Short-term and long-term outcomes of hybrid revascularisation procedures in peripheral artery disease: a systematic review protocol

Introduction
Peripheral artery disease (PAD) is a chronic condition causing arterial narrowing or blockage, leading to significant morbidity and mortality. Hybrid revascularisation combines open surgical and endovascular techniques to manage multilevel disease by addressing inflow and outflow obstructions. Despite increasing adoption, evidence on the long-term outcomes of these procedures remains limited.

Objective
To evaluate the long-term outcomes of hybrid revascularisation procedures in PAD, including patency rates, limb salvage, survival, reintervention rates and complications, and to provide evidence-based insights for clinical practice and research.

Methods and analysis
This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. It will include randomised controlled trials, cohort studies, case-control studies and large case series (≥10 patients, with at least 1 year of follow-up) assessing adult patients undergoing hybrid revascularisation for PAD. Primary outcomes are patency rates, limb salvage and survival; secondary outcomes include complication rates, functional improvements and quality of life. Searches will be conducted in PubMed, Embase, Cochrane Library, CINAHL and ClinicalTrials.gov. Study selection, data extraction and quality assessment will be performed independently in duplicate by two reviewers. Meta-analyses with random-effects models will summarise findings where feasible, while narrative synthesis will address instances of insufficient data. Subgroup analyses will explore outcomes by demographics, lesion characteristics and procedural details. Risk of bias will be assessed using Cochrane and Newcastle-Ottawa tools.

Ethics and dissemination
Ethical approval is not required. Findings will be published in peer-reviewed journals and presented at conferences.

PROSPERO registration number
CRD42024615809.

Leggi
Giugno 2025

Effectiveness of methadone versus buprenorphine in the treatment of opioid use disorder: secondary analyses of prospective cohort study data

Objectives
To compare the effectiveness of buprenorphine-naloxone (bup/nal) and methadone maintenance therapy (MMT) in the treatment of patients with opioid use disorder (OUD) during the fentanyl era.

Design
Secondary analysis of prospective cohort study data.

Setting
Data for the study were collected from 54 clinical sites across Ontario, Canada, between May 2018 and January 2023.

Participants
To be included in the present study, participants had to be at least 16 years of age, have provided written informed consent and be receiving either MMT or bup/nal therapy for OUD. This study includes data from 2601 participants, of whom 2068 were receiving MMT and 533 were receiving bup/nal for OUD. The mean age of participants was 39.4 years (SD: 10.9), and 45% were female.

Interventions
MMT or bup/nal treatment for OUD.

Outcome measures
We employed a propensity score matched analysis to compare treatment outcomes among patients receiving MMT compared with bup/nal. We used ongoing illicit opioid use as an indicator of treatment outcome. We considered participants with >50% of urine drug screens in the past 12 months positive for non-prescribed opioids to be ‘non-responders’. We conducted subgroup analyses to identify whether treatment type was associated with ongoing non-prescribed opioid use among patients with and without a history of intravenous drug use (IVDU), and whether treatment type was associated with retention in treatment.

Results
Eight per cent of patients on bup/nal were considered non-responders, compared with 11.9% of patients on MMT. We did not find a statistically significant association between treatment type and treatment response. However, we did find that patients on MMT were more likely to stay in treatment for 12 months (OR 1.79, 95% CI 1.45 to 2.22, p

Leggi
Giugno 2025

ARBOR-Telehealth study: an examination of telerehabilitation to improve function and reduce opioid use in persons with chronic low back pain in rural communities – protocol of a pragmatic, individually randomised group treatment trial

Introduction
Chronic low back pain (LBP) imposes significant burden on patients, healthcare systems and society. Physical therapy is a cost-effective method for improving pain and disability; however, only a small number of patients (7–13%) with LBP ever receive physical therapy services. Patients report obstacles to accessing physical therapy, such as transportation, provider availability and missed work. Access is especially limited in rural communities, where approximately 40% fewer physical therapists are available per capita than in metropolitan regions. This lack of access likely contributes to the greater rates of LBP-related disability and opioid consumption in rural communities. Innovative methods for improving access to physical therapy for patients with chronic LBP are urgently needed; these can help address differences in health outcomes and mitigate opioid dependence for patients with chronic LBP living in rural communities. Telerehabilitation increases access to physical therapy, which can potentially improve health outcomes for these patients.

Methods and analysis
This prospective, individually randomised group treatment trial will involve primary care clinics serving rural communities on Maryland’s Eastern Shore. We will enroll 434 individuals with chronic LBP. Eligible patients will be randomised to either standardised education for back pain delivered via website or to a risk-informed telerehabilitation. Standardised education will be delivered via a study website containing information consistent with materials provided by primary care providers. Risk-informed telerehabilitation will be delivered by trained physical therapists using a web-based, video-enabled telehealth platform. The primary outcome is LBP-related disability. Secondary outcomes are opioid use, pain intensity, health-related quality of life and LBP-related healthcare use assessed using standard patient-reported outcome measures, participant self-report and medical chart abstraction. Implementation outcomes are acceptability, adoption, feasibility and fidelity of our treatment approach guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework and assessed using surveys, semi-structured interviews and key performance metrics.

Ethics and dissemination
Ethics approval was obtained from the Johns Hopkins Medicine Institutional Review Boards (IRB), which serves as the single IRB for this trial. Upon completion, study data will be shared in compliance with National Institutes of Health guidelines.

Trial registration number
NCT06471920.

Leggi
Giugno 2025

Global prevalence of ultra-short coeliac disease (USCD): the first systematic review and meta-analysis

We reviewed the recent cohort study by Raju et al1 on ultra-short coeliac disease (USCD), the first multicentre international study assessing the characteristics of this new entity and comparing them to classic coeliac disease. The study revealed findings that may necessitate a re-evaluation of the current diagnostic guidelines and screening protocols. However, the results showed disparities in USCD prevalence rates among biopsy-confirmed cases across centres, ranging from 0.2% to 8.8%. Moreover, the study did not report the number of bulb biopsies conducted at each centre. Hence, we aimed to systematically assess the global prevalence of USCD and determine factors that might influence its rates. See the for subgroup analyses and methodology. Literature was searched from inception to June 2024 (PubMed, Web of Science, Cochrane, Scopus) for studies reporting the prevalence of USCD, using the term or reporting seropositive cases with villous atrophy (VA) confined to the bulb

Leggi
Giugno 2025

When Usual Care Is Subpar Care for Hospitalized Patients With Opioid Use Disorder

Hospital-based recommendations for opioid use disorder (OUD) include offering evidence-based medications for OUD (MOUD) with post–hospital OUD treatment linkage. Hospitalization presents an ideal opportunity to initiate MOUD among out-of-treatment adults with OUD, yet only 5% of patients with an OUD-related hospitalization receive MOUD despite their increasing numbers. Innovative care models, including addiction consultation services and hospital-to-community treatment engagement strategies, optimize hospital-based OUD treatment provision and OUD treatment linkage. Clinical benefits of an addiction consultation service include greater likelihood of MOUD treatment initiation and post–hospital discharge OUD treatment linkage and a reduced risk of 30-day rehospitalization. There are also operational and educational benefits for hospitals and staff.

Leggi
Giugno 2025