials, reflecting a gap between the development of AI algorithms and real-world implementation and translational studies.

Introduction
Social media has an impact on the reach and speed with which information is disseminated, benefiting patients and healthcare professionals by sharing knowledge, even from a distance. However, these channels can pose risks when used irresponsibly by these actors. Thus, e-professionalism emerges as a modulator of professionals’ behaviours and attitudes, and its evaluation is fundamental given the demand for quality in services, including in these settings. Thus, this study aims to identify instruments used to assess the e-professionalism of healthcare professionals.

Methods and analysis
A systematic review will be developed to answer the question: ‘How is e-professionalism in healthcare professionals evaluated in the literature?’. The searches will take place in the following databases: PUBMED/Medline, EMBASE, Web of Science, ERIC and Scopus using descriptors such as ‘professionalism’, ‘e-professionalism’, ‘social media’ and synonyms. Studies will be selected after evaluating titles and abstracts, followed by an analysis of full texts using the Rayyan tool. Studies that present the development and validation of e-professionalism assessment instruments for nursing, pharmacy, medicine and dentistry will be included. The quality of the instruments will be assessed based on evidence of content and construct validity reported by the developers.

Ethics and dissemination
This review is exempt from ethical approval because it does not include patient data. The results of the systematic review will be disseminated through a peer-reviewed journal and presented at a relevant conference.

PROSPERO registration number
CRD42023454825.

Introduction
Mental health issues among women in Sub-Saharan Africa (SSA), especially those living with HIV, pose a major public health challenge. Despite the established connections between HIV status and mental health outcomes, there is a noticeable absence of targeted interventions for this group within the literature. Many studies tend to focus on broad mental health concerns without addressing the specific needs of women with HIV, or they neglect to incorporate mental health elements into current HIV-related programmes. This scoping review aims to gather and analyse the existing research on interventions designed to improve the mental health of women in SSA, both with and without HIV. It will identify barriers preventing this population from accessing mental healthcare, highlight important gaps in the current literature and suggest directions for future research.

Methods and analysis
To conduct this scoping review, the researcher will adhere to the methodological framework proposed by Arksey and O’Malley. The literature search will span several databases, including PubMed, MEDLINE, Web of Science and PsychInfo, to ensure a comprehensive collection of relevant studies. The selection process will involve two stages: two independent reviewers will initially screen titles for eligibility and a full-text review of the selected articles. A specially designed tool will be used for data extraction, focusing on minimising bias and accurately capturing study details. The final selection of studies will be analysed using a standardised tool to comprehensively assess all bibliographic information and study characteristics. The planned study dates for the review will be January to March 2025.

Ethics and dissemination
No ethical approval is required as the review will draw on publicly available publications and materials. The study’s conclusions will be subject to peer review and published in a scientific journal, with the abstract shared at local and international conferences. Key findings will be disseminated to health ministries, community-based organisations focused on women’s mental health and HIV, and policymakers to inform policy decisions regarding mental health interventions for women in SSA.

Objective
We assessed whether Penthrox (methoxyflurane) can provide better pain relief for elective, outpatient interventional procedures compared with other methods of pain control.

Design
Systematic review.

Data sources
Cochrane Central Register of Controlled Trial, MEDLINE, Emcare, Embase, ClinicalTrials.gov and the Cumulative Index to Nursing and Allied Health Literature were searched from inception to 6 November 2023.

Eligibility criteria
All published studies including randomised controlled trials (RCTs), cohort studies and case–control studies investigating Penthrox for pain relief, during and/or after an interventional procedure, were included.

Data extraction and synthesis
Two independent reviewers identified eligible studies and retrieved data. Risk of bias was assessed using Cochrane Collaboration Risk of Bias V.2.0 and Risk of Bias in Non-randomised Studies of Interventions (ROBINS I) tools. A meta-analysis was not possible due to heterogeneity.

Results
The literature search yielded 1189 records. 12 studies were eligible for inclusion: 5 RCTs and seven non-randomised studies of interventions (NRSIs). Penthrox was used for a range of procedures across five medical specialities: gastroenterology, gynaecology, haematology, orthopaedics and urology. Two RCTs showed a significant reduction in intraprocedural pain when Penthrox was compared with placebo. However, three RCTs where Penthrox was compared with either placebo or intravenous sedation showed no significant differences in pain or comfort level. Similarly, the NRSIs showed variable results. Most patients were satisfied (63% to >98%; seven studies) with Penthrox, and seven out of eight studies reported that the majority of participants would use it again (46.8%–95%; eight studies). No serious adverse events were reported.

Conclusion
Penthrox (methoxyflurane) shows promise as an analgesic for invasive, elective interventional procedures in the outpatient setting, although the relative benefits appear to vary depending on intervention and comparator pain control measures. There is a pressing need for robustly conducted, large, generalisable multicentre RCTs to evaluate the effectiveness of Penthrox.

PROSPERO registration number
CRD42023404574.

Introduction
Cancer and its treatments can lead to a wide range of side-effects that can persist long after treatments have ended. Across Europe, survivorship care is traditionally hospital-based specialist-led follow-up, leading to gaps in supportive care. Improved screening, diagnosis and treatment increase survival rates. With more individuals living with, through and beyond cancer, the predominance of the hospital-based specialist model is unsustainable, costly and resource-intensive. An understanding of what alternative Models of Care are available and the barriers and facilitators to their implementation is a first step towards enhancing supportive care across the cancer journey. The aim of this scoping review is to source and synthesise information from studies evaluating patient-oriented models of cancer survivorship supportive care for adults in Europe.

Methods and analysis
The scoping review will be reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses—Scoping Review Extension guidelines and will be guided by a six-stage methodological framework. A search strategy has been developed according to the Population, Concept and Context structure and will be applied to seven databases. A targeted search of grey literature will be completed. All identified records will be screened using predefined eligibility criteria by at least two researchers and undergo full-text review for inclusion. Data pertaining to the conceptualisation, evaluation and implementation of sourced Models of Care will be extracted.

Ethics and dissemination
As there is no primary data, ethical approval is not required. This review will be conducted as part of the EU COST Action CA21152—Implementation Network Europe for Cancer Survivorship Care. The protocol and subsequent scoping review will be published in a peer-reviewed journal. The Action involves representatives from most countries across Europe which will assist with the dissemination of the work to key stakeholders.