Risultati per: Passo 11. Monitorare la pratica professionale del proprio gruppo: GPG Network

Introduction
Sleep disturbance is prevalent in pregnancy and can result in significant adverse outcomes for women and their infants. Numerous clinical trials of various nonpharmacotherapies for preventing or treating sleep disturbances have been conducted previously; however, previous systematic reviews with direct comparisons have failed to demonstrate the best options for different kinds of treatments. This systematic review and network meta-analysis (NMA) aims to explore the comparative efficacy and acceptability of nonpharmacological interventions for sleep disturbances in pregnancy and to assist clinical decision-making through ranking interventions concerning critical clinical outcomes.

Methods and analysis
We will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. Two reviewers will systematically search five major bibliographic databases (PubMed, Embase, Cochrane Library, Web of Science and Cumulative Index to Nursing and Allied Health Literature) and registries for published and unpublished randomised controlled trials (RCTs) of any nonpharmacological interventions for sleep disturbances from inception to 24 June 2025. To ensure the search is up to date, we will also perform an updated search up to the time of final analysis submission. Primary outcomes will consider efficacy (the overall mean change of any predefined sleep disturbances, including sleep quality, sleep duration and sleep-specific symptoms) and acceptability (all-cause discontinuation). The risk of bias of each included RCT will be assessed using the Cochrane Risk of Bias 2.0 Tool (RoB2). Traditional pairwise meta-analyses and NMAs will be performed to compare the efficacy and acceptability of different nonpharmacological interventions. Surface under the cumulative ranking curve for the outcomes of interest will be used to rank the competing interventions. The Grading of Recommendations, Assessment, Development and Evaluation system will be used to assess the quality of evidence associated with the main results.

Ethics and dissemination
This review is a secondary analysis of published data and, therefore, does not require ethical approval. The results will be disseminated in a peer-reviewed journal.

PROSPERO registration number
CRD42024546340.

Via libera ad una nuova molecola dal comitato Ema, si riduce la progressione della malattia

RZV vaccination is associated with a reduced risk of HZ among patients with RA aged 50 years and older. While we observed a reduction in all-cause mortality among RZV recipients, this finding should be interpreted with caution, as the effect size may not be entirely attributable to HZ prevention alone. Given the established efficacy of RZV in preventing HZ and its potential to reduce mortality, vaccination should be prioritized among eligible patients with RA.

“Da oggi i cittadini potranno accedere alla piattaforma di Agenas per vedere i tempi di attesa su base nazionale per le visite e gli esami di diagnostica”. Lo ha annunciato…

Campagna Ipsen-Anture, ogni anno colpisce oltre 400mila persone

Campagna Ipsen-Anture, ogni anno colpisce oltre 400mila persone

Although no pharmacological regimen demonstrates superior sedation success compared with propofol–opioids, which serve as the standard comparator, etomidate–opioids regimens offer a favorable balance between sedation efficacy and safety, though they warrant attention due to an increased risk of PONV. Esketamine–remimazolam demonstrates superior hemodynamic stability and faster recovery but may be less effective in achieving sedation success. Midazolam-based regimens demonstrate lower efficacy and prolonged recovery and are therefore not recommended.

Introduction
Epilepsy is a prevalent chronic neurological disorder, with approximately one-third of patients experiencing intractable epilepsy, often necessitating surgical intervention. Deep brain stimulation (DBS) of the thalamus has been introduced as a palliative surgical option for seizure control; however, its precise mechanisms remain largely unclear. The thalamus plays a crucial role in coordinating neural networks, both in normal brain function and the propagation of epileptic activity. This study aims to investigate the involvement of the thalamus in epilepsy networks using stereoelectroencephalography (SEEG) to monitor thalamic activity during epileptic seizures in patients with drug-resistant epilepsy.

Methods and analysis
This single-arm, non-randomised, prospective, exploratory study will be conducted at Nagoya University Hospital, involving 10 patients undergoing SEEG for presurgical evaluation of drug-resistant epilepsy. Participants must be 18 years or older, have normal cognitive function and provide informed consent. Between 7 and 14 SEEG electrodes, including 2 in the bilateral thalamus, will be implanted in key thalamic nuclei (anterior, dorsomedial, centromedian and pulvinar) using a robotic system. The primary outcome focuses on electroencephalographic findings from the thalamus, emphasising waveform and frequency changes around seizures. Secondary outcomes include postoperative seizure frequency, changes in cognitive function and neuroimaging results. SEEG data will be recorded continuously for 1–2 weeks to capture both ictal and interictal activity. Data analysis will employ t-tests to compare ictal and interictal periods, with p values

The evidence of the heterogeneity of WAS and XLT outcomes could be instrumental to draw updated recommendations for the management of the patients affected by these rare conditions. It would be desirable to expand the tools to estimate the risk of infectious and autoimmune events in patients with XLT and the impact of their treatment, including HSCT over time.

Our research confirmed a dose-response relationship between physical activity and anxiety risk, and increasing physical activity within the range recommended by the World Health Organization (WHO) (10–20 MET-h/week) can significantly reduce anxiety risk. Subgroup analysis showed that this protective effect was most significant during the 5-year follow-up period, with a maximum anxiety risk reduction of 49%. Exceeding the recommended dose, there may be additional smaller benefits between doses 20–30 MET-h/week, and exceeding 50 MET-h/week may become a risk factor.

Clozapine remains the gold standard, outperforming several antipsychotics, while specific combinations may offer added benefits but require careful risk-benefit evaluation. Networks sparsity increases the likelihood of chance findings for estimates based on single studies. These results emphasise the need for personalised treatment, further research comparing non-clozapine antipsychotic combinations to high-dose clozapine monotherapy, and studies on long-term outcomes.

Introduction
Diabetic foot osteomyelitis (DFO) poses a serious threat to the quality of life and survival of patients, and systemic antibiotic therapy is effective and plays a pivotal role in the management of patients with DFO without amputation. However, the optimal duration of systemic antibiotic therapy is not clear. We aim to perform a network meta-analysis (NMA) to assess the efficacy and safety of different durations of antibiotic therapy for patients with DFO without amputation.

Methods and analysis
We will search multiple databases, including the China National Knowledge Infrastructure, VIP database, Wanfang Data, ScienceDirect, EBSCO, EMBASE, Web of Science, Cochrane Library, and PubMed. The outcome indicators are remission rate, time needed for complete wound healing, major amputation rates and the rate of antibiotic-related adverse events. Risk of bias will be evaluated using the Cochrane risk-of-bias tool. NMA will be performed using STATA/MP V.15.0. The surface under the cumulative ranking area will be calculated to rank each treatment.

Ethics and dissemination
This study is a systematic review protocol collecting data from published literature and does not require approval from an institutional review board. Results from this systematic review will be published in a peer-reviewed journal.

PROSPERO registration number
CRD42023486089.

Coordinato del San Raffaele, finanziato da associazioni pazienti

Stroke, Ahead of Print. BACKGROUND:Stroke is one of the leading causes of disability and death worldwide, often leading to physical paralysis and cognitive dysfunction, seriously affecting patients’ quality of life, and increasing economic burden. Repetitive transcranial magnetic stimulation (rTMS), a noninvasive brain stimulation technique, has been used in stroke rehabilitation, but the difference in efficacy among rehabilitation methods combined with rTMS is unclear. In this study, we compared the effects of 4 rehabilitation methods, namely, clinical routine rehabilitation therapy, smart rehabilitation therapy, behavioral rehabilitation therapy, and Chinese traditional rehabilitation therapy (CTRT) combined with rTMS on the upper limb function and activities of daily living of patients with stroke through a reticulated meta-analysis, which provided a basis for clinical optimization of rehabilitation strategies.METHODS:Six databases, namely, PubMed, Embase, Web of Science, Cochrane, EBSCO, and China National Knowledge Infrastructure, were systematically searched, and 24 randomized controlled trials with a total of 868 patients with stroke were finally included. The primary outcome indicators were upper limb Fugl-Meyer assessment and activities of daily living (Barthel index, modified Barthel index, and functional independence measure were included). Network meta-analysis was performed using Stata 17.0 to assess the relative effect of each combined intervention and examine the consistency of direct and indirect evidence.RESULTS:In this study, a total of 24 randomized controlled trials involving 868 patients with stroke were included. CTRT combined with rTMS had the most significant upper limb Fugl-Meyer assessment improvement CTRT (standardized mean difference [SMD], 1.23 [95% CI, 0.95–1.52];P

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