Risultati per: Progressi nel trattamento della psoriasi: review

Introduction
Coughing during extubation can lead to several postoperative complications, including surgical site bleeding, intracranial hypertension and high intraocular pressure. Currently, various pharmacological and non-pharmacological interventions are employed in clinical practice to reduce coughing during extubation. However, it is unclear which of these interventions has the best preventive effect and the fewest adverse events. Therefore, we plan to conduct a systematic review and network meta-analysis to compare the effects of all interventions.

Methods and analysis
We will search MEDLINE, Embase, Web of Science, Cochrane Central Register of Controlled Trials, CNKI and Wanfang databases, as well as reference lists from previously published papers, from the date of their inception to April 2024. We will only include randomised controlled trials, regardless of publication in any language. The primary outcome is the incidence of cough during extubation, using the modified Minogue scales. The secondary outcomes are as follows: (1) the incidence of severe coughing (grade 4); (2) the incidence of other types of postoperative airway complications, such as laryngospasm, apnoea, hypoxaemia and sore throat, which will be evaluated within 24 hours after surgery; (3) the side effects related to the interventions, such as bradycardia (heart rate less than 60 beats per minute), hypotension or allergic reactions, which will be evaluated within 24 hours from the start of the drug to the postoperative period and (4) the time from the end of the surgery to the extubation of the endotracheal tube. The articles meeting the criteria will be independently evaluated by two researchers based on the established screening criteria. The data will then be extracted. Bias will be assessed for all included studies using the Cochrane Risk of Bias Risk Assessment Tool Version 2. We will use the Netmeta package of the R software with a random-effects model to make direct and indirect comparisons through the frequency framework. We will assess the quality of evidence using Confidence in Network Meta-Analysis.

Ethics and dissemination
Ethical approval is not required for this protocol, as we will only pool published data. We plan to submit our manuscript for publication in a peer-reviewed academic journal.

PROSPERO registration number
CRD42023401609.

Objectives
Ramadan fasting is an Islamic religious practice involving abstinence from food and drink from dawn to sunset. Its consequences on kidney-relevant outcomes in patients with chronic kidney disease (CKD) and kidney transplant recipients remain unclear.

Design
Systematic review and meta-analysis.

Data sources
MEDLINE, Embase, Global Health, CINAHL (EBSCOhost), Scopus, Web of Science and Google Scholar were searched up to 18 September 2023.

Eligibility criteria
We included observational studies among non-dialysis CKD and kidney transplant recipients who fasted during Ramadan and examined changes in kidney function.

Data extraction and synthesis
Standardised methods were used by two independent reviewers to screen, select and extract data. Outcomes included changes in serum creatinine (SCr), estimated glomerular filtration rate (eGFR), proteinuria, blood pressure, electrolytes and adverse events—all pre- and post-Ramadan. Results were pooled using random effects modelling.

Results
We included 32 observational studies with a total of 2592 participants. 21 studies reported on participants with CKD and 11 studies reported on kidney transplant recipients (studies variably including non-fasting control arms). Meta-analysis of 25 studies revealed that Ramadan fasting was not associated with changes to SCr for the following groups according to study design: CKD with a non-fasting arm (mean difference (MD)=0.82 µmol/L; 95% CI –7.22, 8.86; I2=38%); transplant with a non-fasting arm (MD=–0.17 µmol/L; 95% CI –2.50, 2.15; I2=0%) and CKD without a non-fasting arm (post–pre MD=13.84 µmol/L; 95% CI –3.78, 31.47; I2=88%). For transplant studies without a non-fasting arm, lower SCr was associated with the post-Ramadan period (post–pre MD=–5.40 µmol/L; 95% CI –10.78, –0.02; I2=0%). In the 18 studies that reported on eGFR, fasting during Ramadan was not associated with an effect on eGFR for any of the groups.

Conclusion
We report inconsistent effects of Ramadan fasting on kidney function in CKD or kidney transplantation. Results should be interpreted with caution due to the significant limitations of the underlying studies.

Introduction
The presence of cognitive dysfunction notably affects the quality of life in individuals diagnosed with Parkinson’s disease (PD) and is often recognised as a non-motor symptom. Comprehensive studies have shown the possible advantages of hyperbaric oxygen therapy (HBOT) in alleviating cognitive deficits in these individuals. This systematic review aims to investigate the practicality of incorporating HBOT within a more extensive therapeutic framework for PD, with a specific focus on cognitive symptoms.

Methods and analysis
A comprehensive literature review will be conducted utilising various databases such as PubMed and Cochrane Library and so on. The duration of the search will encompass the entire timeline from the initiation of each database up to 1 April 2024. This investigation seeks to uncover randomised controlled trials that explore the efficacy and safety of HBOT in patients with PD who are facing cognitive impairments. The authors’ autonomous screening and extraction of data will facilitate the attainment of impartial results. The assessment of possible biases will be conducted using the Cochrane risk-of-bias tool, while statistical analyses will be executed with RevMan V.5.3 and Stata V.15.0.

Ethics and dissemination
As this review synthesises and evaluates previously conducted studies, the requirement for ethical approval is not applicable. The findings from this review will be shared via academic publications, comprehensive reports and presentations at pertinent conferences.

PROSPERO registration number
CRD42024504763

Introduction
Orofacial clefts (OFCs), including cleft lip, cleft palate and combined cleft lip and palate, are among the most common craniofacial malformations in newborns and present significant healthcare challenges. Emerging evidence has raised concerns regarding the potential impact of prenatal exposure to antibiotics on fetal development. Antibiotics prescribed during pregnancy—particularly those that cross the placental barrier—may pose teratogenic risks. Previous studies investigating the association between prenatal antibiotic exposure and the risk of OFCs have yielded inconsistent results. However, no studies have yet attempted to summarise this evidence, highlighting the need for a comprehensive evaluation. This report describes a systematic review and meta-analysis protocol to retrospectively analyse the relationship between prenatal antibiotic exposure and the risk of developing OFCs, focusing on the role of antibiotic type and timing of exposure. The results of such a review will hopefully provide a comprehensive synthesis of the available evidence, helping to inform clinical practice and guide patient counselling regarding the use of antibiotics during pregnancy.

Methods and analysis
The planned systematic review and meta-analysis will adhere to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines to ensure a comprehensive and systematic approach to summarising the available evidence on the topic. This study will include longitudinal cohort studies, case–control studies, and interventional trials that investigate the association between prenatal antibiotic exposure and OFCs. The search strategy will cover major databases, including CINAHL, Cochrane Library, ClinicalTrials.gov, EMBASE, PubMed, Scopus and Web of Science, using tailored search terms. A team of independent assessors will screen article titles, abstracts and full texts. Any discrepancies will be resolved through discussions. Quality assessment will use the Newcastle-Ottawa Scale and Grading of Recommendations Assessment, Development and Evaluation criteria. Data extraction will focus on the study characteristics, participant details, exposure specifics and outcome measures. A random-effects meta-analysis will aggregate summary effect sizes, and heterogeneity will be assessed using I2 and Q statistics.

Ethics and dissemination
Ethical approval is not required for this systematic review, as it relies on already published data. The findings will be disseminated through peer-reviewed journals and conference presentations, providing critical insights into clinical practice and public health policies regarding antibiotic use during pregnancy.

PROSPERO registration number
CRD42024565064

Introduction
Evidence on the use of health apps to support healthcare and promote the health of individuals aged 55 and older is limited. Older adults face challenges with literacy, usability and accessibility of digital tools. This scoping review aims to explore how digital health apps promote healthy living and self-empowerment while identifying successful applications for older adults

Methods and analysis
This study will adopt the JBI methodology for scoping reviews, guided by the (Population, Concept, Context) framework. The results will be comprehensively reported in the final scoping review and illustrated using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The inclusion criteria include studies from 2016 to 2024 that investigate the use of health applications within healthcare services for older adults.

Ethics and dissemination
Ethical approval is not required for this scoping review. The findings will highlight potential directions for future research and improve knowledge among professionals, researchers and the public. The results will be published in a peer-reviewed journal and disseminated through professional networks. Data will be available from the Open Science Framework.

Background
Breast cancer is emerging as a leading cause of mortality among women and adolescent girls in Sub-Saharan Africa (SSA). However, there is a lack of clarity on the enablers and barriers associated with the implementation of preventive strategies, such as breast self-examination (BSE), particularly among adolescent girls.

Objective
This paper presents a protocol for conducting a systematic review aiming to synthesise studies on the enablers and barriers to implementing BSE education programmes among adolescent girls in SSA.

Methods and analysis
The systematic review will be conducted from December 2024 to August 2025, following the predefined methodological framework outlined in the PRISMA guidelines. To gather relevant studies, a comprehensive search will be conducted across four main online databases, namely PubMed, Scopus, Cochrane Library and EMBASE, along with other relevant grey literature sources, such as Google Scholar, to identify pertinent literature on this topic. The screening process will involve an initial review of titles and abstracts to quickly identify relevant studies, followed by a thorough assessment of the full-text versions of selected studies. Two reviewers, working independently, will extract data and evaluate the risk of bias in the included studies using either the Joana Briggs Institute’s Critical Appraisal tool or Cochrane’s Risk of Bias tool V.2 (RoB 2). The focus of the included studies will be on BSE among adolescents aged 10 to 19 years of age. Depending on the results of the literature search and the characteristics of the findings in the selected studies, we will conduct a meta-analysis if possible. Alternatively, a narrative synthesis will be conducted. The review will provide empirical evidence to inform health promoters and policymakers in advocating for BSE, particularly, among adolescent girls in SSA, with the ultimate goal of mitigating the risk of breast cancer.

Ethics and dissemination
Since this study is based on the analysis of already published research articles, ethical approval is not required. The results will be disseminated through peer-reviewed academic publications and presentations, informing further research and practice regarding BSE education programmes.

Introduction
Evidence shows that resistance training (RT) reduces lymphoedema in patients with breast cancer–related lymphoedema (BRCL), making it a safe and efficient intervention. However, it is uncertain if RT is safe and effective in patients at risk of developing BRCL. This systematic review (SR) protocol aims to describe all methodological aspects in order to evaluate the short-, medium- and long-term effects of RT on the prevention of BCRL.

Materials and methods
Throughout 2024, randomised clinical trials (RCTs) will be identified in electronic databases MEDLINE/PubMed, Embase, Cochrane Central Register of Controlled Trials, PEDro and LILACS. Only studies in English, Spanish and Portuguese will be included. Grey literature and clinical trial registration will also be reviewed. The primary outcome will be the occurrence of lymphoedema and quality of life. Second, pain intensity, upper limb function, range of movement, grip strength and adverse events will be considered. The individual studies’ risk of bias will be evaluated using the Cochrane Risk of Bias 2.0 tool. Pairwise meta-analyses using a frequentist approach and random effects model will be conducted. The Grading of Recommendations Assessment, Development and Evaluation system will be used to evaluate the certainty of the evidence.

Ethics and dissemination
This protocol does not require the approval of an ethics committee, as it is a secondary study. The results will be disseminated through peer-reviewed publications.

PROSPERO registration number
CRD42023455720.

Introduction
A literature review provides a synthesis on a selection of papers about a specific topic. This is used by health practitioners in critical care as in other specialities when making clinical practice decisions. The task of knowledge transfer through the review process of scientific papers involves a variety of methodologies with differing expectations on the quality and rigour that is applied. Exploration on the types of review methodologies selected by the authors of critical care literature may reveal the extent that choice of methodology has on how papers are selected and appraised may influence evidence-based practice recommendations. This scoping review aims to systematically map the breadth of current literature with the objective of identifying the types of review methodologies used by interdisciplinary authors synthesising the literature in adult critical care.

Methods and analysis
Arksey and O’Malley’s approach in conducting a scoping review will be followed and use of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review guidelines in the reporting of findings. Papers with diverse review methodologies will be identified by searching four electronic databases (CINAHL/EBSCO, MEDLINE/PubMed, Scopus and Embase). Grey literature will be excluded due to the clinical nature of the review question. Search results will be reviewed independently by two researchers based on title and abstract followed by full-text papers that meet inclusion criteria. Characteristics of review methodologies will be collected and analysed using a tool developed by the interdisciplinary research team.

Ethics and dissemination
This scoping review will provide an overview of the types of review methodologies most often undertaken with the interdisciplinary research team synthesising the quality of critical care literature. Scrutiny will be applied to the review methodologies selected, the challenges faced and current trends in the transfer of knowledge towards evidence-based practice. The results will be disseminated by publication through a peer-reviewed journal and by presentation as a part of conference proceedings. Ethics approval is not applicable for this scoping review.

The findings suggest that multicomponent interventions comprising multidisciplinary teams, in-person interpreting, maternal education, and social welfare support can improve perinatal outcomes for migrant women and their infants. Removing financial barriers to care may improve perinatal outcomes and be cost saving to healthcare systems. However, these findings should be interpreted with caution given that most included studies were of poor quality and that sensitivity analysis restricting to interventional studies only did not demonstrate any effect on the main outcomes of interest.

Annals of Internal Medicine, Ahead of Print.

Introduction
Tonsillitis is a self-limiting inflammatory process of the tonsils. In high-income countries, guidelines have been developed to decide if a patient needs an antibiotic or not. These guidelines help to reduce unnecessary antibiotic prescriptions and prevent the development of antimicrobial resistance (AMR). In low- and middle-income countries (LMICs), medical practitioners have the tendency to prescribe antibiotics in all cases of tonsillitis; there is an overprescription of antibiotics. These prescriptions are probably unjustified and seem to be responsible for the increased AMR seen in developing countries. The aim of this review will be to estimate the proportion of unjustified antibiotic prescriptions in LMICs.

Methods and analysis
We will conduct a systematic review of all observational studies on the diagnosis and treatment of tonsillitis in LMICs. The selected database will include PubMed, Web of Sciences Global Index Medicus and the Grey literature. The search will include studies published from January 2012 until December 2024. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and bias will be assessed by a Risk of Bias Assessment Tool for observational studies by Hoy et al. A meta-analysis will be conducted for homogeneous studies, eventually using the random effect model. Subgroup analysis will include a period of study, study quality, countries and/or subregions of LMICs involved, study setting, age of participants, tools and definition used.

Ethics and dissemination
Formal ethical approval is not required, as primary data will not be collected. The results will be disseminated through peer-reviewed publications and presented at scientific conferences.

PROSPERO registration number
CRD 42022384957

Introduction
Hospitals are vital infrastructures that provide health services during emergencies and disasters. However, in recent years, disasters have led to hospital losses and interruptions in medical services. Consequently, the concept of resilience has garnered significant attention. Despite extensive research, the lack of clarity in explaining hospital resilience poses challenges in effective assessment and identifying key priorities for enhancing disaster risk management. Recently, the WHO’s Eastern Mediterranean Regional Office (EMRO) introduced a conceptual framework for the conceptualisation of hospital resilience, defining it through six interconnected components and four resilience capacities. Identifying specific indicators and characteristics for hospital resilience components based on the EMRO framework. This protocol outlines the method for conducting a scoping review to identify such indicators and characteristics to develop a comprehensive hospital resilience assessment tool.

Methods and analysis
This scoping review will adhere to the six-step protocol proposed by Arksey and O’Malley. It aims to comprehensively understand current knowledge about resilient hospital characteristics and identify effective components and indicators for assessing hospital resilience. The review will encompass available articles indexed in PubMed, Scopus and Web of Science. Additionally, searches will explore the grey literature on Google Scholar, the WHO’s website and regional offices. There will be no publication date restrictions applied to the search. Quantitative and qualitative content analyses will assess and categorise the study results. Our protocol was drafted using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols extension for scoping reviews.

Ethics and dissemination
This protocol describes a scoping review within a doctoral thesis focused on health in emergencies and disasters, specifically hospital resilience. The study, associated with ethics code number (IR.USWR.REC.1402.120), aims to develop a comprehensive assessment tool for hospital resilience. Once peer-reviewed and published, the findings will inform experts, policymakers and relevant organisations in emergency and disaster management.

Background
Tandem Spinal Stenosis (TSS) is a disease characterised by the narrowing of the spinal canal in two or more non-adjacent areas of the spine, often affecting both the cervical and lumbar vertebrae. Doctors and patients increasingly favour non-surgical treatments that have the function of relieving symptoms and improving outcomes. This systematic review aims to evaluate the effectiveness and safety of non-surgical therapies for TSS and comprehensively summarise existing evidence.

Methods and analysis
We will conduct comprehensive searches, both manual and electronic, of literature published up to 30 September 2024; database searches will commence after the publication of this agreement, with an estimated commencement date of 1 December 2024, and the end date is 31 May 2025, without language restrictions. Key databases such as MEDLINE, PubMed, EMBASE, Web of Science, Cochrane Library, WHO International Clinical Trial Registration Platform, China National Knowledge Infrastructure, China Biomedical Literature Database, China Scientific Journal Database and Wan-Fang Database will be explored. In addition, we will include resources such as library journals and conference abstracts. Following the identification and screening of all randomised controlled trials focusing on non-surgical treatments for TSS, two investigators will perform a meta-analysis of the included studies. The findings will be summarised as the risk ratio for binary data and the standardised or weighted mean difference for continuous data.

Ethics and dissemination
Ethical approval is not required, as the review does not involve individual patient data. The review’s findings will provide clinicians with evidence on using non-surgical treatments for TSS, disseminated through peer-reviewed publications or conferences.

PROSPERO registration number
CRD42024496634.

Objectives
Study objective was to map the current literature on the economic effects of priority setting at the system level in healthcare.

Design
The study was conducted as a scoping review.

Data sources
Scopus electronic database was searched in June 2023.

Eligibility criteria
We included peer-reviewed articles published 1 January 2020–1 January 2023. All study designs that contained empirical evidence on the financial effects or opportunity costs of healthcare priority setting were included excluding disease, condition, treatment, or patient group-specific studies.

Data extraction and synthesis
Two independent researchers screened the articles, and two additional researchers reviewed the full texts and extracted data. We used Joanna Briggs Institute checklists to assess the quality of qualitative, quasi-experimental and economic evaluations and the mixed methods appraisal tool for the mixed method studies. Synthesis was done qualitatively and through descriptive statistics.

Results
8869 articles were screened and 15 fulfilled the inclusion criteria. The most common study focus was health technology assessment (7/15). Other contexts were opportunity costs, effects of programme budgeting and marginal analysis, and disinvestment initiatives. Priority setting activities analysed in the studies did not achieve cost savings or cost containment (4/15) or have mixed findings at best (8/15). Only five studies found some indication of cost savings, cost containment or increased efficiency. Also, many of the studies consider costs only indirectly or qualitatively.

Conclusions
All in all, there is very little research addressing the pressing question of whether explicit priority setting and priority-setting methods can support cost containment on a health service system level (regional or national). There is limited evidence of the economic effects of priority setting.

Introduction
It is important to incorporate the patient perspective into healthcare education, as we know that patients are experts in their own conditions. The expertise gained through lived experience serves to complement the theoretical knowledge that healthcare educators can provide. This scoping review aims to explore patient involvement in medical education within obstetrics and gynaecology, a specialty that can provide unique challenges and complexities to patient involvement due to its potentially highly sensitive and intimate nature. The goal of this study is to map the available literature on this topic which will allow for the identification of potential gaps in the provision of training for medical students in this field. The research also aims to highlight challenges that may be associated with patient involvement in this specialty in order to guide future initiatives.

Methods and analysis
The Joanna Briggs Institute scoping review framework and methodology will be used to guide and conduct this scoping review. A systematic search of electronic databases MEDLINE, CINAHL, Embase, Scopus, PsycINFO, ERIC, Google Scholar, Web of Science, African Journals Online, Cochrane Library and SciVerse will be carried out. Articles will be limited to the English language. No geographical limitations will be placed on the search. Literature from 1960 to 2023 will be considered for inclusion which corresponds with the first reports of patient educators used to assist with the demonstration of clinical skills in obstetrics and gynaecology. Relevant academic journals will be hand-searched for the previous 5 years. Identified studies will be screened by two independent reviewers and data extraction carried out by the primary researcher. Key findings will be presented in tables and summarised in narrative form. Findings from the review will be reported according to the PRISMA Extension for Scoping Reviews reporting checklist.

Ethics and dissemination
Ethical approval is not required for this study. The findings from the study will be submitted for publication in peer-reviewed journals and at medical education conferences.

Introduction
Carbapenems are used to treat multidrug-resistant organisms as last-resort antibiotics. Resistance to carbapenems is an emerging public health threat worldwide, with alarming reported rates in Asian countries. To minimise further spread of resistant strains and guide interventions, it is important to understand the prevalence rates and causative molecular determinants. Therefore, the systematic review and meta-analysis arising from this protocol will aim to comprehensively describe the available surveillance data on carbapenem resistance in Asian countries to provide an in-depth overview of the carbapenem resistance status in this region.

Methodology and analysis
A systematic review and meta-analysis will be conducted via PubMed, ScienceDirect, Cochrane Library and Web of Science databases. Additional articles and grey literature will be searched in Google Scholar, OpenGrey and Google Chrome by manually searching the reference lists of selected studies. The review question was designed according to components in the ECLIPSE (E-expectations, C-client, L-location, I-impact, P-profile and S-service) framework. Studies conducted with samples other than clinical samples will be excluded. Only original articles published in the English language will be included. The Joanna Briggs Institute critical appraisal tool will be used to assess the quality of the included studies. A random-effects meta-analysis will be performed if the data are sufficiently homogenous. Heterogeneity between studies will be assessed via the I² statistic. The subgroup analysis will be performed considering the type of sample, pathogen type, region/country where the studies were conducted and genetic determinants.

Ethics and dissemination
As this study is conducted on the basis of published data, ethical approval is exempt. The findings of this study will be disseminated in a peer-reviewed journal with the intention of providing summarised data on the globally emerging threat of carbapenem resistance and emphasising the need to introduce alternative, more effective treatment options.

PROSPERO registration number
CRD42024515806.