Risultati per: Ipertensione polmonare: review

Background
The healthcare workforce is in crisis. Despite a competitive selection process, a substantial number of doctors leave specialty training (ST) programmes prematurely. This attrition causes increased costs for the National Health Service, exacerbates workforce shortages and threatens quality and safety of care. It also increases pressure on trainees who remain, further compounding the risk of attrition. There is an urgent need to understand why doctors leave ST in order to find ways to maintain the training pipeline from ST to consultant.

Objectives
We aimed to understand what is known about why doctors choose to leave ST programmes in secondary care, to map current knowledge and identify avenues for future research.

Eligibility criteria
All studies which investigated why doctors leave ST programmes in secondary care were included.

Sources of evidence
Ovid Medline, Web of Science, SCOPUS and EMBASE were searched until January 2024. Descriptive codes were assigned to the findings of each study. These descriptive codes were reviewed and grouped together in broader categories.

Charting methods
Data was extracted and charted, and a qualitative content approach was used to synthesise data.

Results
A total of 6079 potentially relevant abstracts were retrieved, of which 23 were included in the final analysis. This included the experience of 1896 doctors who have left training and 454 programme directors. Doctors chose to leave training programmes because (1) they felt unsupported and underappreciated, (2) training was associated with unacceptable personal costs and (3) career prospects were unattractive.

Conclusion
There is a mismatch between trainees’ expectations of ST and the reality of being a trainee in ST. Understanding the issues which drive attrition and developing evidence-based solutions, has the potential to both reduce attrition, and improve the training experience for doctors in training more widely.

Introduction
Where a person lives, the characteristics of their housing and neighbourhood environment influence their exposure to climate-related hazards and vulnerability to associated mental health impacts. This suggests that the built environment may be a promising focus for integrated policy responses to climate change and public mental health challenges. However, few empirical studies have focused on the role of the built environment as an important mediator of climate-attributable mental health burden. The proposed scoping review seeks to identify and synthesise existing conceptual models and frameworks linking climate change to mental health via built environment pathways. We aim to provide a preliminary overview of the housing and neighbourhood pathways through which climate change may impact mental health, which will inform future empirical work in this emerging area of research.

Methods and analysis
A systematic scoping review of the global peer-reviewed and grey literature will be conducted in accordance with Arksey and O’Malley’s methodological framework and Joanna Briggs Institute recommendations. Included articles must present a conceptual model or framework incorporating relevant built environment pathways through which climate change may impact mental health and well-being. Relevant models and frameworks will be identified through systematic searches (for English-language reports) of Medline, PsycINFO, Embase, Scopus, Web of Science and grey literature databases. Two reviewers will independently screen the article titles, abstracts and full texts, with conflicts resolved by a third reviewer. Data extraction will occur using a predefined template. The presentation of findings will conform to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, including a narrative synthesis of the role of housing and neighbourhood factors in the relationship between climate change and mental health, as identified from the existing literature. The review will lay essential foundations for future empirical research and place-based policy responses to the mental health consequences of a changing climate.

Ethics and dissemination
The scoping review will be a secondary analysis of published data, for which ethics approval is not required. The results will be disseminated through a peer-reviewed publication and targeted distribution to stakeholders involved in climate change, built environment and health research and policymaking.

Study registration
Open Science Framework: doi.org/10.17605/OSF.IO/XR74C.

Objectives
Falls from heights are a leading cause of workplace injuries and fatalities. Ensuring worker fitness is crucial, yet many countries lack formal guidelines for fitness for work (FFW) assessments, posing safety and legal risks. This scoping review sought to identify and map the existing evidence on the assessment of fitness to work at heights.

Design
Scoping review following the Joanna Briggs Institute Scoping Review Methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines.

Data sources
Searches were conducted in March 2024 across ProQuest Central, Google Scholar, PubMed, Scopus, ScienceDirect, Web of Science and PsycINFO. Grey literature was sourced from the websites of organisations including the International Labour Organisation, Safe Work Australia, Canadian Centre for Occupational Health and Safety, Health and Safety Executive (UK), Occupational Safety and Health Administration (USA), WHO, Centre for Construction Research and Training (USA), Institution of Occupational Safety and Health (UK), South African Society of Occupational Medicine, South African Society of Occupational Health Nursing and Institute for Work at Height (South Africa), in addition to general Google searches.

Eligibility criteria for selecting studies
Our inclusion criteria encompassed both peer-reviewed and grey literature that addressed either ‘fitness for work at heights’, ‘fitness for work in high-risk settings requiring work at heights’ or human risk factors associated with working at heights.

Data extraction and synthesis
A data extraction framework and guidance sheet were developed, piloted and refined through team discussions. An iterative review process was followed, with one author extracting and coding data while two authors conducted quality checks. Deductive qualitative content analysis was applied to the extracted data.

Results
68 articles met the inclusion criteria, but only 7 directly addressed fitness to work at heights, with the rest focusing on fitness to work in high-risk settings requiring work at heights or human risk factors associated with work at heights. This highlights a lack of peer-reviewed research specific to the topic. Key challenges included FFW assessments failing to reflect job demands, inconsistent application of FFW evaluations, lack of standardisation and inadequate stakeholder collaboration. Legal tensions between employer safety obligations and worker rights were also noted. Critical human risk factors—such as physical and mental limitations, adverse states, human error and rule violations—significantly affected worker safety, though evidence of their specific impact in this context remained limited. Findings on the economic implications of FFW assessments were also inconclusive.

Conclusion
Assessing FFW at heights is vital for worker safety, yet key challenges persist. This review highlights gaps in evidence on human risk factors and assessment methods. Findings emphasise the need for practice-based research, standardised fitness criteria and interdisciplinary protocols for preplacement assessment and ongoing monitoring.

Introduction
Over the past decades, there has been increasing recognition that assessing patients with cancer’s health-related quality of life (HRQoL) is pivotal to delivering optimal patient-centred healthcare. However, with the increasing number of patient-reported outcome measures (PROMs) available, it becomes more and more challenging to identify the most appropriate PROM to capture HRQoL. Therefore, the aim of this systematic review is to (1) identify all available PROMs assessing HRQoL across the European cancer continuum and (2) critically appraise, compare and summarise the psychometric properties of the identified PROMs.

Methods and analysis
Bibliographic databases MEDLINE and PubMed Central (through PubMed) and EMBASE (through Scopus) will be comprehensively searched from database inception until March 2024. Studies reporting on the measurement properties of PROMs assessing HRQoL throughout the European cancer continuum will be included. The evaluation of the psychometric properties, data extraction and data synthesis will be conducted according to the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology. Two reviewers will independently assess the methodological quality using the COSMIN risk of bias checklist and the COSMIN criteria for good measurement properties. Subsequently, findings will be qualitatively summarised. The Grading of Recommendations Assessment, Development and Evaluations (GRADE) guidelines will be used to grade and summarise the quality of the evidence.

Ethics and dissemination
Ethical clearance for this research is not required, as the systematic review will only use information from previously published research. The results of this review will be submitted for publication in a peer-reviewed journal and will be used to provide a set of evidence-based recommendations for a European project (EUonQOL), which aims at developing a new PROM (EUonQOL toolkit) to assess HRQoL across the European cancer continuum. Moreover, findings will be disseminated to a clinical audience and policymakers through conferences, supporting researchers and clinicians in choosing the best measure to evaluate HRQoL in patients with cancer and survivors in Europe.

PROSPERO registration number
CRD42023418616.

Introduction
Substance use disorders (SUDs) are a major public health challenge, affecting millions of individuals globally and contributing to substantial morbidity and mortality. Individuals with SUDs face numerous barriers to accessing high-quality healthcare, leaving vulnerable populations susceptible to the undertreatment of SUDs. Despite the availability of clinical practice guidelines and effective interventions for SUD, there is a notable gap in the implementation and adherence to evidence-based care.
Measuring the quality of care (QoC) is a critical initial step toward enhancing the treatment and services provided to individuals with SUDs. While quality indicators (QIs) for SUD care have been established in various regions, including the USA, Canada and the UK, the application of QIs for the routine measurement of QoC for SUDs is not common. Identifying and characterising the areas of low QoC in SUD management can highlight critical targets for quality improvement initiatives. However, QoC measurement in SUD care is complex, with potentially redundant indicators derived from different sources, each with its own definitions, criteria and data requirements. This scoping review aims to explore the range of QIs that are currently available to assess the QoC for individuals with SUDs.

Methods
The review will follow the Arksey and O’Malley framework and incorporate methods proposed by the Joanna Briggs Institute (JBI) and Levac et al. Reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review guidelines (PRISMA). Stage 1: the research question will be identified, clarifying the purpose of the scoping review. Stage 2: six academic databases (Cochrane Library, Embase, CINAHL, Medline, APA PsycINFO and Scopus) and grey literature sources will be searched for studies reporting QIs and published from 1990 until 2023. Stage 3: study screening and selection will be completed by two reviewers independently to review titles, abstracts and full texts based on study inclusion criteria. Stage 4: a pilot data charting form has been developed to capture information from each study, including study design, population details, setting, methodology for QI development and reported QIs. Stage 5: data synthesis and consultation will employ thematic analysis and frequency counts to categorise identified QIs within established domains for quality of healthcare. Any discrepancies in data extraction or thematic synthesis will be identified and resolved using a third reviewer when necessary. A consultation exercise using a modified Delphi process will engage experts to prioritise identified QIs, aligning with JBI recommendations for stakeholder involvement in scoping reviews.

Patients and public involvement
Patients and the public will not be directly involved in the design or conduct of this scoping review. However, stakeholder consultation, including individuals with lived experience of SUDs, will be incorporated during the Delphi process to prioritise identified QIs for SUD care.

Ethics and dissemination
Ethics approval is not necessary for stages 1–4 of this scoping review as it will not involve primary data collection. Ethics approval will be obtained from the University of Calgary Health Research Ethics Board prior to the commencement of stakeholder consultation (Stage 5) in January 2025. This scoping review was preregistered on the Open Science Framework. The results of this scoping review will be disseminated through peer-reviewed publications and conference presentations. Findings will be shared with local clinicians through presentations and with the research and clinical community at relevant conferences. This study represents a necessary first step towards establishing routine QoC measurement for SUDs. Results will be used in a stakeholder consensus exercise aimed at identifying key QIs for SUD care in Alberta, Canada, that will guide the future development of continuous QoC measurement using population-based data.

Introduction
Diabetic retinopathy is one of the leading causes of vision impairment globally. Alongside the systemic control of diabetes and timely detection of diabetic retinopathy, the prompt initiation and completion of treatment is essential to prevent vision loss. Routine monitoring of access to retinal screening services for the detection of diabetic retinopathy is common, while monitoring of coverage of subsequent treatment services is far less common. When diabetic retinopathy treatment coverage is assessed, there is great variability in how it is defined and reported. If a definition of treatment coverage could be standardised, the monitoring of the quality of diabetes eye care could more readily be compared between settings and over time. The aim of this review is to summarise how diabetic retinopathy treatment coverage has been measured in published studies and the extent to which these have been disaggregated by population groups.

Methods and analysis
A search will be conducted on Medline and Embase without any language restrictions, for cohort and cross-sectional studies published from 1 January 2015 that report diabetic retinopathy treatment coverage for adults with diabetic retinopathy and/or macular oedema. We will include studies from any world region reporting diabetic retinopathy treatment coverage for one or more of: (1) laser photocoagulation; (2) intravitreal injections of antivascular endothelial growth factor agents; (3) intravitreal injections of corticosteroids; (4) vitrectomy. The PROGRESS framework (place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status and social capital) will be used to assess disaggregation by population groups. Two investigators will independently screen studies and extract relevant data. Data will be synthesised descriptively to outline the full range of definitions of diabetic retinopathy treatment coverage in the literature and identify the common sources of data used.

Ethics and dissemination
This review will only include published data; thus, no ethical approval will be sought. The findings of this review will be published in a peer-reviewed journal and presented at relevant conferences. The findings will also be considered in conjunction with an ongoing review on retinal screening for diabetic retinopathy to develop indicators for monitoring of services along the diabetes eye care pathway, which may include an indicator of effective service coverage.

Registration
Open Science Framework registration 6/08/2024: https://osf.io/5b93m

Introduction
Interventions are needed to increase participation in clinical trials through optimised trial design and enrolment workflows. Patient navigation is a promising intervention for increasing participation in clinical trials by optimising enrolment workflows. Patient navigation is defined as a personalised intervention aimed at overcoming barriers and ensuring timely access to healthcare services, diagnosis, treatment and care. This scoping review aims to fill a gap in current literature by summarising what is known about patient navigation, aiming to increase clinical trial participation.

Methods and analysis
A search was conducted for peer-reviewed literature published in English from inception through 21 December 2023, and the search was updated on 5 March 2025. Sources of literature included Cochrane CENTRAL (Ovid), MEDLINE (Ovid), EMBASE (Ovid), Cumulative Index of Nursing and Allied Health (CINAHL; on EBSCOhost; EBSCO Industries, Inc), Epistemonikos and PROSPERO databases. Searches were also conducted through the Turning Research into Practice and International Clinical Trials Registry Platform (WHO) databases, Google Scholar and the Agency for Health Research and Quality platform to ensure the retrieval of all relevant articles. Reference lists of eligible studies were also examined. The Google Scholar search was limited to the first 10 pages of results. The search strategy focused on the following key concepts: navigation (eg, navigator, care coordination, case management) and clinical trials. Searches were reviewed using the PRESS Peer Review of Electronic Search Strategies 2015. This review was guided based on the JBI methodology for scoping reviews using a five-step review process: identify the research questions; search and identify relevant studies; select studies based on a priori criterion; chart the data; and collate, summarise and report the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews.

Ethics and dissemination
This scoping review identifies and analyses existing research; therefore, ethics approval is not required. Findings will be disseminated through conference presentations and a publication in a scientific journal.

Objectives
SARS-CoV-2 poses significant challenges to people living with diabetes (PLWD). This systematic review aimed to explore the impact of COVID-19 on mortality, complications associated with diabetes and haematological parameters among PLWD.

Design
Systematic review and meta-analysis using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Data sources
EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials and LILACS were searched between 1 December 2019 and 14 January 2025.

Eligibility criteria for selecting studies
Eligible studies included case-control and cohort studies involving PLWD categorised into two groups: those with confirmed SARS-CoV-2 infection and those without.

Data extraction and synthesis
Meta-analyses estimated the odds ratios (ORs) and mean differences (MDs) of outcomes including mortality, intensive care unit (ICU) admission, diabetic ketoacidosis (DKA), acute kidney injury, hospitalisation length and haematological parameters. We pooled results using random-effects models and assessed study quality with the Newcastle-Ottawa Scale. A funnel plot was used to detect potential publication bias. The overall certainty of evidence was assessed using GRADE.

Results
25 of 7266 unique studies were eligible, including 1 154674 PLWD (561 558 with COVID-19 and 593 116 without COVID-19). SARS-CoV-2 infection in PLWD was associated with significantly increased mortality (OR 2.52, 95% CI 1.45 to 4.36, I2=99%), acute kidney injury (3.69, 95% CI 2.75 to 4.94, I2=0%), random plasma glucose in subjects with type 1 diabetes (MD 20.38 mg/dL, 95% CI 7.39 to 33.36, I2=0%), haemoglobin A1C in subjects with type 2 diabetes (0.21%, 95% CI 0.05 to 0.38, I2=13%), creatinine (0.12 mg/dL, 95% CI 0.04 to 0.19, I2=0%), C reactive protein (38.30 mg/L, 95% CI 4.79 to 71.82, I2=82%) and D-dimer (1.52 µg/mL, 95% CI 0.73 to 2.31, I2=0%). No significant differences were observed in the incidence of ICU admission and DKA, hospitalisation length, haemoglobin, leucocyte, lymphocyte, neutrophil to lymphocyte ratio, platelet, blood urea nitrogen, estimated glomerular filtration rate, procalcitonin, albumin, ferritin and bilirubin among PLWD with and without SARS-CoV-2 infection.

Conclusions
SARS-CoV-2 infection is associated with elevated risks of mortality and acute kidney injury and poor glycaemic control in PLWD, alongside increased levels of inflammatory and coagulation biomarkers. These findings underscore the urgent need for tailored clinical management strategies for PLWD with COVID-19.

PROSPERO registration number
CRD42023418039.

Objectives
SARS-CoV-2 poses significant challenges to people living with diabetes (PLWD). This systematic review aimed to explore the impact of COVID-19 on mortality, complications associated with diabetes and haematological parameters among PLWD.

Design
Systematic review and meta-analysis using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Data sources
EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials and LILACS were searched between 1 December 2019 and 14 January 2025.

Eligibility criteria for selecting studies
Eligible studies included case-control and cohort studies involving PLWD categorised into two groups: those with confirmed SARS-CoV-2 infection and those without.

Data extraction and synthesis
Meta-analyses estimated the odds ratios (ORs) and mean differences (MDs) of outcomes including mortality, intensive care unit (ICU) admission, diabetic ketoacidosis (DKA), acute kidney injury, hospitalisation length and haematological parameters. We pooled results using random-effects models and assessed study quality with the Newcastle-Ottawa Scale. A funnel plot was used to detect potential publication bias. The overall certainty of evidence was assessed using GRADE.

Results
25 of 7266 unique studies were eligible, including 1 154674 PLWD (561 558 with COVID-19 and 593 116 without COVID-19). SARS-CoV-2 infection in PLWD was associated with significantly increased mortality (OR 2.52, 95% CI 1.45 to 4.36, I2=99%), acute kidney injury (3.69, 95% CI 2.75 to 4.94, I2=0%), random plasma glucose in subjects with type 1 diabetes (MD 20.38 mg/dL, 95% CI 7.39 to 33.36, I2=0%), haemoglobin A1C in subjects with type 2 diabetes (0.21%, 95% CI 0.05 to 0.38, I2=13%), creatinine (0.12 mg/dL, 95% CI 0.04 to 0.19, I2=0%), C reactive protein (38.30 mg/L, 95% CI 4.79 to 71.82, I2=82%) and D-dimer (1.52 µg/mL, 95% CI 0.73 to 2.31, I2=0%). No significant differences were observed in the incidence of ICU admission and DKA, hospitalisation length, haemoglobin, leucocyte, lymphocyte, neutrophil to lymphocyte ratio, platelet, blood urea nitrogen, estimated glomerular filtration rate, procalcitonin, albumin, ferritin and bilirubin among PLWD with and without SARS-CoV-2 infection.

Conclusions
SARS-CoV-2 infection is associated with elevated risks of mortality and acute kidney injury and poor glycaemic control in PLWD, alongside increased levels of inflammatory and coagulation biomarkers. These findings underscore the urgent need for tailored clinical management strategies for PLWD with COVID-19.

PROSPERO registration number
CRD42023418039.

Background
Mental health disorders are common among residents of long-term care (LTC). Despite depression being the most common type of mental illness, it is often undiagnosed in LTC. Due to its prevalence, chronicity and associated morbidity, depression poses a considerable service use burden. The COVID-19 pandemic has brought needed attention to the mental health challenges faced by older adults in LTC.

Objectives
To explore the effects of isolation on the mood of LTC residents and compare between both the pre-COVID-19 and COVID-19 periods.

Design
A scoping review.

Methods
PubMed, CINAHL, PsycINFO, SCOPUS, Google Scholar and medRxiv were searched for studies that met the eligibility criteria: (1) articles assessing mood or mental health status of LTC residents; (2) mood disturbance resulting from visitation restrictions/isolation or loneliness; (3) residents were without severe dementia or moderate/severe cognitive impairment and (4) studies were available in English. Studies were excluded if their entire sample was residents with severe cognitive impairment or severe dementia. A total of 31 studies were included in this review. The total number of articles retrieved from the databases searched was 3652 articles, of which 409 duplicates were removed. 3242 article titles and abstracts were screened for eligibility, of which 3063 were excluded. The remaining 180 full-text studies were reviewed for eligibility, where an additional 149 studies were excluded. Data were then extracted from all full-length pieces for analysis, and findings were summarised.

Results
The review identified contradictory views with a diversity of findings highlighting the complexity of factors influencing residents’ mood during a global health crisis such as that of COVID-19. Studies highlighted the importance of quality interactions with others for the well-being of LTC residents. Significant correlations were found between social isolation, loneliness and depression. During COVID-19, visitation restrictions led to increased loneliness, depression and mood problems, especially among residents without cognitive impairment. However, some studies reported no significant adverse effects or even a decrease in depression symptoms during COVID-19 restrictions, possibly due to implemented strategies to maintain social engagement.

Conclusion
The COVID-19 pandemic had a substantial impact on LTC homes, influencing the physical and mental well-being of residents. This highlighted pre-existing challenges in the LTC system, emphasising the importance of comprehensive strategies to safeguard resident mental health. It is important to combine measures to ensure both physical safety and mental well-being.

Introduction
The immunological composition of breastmilk has gained research interest as breastfeeding has been persistently correlated with improved health outcomes in children. Immune cells, also known as leucocytes, are key components of the body’s immune system, but they remain understudied in breastmilk. The relevance of breastmilk leucocytes for breastfeeding-mediated immune benefits remains controversial. To identify the current state-of-the-art on breastmilk leucocyte research, unearth knowledge gaps and propose research priorities, a scoping review is necessary.

Methods and analysis
This scoping review will address the general question of what is known about leucocytes in human breastmilk. The development of this scoping review protocol adhered to the recommendations set forth by the Joanna Briggs Institute guidelines. Peer-reviewed research articles published in English, French or Spanish will be eligible for inclusion in the scoping review. The initial literature search was conducted in January 2024 within the Medline, Embase, Cochrane Central and BVS databases.

Ethics and dissemination
This review does not require ethics approval. Our dissemination strategy includes peer-review publication and presentations at conferences and to relevant stakeholders.

Registration details
This protocol was registered in Open Science Framework (available at: https://osf.io/kwfsy) on 19 February 2024.

Introduction
Family physician anaesthesiologists (FPAs) are essential to providing surgical, critical and obstetrical care in rural communities of Canada. They experience pressing challenges like burnout, isolation and limited opportunities for professional growth. There is a lack of studies synthesising the available evidence on the factors associated with recruitment and retention of FPAs in Canada. We aim to systematically review and describe the nature of the scientific evidence on the facilitators and barriers to the recruitment and retention of FPAs in Canada, and to identify areas to inform potential solutions.

Methods and analysis
Our scoping review will search Pubmed, Embase (Ovid), Scopus and grey literature for empirical or theoretical publications in English or French on facilitators and barriers to the recruitment and retention of FPAs in Canada. We will conduct a narrative synthesis of the included publications.

Ethics and dissemination
Our results will guide future research and initiatives to enhance the availability of FPAs in Canadian rural and remote settings. The results will be shared through professional networks, presentations at conferences, and publication in a scientific journal. Ethics approval is not required.

Background
Gastrointestinal (GI) cancers are among the most significant contributors to the global cancer burden, causing substantial physical and emotional distress. Effective management of patient-reported outcomes (PROs) is essential for enhancing quality of life and overall survival in cancer care. Despite significant advances in cancer care, understanding PROs and their integration into clinical practice remains limited. Prediction models for PROs have the potential to support patient-centred care by improving shared decision-making and informing care plans. However, the development and application of clinical tools that predict PROs in patients with GI cancer have not been systematically explored. This scoping review aims to explore clinical prediction tools for PROs and the quality of life in patients with GI cancer, identifying current tools, predictors and outcomes, as well as evaluating their clinical usability and equity considerations.

Methods and analysis
A scoping review methodology, guided by the JBI Manual for Evidence Synthesis and the Arksey and O’Malley framework, will be used. The review will include studies of adult patients with primary GI cancer that developed or validated clinical prediction tools for PROs or quality of life. Inclusion criteria require the use of self-reported PRO measures. A systematic search of Ovid Medline, Embase and CINAHL will be conducted from 1946 to 2024. The search strategy will be updated periodically to incorporate the most recent literature and complemented by hand-searching references. Data extraction will focus on tool characteristics, predictors, statistical methods and equity considerations. The findings will be synthesised descriptively, mapping trends, identifying gaps and highlighting areas for future research.

Ethics and dissemination
Ethical approval is not required for this literature-based study. Results will be disseminated through peer-reviewed publications, conferences and patient advocacy networks to maximise the impact on research, policy and clinical practice.

Introduction
As people get older, they tend to take more preventive medication such as statins, beta-blockers and anti-coagulants to help prolong their lives. The risks of taking medication can start to outweigh the benefits in older people, and whether those with comorbidities want to extend these years of poor health is another consideration. One-third of older people will develop dementia, and they may not have the mental capacity to decide whether to continue or withdraw preventive medication. In these cases, deprescribing is left to advocates, such as healthcare professionals and family members. This systematic review will look at the views of stakeholders, including advocates, people living with dementia and any other people involved in the decision-making process for deprescribing preventive medication in dementia.

Methods and analysis
A systematic review of qualitative evidence using thematic synthesis and an inductive approach will be conducted. The following databases and platforms will be searched: Embase, HMIC, MEDLINE, PsycINFO, CINAHL, PubMed, Cochrane Central Library, OATD, ProQuest, Scopus and the Web of Science, along with manual searches through citation mining and grey literature. Only primary qualitative studies (or the qualitative elements of mixed method studies) will be used. There will be no date limit, and the search will be completed by April 2025. Only English-language articles will be used. The included studies will present views and experiences about deprescribing specifically preventive medication in dementia cases. Principles identified by Cochrane for qualitative studies will be used as guidance. Covidence will facilitate two independent reviewers to identify relevant studies, and the Critical Appraisal Skills Programme and Mixed Methods Appraisal Tool will be used to assess quality. NVivo will be used to manage the extracted findings from the included studies.

Ethics and dissemination
Ethical approval is not applicable for this study as no original data is going to be collected as it is a systematic review. The findings will be disseminated in a peer-reviewed open-access publication and at conference presentations.

PROSPERO registration number
CRD42023476394. Any changes made to the protocol will be reported on PROSPERO.

Introduction
Antibiotic resistance has been a global health challenge for decades now and has been increasingly on the rise, and developing countries are more vulnerable to the adverse health impacts of antibiotic resistance. Healthcare providers play an important role in antibiotic use and in addressing antibiotic resistance. This scoping review aims to map studies conducted on knowledge, attitudes and perceptions regarding antibiotic use and resistance among healthcare providers in Africa.

Methods and analysis
A scoping review searching for evidence on knowledge, attitudes and perceptions regarding antibiotic use and resistance among healthcare providers in Africa will be conducted. Relevant English literature will be identified from the year 2000 to 2024. Peer-reviewed literature will be searched from PubMed, MEDLINE, Google Scholar, Cochrane Library and Scopus. The eligibility criteria will guide the study selection. Search terms: ‘antibiotics’, ‘antibiotics resistance’, ‘knowledge’, ‘attitudes’, ‘perceptions’, ‘healthcare providers’, Africa and related syntax will be used to identify literature.
A stepwise methodological framework by Arksey and O’Malley shall be the methodological basis of this scoping review. The methodology will be strengthened further by consulting the Joanna Briggs Institute methodology for scoping reviews, which will help to enhance the precision of the scoping study methodology. Three reviewers will be engaged to do initial title screening, abstract screening and full-text screening of the literature. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will be used to report the results of this study.

Ethics and dissemination
Ethical approval is not required for this review since no primary data will be collected. The findings of this study will be disseminated through a peer-reviewed scoping review paper once the data collection and analysis are complete.

Trial registration number
The protocol is registered with the Open Science Forum (registration DOI: https://doi.org/10.17605/OSF.IO/KMQP5).

Objectives
Vitamin D deficiency is prevalent among the population. Previous studies have shown that vitamin D supplementation might be useful for treating COVID-19 infection. Therefore, we performed a meta-analysis to explore vitamin D supplementation efficacy in treating COVID-19 patients with vitamin D deficiency.

Design
Systematic review and meta-analysis

Data sources
PubMed, Cochrane Library, Embase and Web of Science.

Eligibility criteria
Randomised controlled trials exploring vitamin D supplementation for patients with COVID-19 and vitamin D deficiency.

Data extraction and synthesis
Two independent reviewers employed standardised methods to search, screen and code the included studies. The primary outcomes included mortality during follow-up, 28-day mortality, need for mechanical ventilation and intensive care unit (ICU). The secondary outcome included length of stay in hospital and ICU. The risk of bias was assessed using the Risk of Bias 2 tool. Depending on the level of heterogeneity, either a random-effects model or a fixed-effects model was applied. The findings were summarised using Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence profiles and synthesised qualitatively.

Results
A total of nine studies, comprising 870 participants, were included in the analysis. The pooled results indicated that vitamin D supplementation was associated with a lower risk of mortality (risk ratio 0.76; 95% CI 0.60 to 0.97). However, this apparent benefit was not robust when examined through the leave-one-out method and trial sequential analysis. Regarding other outcomes, there was no statistically significant difference between vitamin D supplementation and no supplementation in terms of 28-day mortality, the need for mechanical ventilation and ICU admission. Vitamin D supplementation was associated with a 0.41 day shorter length of stay in the ICU (mean difference –0.41; 95% CI –1.09 to 0.28) and a 0.07 day shorter length of stay in the hospital (mean difference –0.07; 95% CI –0.61 to 0.46) compared with no supplementation; however, neither difference was statistically significant.

Conclusion
Based on evidence of low to moderate quality, vitamin D supplementation reduced the mortality rate during follow-up in COVID-19 patients with vitamin D deficiency. However, it did not improve 28-day mortality, nor did it reduce the need for mechanical ventilation and ICU admission, or the length of stay in the ICU and hospital.

PROSPERO registration number
CRD42024573791.