Risultati per: Infezione da Helicobacter pylori: review

Objectives
This study aims to compare the outcomes of different pharmacotherapies for subjective tinnitus patients using a comprehensive network meta-analysis.

Design
Systematic review and network meta-analysis.

Data sources
PubMed, EMBASE, Web of Science and CINAHL Complete databases were searched from inception until 6 March 2025.

Eligibility criteria
Randomised controlled trials (RCTs) comparing pharmacotherapy treatment effects for subjective tinnitus patients were included with tinnitus severity as the primary outcome, and annoyance and tinnitus loudness as secondary outcomes.

Data extraction and synthesis
Two reviewers independently retrieved and screened full articles using a standardised and prepiloted Excel form. Network meta-analysis was conducted with heterogeneity, study risk of bias (ROB), risk of publication bias and certainty of evidence examined using I2, 2, ROB2, funnel plots and Grading of Recommendations, Assessment, Development, and Evaluation assessments.

Results
Sixty full-text RCTs from 21 countries were included in the analysis with 22% low ROB, 58% some concerns and 20% high ROB. The heterogeneity parameter I2 was 0.67 (95% CI 0.33 to 0.84), 0 (95% CI 0 to 0.9) and 0.63 (95% CI 0 to 0.89) for the severity, annoyance and loudness network analysis, respectively. The only significant publication bias assessment by Egger’s test was detected in the loudness network analysis (p

Objectives
Patient activation (PAct)—a measure assessing an individual’s perceived knowledge, skills and confidence in managing their health and well-being—is often used to personalise and evaluate care, although its causal link to self-management behaviours (SMBs) and clinical outcomes remains uncertain. We aimed to synthesise the evidence on the causal association between PAct, SMBs and clinical outcomes in type 2 diabetes (T2D).

Design
Systematic review and narrative synthesis of data summarised in a harvest plot.

Data sources
We searched Medline, Embase, CENTRAL, PsycInfo, Web of Science and CINAHL up to April 2024 for relevant English articles.

Eligibility criteria
We included studies of any quantitative design that reported on the association of PAct with clinical outcomes or SMBs in adult patients with T2D.

Data extraction and synthesis
Two independent reviewers were involved, and any disagreements were discussed and resolved collaboratively. Risk-of-bias (RoB) was assessed using an adapted RoB Assessment Tool for Nonrandomised Studies. Levels of evidence were evaluated for each T2D-related outcome.

Results
We identified 21 studies published between 2009 and 2023, including 15 cross-sectional studies and no randomised controlled trials. Eleven studies were conducted in the USA. Seventeen studies used the Patient Activation Measure questionnaire. There is moderate evidence that higher PAct scores are associated with better glycated haemoglobin levels (studies reporting on this association, n=14). There is very limited evidence that PAct improves diet (n=5) and physical activity (n=6). All other clinical outcomes and SMBs had inconclusive results due to either inconsistent or insufficient evidence, or both.

Conclusion
A causal relationship between PAct, clinical outcomes and SMBs in T2D cannot be established due to inconsistent evidence and a lack of high-quality studies. Thus, the use of PAct scores as a tailoring tool and an outcome measure in healthcare services requires further evaluation.

PROSPERO registration number
CRD42021230727.

Introduction
Secure mental health pathways are complex. They are typically based around secure hospitals, but also interface with justice agencies and other clinical services, including in the community. Consideration of risk is fundamental to clinical care and to decisions relating to a patient’s stepwise journey through the pathway. Patient autonomy and involvement in decision-making are policy priorities for health services. However, improving collaboration in risk-related decisions in secure services is complicated by potential issues with insight and capacity and the necessary involvement of other agencies. In addition, although some collaborative approaches are feasible and effective, their impact, mechanisms and the contexts in which they work are not well understood. Therefore, using realist methodology, this review will outline what works, for whom, why and under what circumstances in terms of collaborative risk assessment and management in secure services.

Methods and analysis
The review will consist of four stages: (1) Development of an initial programme theory to explain how and why collaborative risk assessment and management works for different groups of people, (2) search for evidence, (3) data selection and extraction and (4) evidence synthesis and development of a final programme theory. Our initial programme theory will be informed by an informal search of the literature and consultation with experts and patient and public involvement and engagement representatives. Following this, our formal literature search will include both the published and unpublished literature. During full text screening, each document will be assessed according to the principles of rigour and relevance and, if included, data will be extracted and synthesised to refine the programme theory.

Ethics and dissemination
This protocol is for a review of published literature and so does not require ethical approval. The main output will be the final programme theory. Remaining gaps will inform planned future work to further refine the theory using mixed methods. Our dissemination strategy will be codeveloped with our public and patient involvement group and will include publishing findings in a peer-reviewed journal and presenting findings at relevant professional conferences, as well as engaging patient, carer and clinician groups directly.

Objectives
To identify currently available functional vision tests and evaluate their use as clinical trial outcome measures in ophthalmology.

Design
Scoping review using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews) guidelines.

Methods
A literature search was conducted in MEDLINE and Embase (via Ovid) for articles published between 1 January 2003 and 1 August 2024. Additional grey literature was sourced from institutional repositories, conference proceedings and a manual citation search. Article screening was conducted against a predefined inclusion criteria by two independent, masked reviewers, with a third reviewer acting as arbiter. The inclusion criteria were English language articles which feature a test assessing functional vision in patients with an ophthalmological disease. Details of source characteristics, test methodology and accessibility and evidence of test validation were collected.

Results
Of 2665 articles returned by the search, 73 were included and 45 unique tests of functional vision were identified. Diseases affecting the peripheral retina were mainly affected, accounting for 77% (56 out of 73) of the diseases featured in all included studies. Overall, 82% (37 out of 45) functional vision tests reported evidence of statistical validation with varying robustness. Functional vision tests were mapped to domains of orientation and mobility, facial recognition, observer-rated task performance, visual search and driving. Obstacle courses assess vision-guided orientation and mobility, correlate highly with clinical measures of visual function in severe peripheral retinal disease and have been validated for use in clinical trials. Their requirement of physical space and time limits utility in multicentre trials; equivalent tests leveraging virtual reality and eye tracking technologies are in development. Early iterations of visual search tests to simulated realistic scenes have demonstrated discriminative ability, even in paediatric patients.

Conclusions
Functional vision tests can facilitate research into future novel ophthalmological treatments that prioritise patients in terms of how clinical benefit is defined. The principal barriers to the uptake of these tests are lack of accessibility, low quality validation and that many tests remain early in their development stage. This review captures the current landscape of functional vision tests and serves as a reference for investigators and regulatory bodies to evaluate the suitability of these tests for ophthalmic clinical trials.

Introduction
Over half of children and adolescents with attention-deficit/hyperactivity disorder (ADHD) have difficulties with emotion dysregulation (EDR) and/or sleep, yet the interrelations between emotional regulation and sleep are not well-characterised in this population. This systematic review will address the relationship between these difficulties and investigate whether specific aspects of EDR are more strongly related to sleep problems in youth with ADHD.

Methods and analysis
We will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guideline for systematic reviews. A wide set of electronic databases will be searched for peer-reviewed quantitative studies investigating the relationship between EDR and sleep in children and adolescents (ages 5 to 18 years) with ADHD. In addition, the reference list of all studies will be searched for other relevant studies, and Scopus will be used to search for citations of the included studies. We will also contact experts in the field to request published and unpublished studies. The primary outcome will be the effect size of the relationship between EDR and sleep in children and adolescents with ADHD. We will look at EDR and sleep broadly and also consider the multifaceted nature of both terms. Secondary outcomes will include which facets of EDR and sleep have been measured and how they have been measured, developmental differences between children and adolescents with ADHD and how—and the extent to which—studies controlled for the use of CNS medications and cooccurring disorders in their study design and/or statistical analyses. The quality and risk of bias of the included studies will be assessed using the Mixed Methods Appraisal Tool.

Ethics and dissemination
This protocol is for a review of studies and does not involve any new data collection and therefore does not need ethical or human subjects approval. The results will be presented at international conferences and in a peer-reviewed journal.

PROSPERO registration number
CRD42024612984.

Annals of Internal Medicine, Ahead of Print.

Current interventions bring about improvements in medication adherence, but such improvements are not sustained over the long-term. For real world and practice implications, interventions must be multipronged in nature, addressing a combination of at least two dimensions of medication adherence. Additional global studies, particularly long-term randomised controlled trials, are required to corroborate our findings.

Introduction
Healthy dietary choices have an important role in preventing chronic diseases such as cardiovascular disease (CVD). Increasing evidence suggests micronutrient intake (essential minerals and vitamins) is associated with abdominal aortic calcification (AAC), which is an advanced marker of CVD. However, the existing reports seem inconsistent. Some studies reported micronutrients are associated with a lower risk of AAC, while others have reported an increased risk. Therefore, this systematic review and meta-analysis sought to summarise the available evidence on the association of dietary micronutrient intake on AAC.

Methods and analysis
A comprehensive systematic search of the PubMed/MEDLINE, EMBASE, Web of Science and Google Scholar databases from their inception up to September 1, 2024, will be conducted. All clinical studies that report eligible exposure/s (dietary micronutrient intake) and outcome/s (presence/severity of AAC) will be included, and this systematic review and meta-analysis protocol will be reported following the revised Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines. The risk of bias for observational studies will be assessed using the Newcastle-Ottawa Scale and publication bias will be evaluated through visual inspection of funnel plots and the Egger’s and Begg’s regression tests. The Der Simonian and Laird random-effects model meta-analysis will be calculated to provide pooled results, and the weighted risk ratio with their 95% confidence intervals will be presented.

Ethics and dissemination
The results will be disseminated through publishing in a peer-reviewed journal and public presentations at relevant local, national and international conferences, workshops and symposiums. Ethical approval is not required as this is a systematic review of publicly available data.
PROSPERO registration number
CRD42024575902

Introduction
Climate degradation poses a significant global health challenge, with healthcare systems paradoxically contributing to this issue while adhering to the principle of ‘do no harm’. Notably, the healthcare sector accounts for a considerable share of greenhouse gas emissions in many industrialised countries, primarily due to the supply chain, including pharmaceuticals, disposable medical devices and personal protective equipment (PPE). The COVID-19 pandemic exacerbated this issue, with millions of tons of CO2 emissions attributed to single-use PPE. In response to the pandemic, some hospitals have begun adopting and implementing reusable PPE as a sustainable alternative to reduce emissions, enhance resilience to supply chain disruptions and achieve cost savings. This scoping review aims to synthesise the available evidence on the adoption, implementation barriers and facilitators, as well as the impacts of reusable PPE in hospital settings.

Methods and analysis
This protocol is based on York’s five-stage framework outlined by Arksey and O’Malley. We will map evidence on the environmental and economic impacts of reusable versus disposable PPE, and the associated infection risks. Using an adapted Consolidated Framework for Implementation Research, our scoping review will identify enablers and barriers to implementation across different clinical settings. The methodology will adhere to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Review guidelines and will include a comprehensive search of peer-reviewed articles in five databases (Medline, Embase, CINAHL, Web of Science and Global Health) and grey literature. Databases will be searched from inception to December 2024. Two reviewers will independently evaluate the eligibility of all identified titles and abstracts for inclusion in the full-text review, as well as for data extraction. Descriptive data will provide insights into the enablers and facilitators of reusable PPE adoption and implementation, along with its impacts on patient and staff safety, costs, the environment and supply chain resilience to disruptions will be reported.

Ethics and dissemination
We expect the results to both identify research gaps and generate novel ideas for future studies on transitioning to reusable PPE in healthcare settings. This review will offer healthcare decision-makers valuable insights into the factors influencing the shift from disposable to reusable PPE and its associated impacts. By refining PPE management strategies, the findings will enable managers to clearly understand the challenges and anticipated outcomes, thereby guiding effective decision-making and facilitating a smooth transition that minimises operational disruptions while upholding patient and staff safety. Ethics approval was not required for this review. The findings will be shared through conferences on healthcare management and sustainability, and submitted to peer-reviewed journals in healthcare management and implementation science.

Trial registration details
https://doi.org/10.17605/OSF.IO/DESVU.

Objectives
Tissue viability assessment is one of the main challenges in trauma surgery. Vitality assessment using indocyanine green fluorescence angiography (ICG-FA) may improve surgical decision-making. This systematic review gives an overview of current applications of ICG-FA in surgical treatment of traumatic injury and its effects on the incidence of postoperative complications and intraoperative decision-making.

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

Data sources
PubMed, EMBASE and MEDLINE were searched through 18 December 2023.

Eligibility criteria for selecting studies
Primary research reports regarding indocyanine green (ICG)-fluorescence in patients with traumatic injury were included. Exclusion criteria were use of ICG for treatment of burn wounds, traumatic brain injury or reconstructive surgery, absence of an English or Dutch full-text and non-primary study design.

Data extraction and synthesis
Two independent reviewers performed the search and screening process according to standardised methods. Risk of bias was assessed using the Methodological Index for Non-Randomised Studies. Data were presented in text and overview tables.

Results
Thirteen studies were included, of which six were case series/reports including three or fewer patients. Within the other seven studies, 301 patients received ICG-guided surgery. ICG was used for perfusion assessment in all studies. Injury types consisted of traumatic extremity and abdominal injury. All studies reported beneficial effects such as necrosis detection, determination of resection/debridement margins and reduction of debridement procedures. ICG could improve intraoperative decision-making and significantly decrease postoperative complications. No included studies reported ICG-related complications or adverse events.

Conclusion
The available literature regarding the use of ICG-FA in trauma surgery is limited, and comparability is low. Still, the results are promising and show a large potential of ICG-FA for better and more efficient treatment of trauma patients. Further research with larger samples and comparable conditions is thus necessary and highly recommended.

Background
Extrapulmonary tuberculosis (EPTB) is a significant public health issue in Indonesia, a country with a high tuberculosis burden. EPTB accounts for 15%–20% of global TB cases, with the proportion rising in populations co-infected with HIV. In Indonesia, estimates of EPTB prevalence vary significantly due to inconsistencies in diagnostic criteria, population demographics and methodologies. These variations highlight the need for a systematic review to synthesise existing evidence and provide a comprehensive understanding of EPTB’s epidemiology in Indonesia. This study aims to consolidate findings from various studies to identify prevalence trends, inform public health strategies and address knowledge gaps in diagnosing and managing EPTB.

Methods
This systematic review will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines and has been registered with PROSPERO (Registration Number: CRD42024601175). A comprehensive search will be conducted in databases including PubMed, Google Scholar, ScienceDirect, Scopus and Southeast Asian Index Medicus to identify studies published between 2005 and 2024. Inclusion criteria include observational studies reporting EPTB prevalence in Indonesia based on clinical, microbiological or radiological diagnoses. Two independent reviewers will conduct study selection, data extraction and quality assessments using the Newcastle-Ottawa Scale. Data will be analysed using a random-effects model to estimate pooled prevalence, and subgroup analyses will explore variability by region, age and clinical setting. The study selection process will be documented using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram, and potential publication bias will be evaluated with funnel plots and the trim-and-fill method.

Ethics and dissemination
As this review involves secondary analysis of published data, no ethical approval is required. Findings will be disseminated through peer-reviewed journal publications and conference presentations.

Introduction
Orthorexia nervosa (ON) is a newly recognised condition characterised by an excessive fixation with healthy eating, yet the prevalence of ON is poorly understood. This protocol presents the methodology to undertake a systematic review and meta-analysis on the prevalence of ON in a wide range of populations (including general population and ‘high-risk’). To the authors’ knowledge, the proposed review will be the first systematic review to critically appraise the quality and quantity of evidence on this topic.

Methods
The protocol has been developed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. Eligible studies will be identified through a systematic search of electronic databases (eg, Medline Complete, PsycInfo and CINAHL complete via the EBSCOHost platform and Embase). Two reviewers will independently screen and review the full text of records, extract the data and critically appraise the evidence using the Joanna Briggs Institute critical appraisal checklist for prevalence studies. A descriptive synthesis will present the characteristics of the included studies and key findings in text and tables. Where appropriate, meta-analysis will be conducted to determine the proportion of individuals with ON (yes/no) according to population groups of interest (ie, general and ‘high-risk’ populations) and/or ON tools.

Ethics and dissemination
This review will include published data only; thus, ethical permission will not be necessary. Results of this review will be published in a relevant peer-reviewed scientific journal and presented at conferences in related fields.

PROSPERO registration number
CRD42024576557.

Objectives
A consensus study to establish a Core Outcome Set for dysarthria after stroke identified four key outcome domains that should be measured in research and clinical practice: (1) intelligibility of speech, (2) ability to participate in conversations, (3) living well with dysarthria and (4) communication partners skills and knowledge (where relevant). This review aimed to systematically identify corresponding measurement instruments and to examine their clinical utility and psychometric properties.

Design
Systematic review conducted in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data sources
CINAHL, EMBASE, MEDLINE, PsycInfo and Cochrane Stroke Group Trials Register, CENTRAL, Linguistics and Language Behavioral Abstracts (LLBA). Major trials registers: WHO ICTRP, ISRCTN registry and ClinicalTrials.gov searched March 2024.

Eligibility criteria for selecting studies
We included trials that developed or used measurement instruments for poststroke dysarthria. We identified studies that could be included in an update of the Cochrane systematic review of interventions for non-progressive dysarthria to identify what measurement instruments were used in therapy trials for poststroke dysarthria.

Data extraction and synthesis
Records were screened independently by three authors. Psychometric data were extracted, by two authors, from included studies and methodological quality was evaluated using Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) and Core Outcome Measures in Effectiveness Trials (COMET) guidance. Assessment of clinical utility followed Outcome Measures in Rheumatology (OMERACT) guidance.

Results
Following screening, 19 publications reporting 12 measurement instruments were identified. According to COSMIN standards, all 19 publications were rated as having low, very low or unknown quality of evidence. Three measurement instruments were identified as having the most relevant clinical utility to the population, the highest quality of evidence and had the potential to measure some specific aspects from three of the four agreed domains, intelligibility, conversations and living well with dysarthria from the patient and clinician perspective. These were the Frenchay Dysarthria Assessment II, the Communication Outcomes After Stroke Scale and the Therapy Outcome Measures for Dysarthria.

Conclusions
This review provides a comprehensive overview and appraisal of dysarthria measurement instruments to align with a Core Outcome Set. We only included English language-based measurement instruments. Many dysarthria measurement instruments were developed for non-stroke populations, including progressive dysarthria, with limited psychometric data for stroke. Measurement instruments with uncertain quality of evidence can still be considered for inclusion with a Core Outcome Set and three have been suggested. There is a need for further psychometric testing of these and the development of new measurement instruments to cover all aspects of intelligibility, conversations, living well with dysarthria and communication partner skills.

PROSPERO registration number
CRD42022302998.

Introduction
Mental health is a fundamental component of overall well-being, underpinning our ability to make both individual and collective decisions. In Mozambique, estimates suggest that a significant number of Mozambicans suffer from common mental disorders such as depression and anxiety, yet the majority go undiagnosed and untreated. In recognition of this burden, the Mozambican Ministry of Health had approved the country’s first Mental Health Strategy and Action Plan in 2007, alongside the National Health Policy Mental Health Guidelines (2006–2015). However, the implementation of this plan and strategy has been challenged by a severely limited mental health workforce and fragile infrastructure. Despite these challenges, recent years have seen some progress, including multisite studies and international collaborations aiming to understand the burden of disease and improve services. Yet, the mental health literature in Mozambique remains fragmented, with significant gaps regarding specific population groups, barriers to care and the effectiveness of interventions. This fragmentation highlights the need for a comprehensive scoping review to map the current state of mental health research in the country and to guide future studies, policy development and clinical practice.

Methods and analysis
This scoping review aims to map the existing scientific literature on mental health in Mozambique over the past 15 years, focusing on study types, target populations, methodological approaches and key findings. Employing a two-stage screening process and both quantitative and a thematic synthesis approach, the review will analyse studies meeting predefined eligibility criteria. A rigorous search strategy will be implemented across identified electronic databases and grey literature sources, including published studies from 2009 to the present. Data will be charted using a standardised form, and information regarding study characteristics, scope of the research, population involved, geographic distribution and reported outcomes/findings will be collected. This scoping review will follow a standard protocol adhering to the methodological framework outlined by Arksey and O’Malley (2005).

Ethics and dissemination
Ethical considerations involve respecting original authors, maintaining integrity and transparency, managing data ethically and disclosing conflicts of interest. Dissemination will occur through publication in peer-reviewed journals, conference presentations, open-access repositories, policy briefs, stakeholder engagement activities and social media platforms.

Registration details
Open Science Framework DOI 10.17605/OSF.IO/8R2P7.

This systematic review and meta-analysis provides population-based estimates of CRC risk in patients with UC, based on high-quality studies with rigorous methodology. The results offer reliable reference values for incidence, SIR, and prevalence, which are applicable to the broader UC population and relevant to clinical decision-making and public health planning. Nonetheless, substantial heterogeneity across studies and limited geographic representation—particularly from Asia, South America, Africa, and Oceania—highlight the need for additional population-based research in underrepresented regions to improve the global applicability of CRC risk estimates in UC.

Introduction
While individuals living in rural areas often have poorer health outcomes and reduced access to healthcare services compared with those in urban areas, there is a disproportionate gap in research examining rural health issues and identifying solutions to healthcare challenges. This is likely due to the numerous barriers to conducting rural health research, including the centralisation of research in urban areas and limited trained personnel and resources to conduct research in rural communities. This realist review aims to identify articles focused on building rural health research capacity and develop an evidence-based framework to be used by researchers, clinicians and policymakers to improve rural health services and well-being for rural populations.

Methods and analysis
We will conduct a realist review using the following steps: (1) develop a search strategy, (2) conduct article screening and study selection, (3) perform data extraction, quality appraisal and synthesis, (4) engage stakeholders for feedback on our findings and (5) report our findings and engage in knowledge translation. Search terms include variations of the terms ‘research’, ‘capacity building’ and ‘rural’. Databases include (since inception) Ovid MEDLINE, Embase, CINAHL Plus, APA PsycINFO, ERIC and Scopus. A separate search of the same databases was also designed to identify relevant theories or frameworks related to research capacity building, using variations of the terms ‘research’, “‘capacity building’, ‘theory’ and ‘framework’. Studies will be screened by title and abstract and full text by two research team members and included based on their relevance to rural health research capacity building. We will exclude articles not published in English. We will also search the grey literature to identify rural health research centres, networks or training programmes that have not been described in the academic literature. Two research team members will extract relevant data from included studies and perform a qualitative analysis based on guidelines for realist reviews.

Ethics and dissemination
This review does not require ethical approval as it draws on secondary data that is publicly available. The findings will be disseminated at academic conferences, published in peer-reviewed journals and summarised in a lay report for individuals interested in developing strategies, programmes or policies to improve rural health research. The results will inform individuals developing rural health research training programmes, establishing rural research centres, or others interested in building rural health research capacity.

PROSPERO registration number
CRD42023444072.