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Objectives: To assess the current quality of surgical outcome reporting in the medical literature and to provide recommendations for improvement. Background: In 1996, The Lancet labeled surgery as a "comic opera" mostly referring to the poor quality of outcome reporting in the literature impeding improvement in surgical quality and patient care. Methods: We screened 3 first-tier and 2 second-tier surgical journals, as well as 3 leading medical journals for original articles reporting on results of surgical procedures published over a recent 18-month period. The quality of outcome reporting was assessed using a prespecified 12-item checklist. Results: Six hundred twenty-seven articles reporting surgical outcomes were analyzed, including 125 randomized controlled trials. Only 1 (0.2%) article met all 12 criteria of the checklist, whereas 356 articles (57%) fulfilled less than half of the criteria. The poorest reporting was on cumulative morbidity burden, which was missing in 94% of articles (n= 591) as well as patient-reported outcomes missing in 83% of publications (n=518). Comparing journal groups for the individual criterion, we found moderate to very strong statistical evidence for better quality of reporting in high versus lower impact journals for 7 of 12 criteria and strong statistical evidence for better reporting of patientreported outcomes in medical versus surgical journals (P<0·001). Conclusions: The quality of outcomes reporting in the medical literature remains poor, lacking improvement over the past 20 years onmost key end points. The implementation of standardized outcome reporting is urgently needed to minimize biased interpretation of data thereby enabling improved patient care and the elaboration of meaningful guidelines. [ABSTRACT FROM AUTHOR]

In longitudinal studies with time-varying exposures and mediators, the mediational g-formula is an important method for the assessment of direct and indirect effects. However, current methodologies based on the mediational g-formula can deal with only one mediator. This limitation makes these methodologies inapplicable to many scenarios. Hence, we develop a novel methodology by extending the mediational g-formula to cover cases with multiple time-varying mediators. We formulate two variants of our approach that are each suited to a distinct set of assumptions and effect definitions and present nonparametric identification results of each variant. We further show how complex causal mechanisms (whose complexity derives from the presence of multiple time-varying mediators) can be untangled. We implemented a parametric method, along with a user-friendly algorithm, in R software. We illustrate our method by investigating the complex causal mechanism underlying the progression of chronic obstructive pulmonary disease. We found that the effects of lung function impairment mediated by dyspnea symptoms accounted for 14.6% of the total effect and that mediated by physical activity accounted for 11.9%. Our analyses thus illustrate the power of this approach, providing evidence for the mediating role of dyspnea and physical activity on the causal pathway from lung function impairment to health status. See video abstract at, http://links.lww.com/EDE/B988 . [ABSTRACT FROM AUTHOR]

Older patients are often deemed ineligible for clinical research, and many frequently-used endpoints and outcome measures are not as relevant for older patients for younger ones. This systematic review aimed to present an overview of outcomes used in clinical research regarding patients over the age of 65 years with prostate cancer. PubMed and Embase were systematically searched to identify studies on prostate cancer (treatment) in patients aged ≥65 between 2016 and 2023. Data on title, study design, number of participants and age, stage of disease, treatment, and investigated outcomes were synthesized and descriptively analyzed. Sixty-eight studies were included. Of these most included patients over 65 years, while others used a higher age. Overall, 39 articles (57.3%) reported on survival-related outcomes, 22 (32.4%) reported on progression of disease and 38 (55.9%) used toxicity or adverse events as an outcome measure. Health-related quality of life and functional outcomes were investigated in 29.4%, and cognition in two studies. The most frequently investigated survival-related outcomes were overall and cancer-specific survival (51.3%); however, 38.5% only studied overall survival. The main focus of studies included in this review remains survival and disease progression. There is limited attention for health-related quality of life and functional status, although older patients often prioritize the latter. Future research should incorporate outcome measures tailored to the aged population to improve care for older patients with prostate cancer. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is available in the text Objective: To define a standardized methodology for establishing benchmarks for relevant outcomes in surgery. Summary Background Data: Benchmarking is an established tool to improve quality in industry and economics, and is emerging in assessing outcome values in surgery. Despite a recent 10-step approach to identify such benchmark values, a standardized and more widely agreed-on approach is still lacking. Methods: A multinational web-based Delphi survey with a focus on methodological requirements for establishing benchmarks for surgical outcomes was performed. Participants were selected among internationally renowned specialists in abdominal, vascular, and thoracic surgery. Consensus was defined as ≥70% agreement and results were used to develop a checklist to establish benchmarks in surgery. Results: Forty-one surgical opinion leaders from 19 countries and 5 continents were involved. Experts' response rates were 98% and 80% in rounds 1 and 2, respectively. Upon completion of the final Delphi round, consensus was successfully achieved for 26 of 36 items covering the following areas: center eligibility, validation of databases, patient cohort selection, procedure selection, duration of follow-up, statistical analysis, and publication requirements regarding center-specific outcomes. Conclusions: This multinational Delphi survey represents the first expert-led process for developing a standardized approach for establishing benchmarks for relevant outcome measures in surgery. The provided consensual checklist customizes the methodology of outcome reporting in surgery and thus improves reproducibility and comparability of data and should ultimately serve to improve quality of care. [ABSTRACT FROM AUTHOR]

Background: Epidemiological evidence on dementia prevalence is outdated and still limited, and recent estimates (including those from the Institute for Health Metrics and Evaluation, IHME) may be an underestimation. Moreover, the recent WHO blueprint exercise confirmed that the quality of data we have is poor and based on weak and non‐standardized or even flawed methods. Dementia prevalence in nursing homes (NH) is likely high but evidence is scarce. We aimed to explore dementia and compare dementia prevalence in Southern Switzerland in community and in NH settings, using standardized and previously validated procedures and assessments. Method: We conducted a cross‐sectional study among a random sample of community dweller older adults and a convenience sample of NH residents in the Canton of Ticino. Participants were dyads formed by an older adult (≥65 years old) and an informant. We collected socio‐demographic data and assessed cognitive function using the electronic version of the 10/66 short Dementia Diagnostic Schedule, which comprises the Community Screening Instrument for Dementia (CSI‐D), the CERAD animal verbal fluency and ten‐word list learning tasks, and the EURO‐Depression scale (EURO‐D). We performed descriptives, t‐tests, and chi‐square tests. Result: We recruited 462 participants between June 2021 and August 2022. Participants living in the community (N = 300) had a mean age of 76.11 (SD = 6.46), and those living in NH (N = 162) of 87.62 (SD = 6.44). The prevalence of dementia was 6.3% (CI: 3.56‐9.11) in the community, and 75% (CI: 68.6‐82.02) in NH. Overall, dementia caseness was positively associated with age (p‐value <0.001), being a woman (p‐value < 0.001), and lower educational level (p‐value <0.001). However, these associations were not significant in the NH subsample (all p‐values >0.05). Among community‐dwelling older adults, dementia caseness was associated with age (p‐value <0.001), but not with gender, and education (all p‐values >0.05). Conclusion: Our study shows the marked differences in dementia prevalence between community and NH settings, expanding recent models from the IHME. It is crucial to include institutionalised older adults when measuring dementia prevalence in populations, particularly in high‐income countries, and where people with dementia are more likely to and can live in NH. [ABSTRACT FROM AUTHOR]

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Objective: To assess whether specific patterns of early postoperative complications may predict overall severe morbidity after major surgery, warranting early escalation of care and prevention of failure to rescue. Summary of Background Data: It is unclear whether early postoperative complications predict a poor outcome. Detailed knowledge of the chronology and type of early complications after major surgery may alert clinicians when to expect higher risk for subsequent major negative events. Methods: All 90-day postoperative events following complex pancreas, liver, and rectal surgeries, and liver transplantation were analyzed over a 3-year period in a single tertiary center. Each complication was recorded regarding severity, type (cardiac, infectious, etc), etiology (surgical/medical), and timing of occurrence. The Comprehensive Complication Index (CCI®), covering the first 7 postoperative days, was calculated as a measure for early cumulative postoperative morbidity. The statistical analysis (descriptive, sequence pattern analyses, and logistic regression analyses) aimed to detect any combinations of events predicting poor outcome as defined by a cumulative CCI® ≥37.1 at 90-days. Results: The occurrence of ≥2 complications, irrespective of severity, type or etiology, was strongly associated with a severe postoperative course (P < 0.001). Even 2 mild complications (≤ grade II) greatly increased the chance for high morbidity compared to patients with 0 or 1 complication within the first postoperative week (odds ratio 10.2, 95% confidence interval 5.82–17.98). The CCI® at postoperative day 7 strongly predicted high 90-day morbidity (odds ratio 3.96 per 10 CCI® points, P < 0.001). Conclusion: Multiple complications of any cause or severity within the first postoperative days represents a “warning-signal” for overall high morbidity by 90 days, which should be used to trigger an escalation of care to prevent failure to rescue and eventually poor outcome. [ABSTRACT FROM AUTHOR]

Objective: To assess the adoption of recommendation from randomized clinical trials (RCTs) and investigate factors favoring or preventing adoption. Background: RCT are considered to be the cornerstone of evidence-based medicine by representing the highest level of evidence. As such, we expect RCT's recommendations to be followed rigorously in daily surgical practice. Methods: We performed a structured search for RCTs published in the medical and surgical literature from 2009 to 2013, allowing a minimum of 5-year follow-up to convincingly test implementation. We focused on comparative technical or procedural RCTs trials addressing the domains of general, colorectal, hepatobiliary, upper gastrointestinal and vascular surgery. In a second step we composed a survey of 29 questions among ESA members as well as collaborators from their institutions to investigate the adoption of surgical RCTs recommendation. Results: The survey based on 36 RCTs (median 5-yr citation index 85 (24-474), from 21 different countries, published in 15 high-ranked journals with a median impact factor of 3.3 (1.23-7.9) at the time of publication. Overall, less than half of the respondents (47%) appeared to adhere to the recommendations of a specific RCT within their field of expertise, even when included in formal guidelines. Adoption of a new surgical practice was favored by watching videos (46%) as well as assisting live operations (18%), while skepticism regarding the methodology of a surgical RCT (40%) appears to be the major reason to resist adoption. Conclusion: In conclusion, surgical RCTs appear to have moderate impact on daily surgical practice. While RCTs are still accepted to provide the highest level of evidence, alternative methods of evaluating surgical innovations should also be explored. [ABSTRACT FROM AUTHOR]

The current guidelines of statins for primary cardiovascular disease (CVD) prevention were based on results from systematic reviews and meta-analyses that suffer from limitations.Methods: We searched in PubMed for existing systematic reviews and individual open-label or double-blinded randomized controlled trials that compared a statin with a placebo or another, which were published in English until January 01, 2018. We performed a random-effect pairwise meta-analysis of all statins as a class and network meta-analysis for the specific statins on different benefit and harm outcomes.Results: In the pairwise meta-analyses, statins as a class showed statistically significant risk reductions on non-fatal MI (risk ratio [RR] 0.62, 95% CI 0.53-0.72), CVD mortality (RR 0.80, 0.71-0.91), all-cause mortality (RR 0.89, 0.85-0.93), non-fatal stroke (RR 0.83, 0.75-0.92), unstable angina (RR 0.75, 0.63-0.91), and composite major cardiovascular events (RR 0.74, 0.67-0.81). Statins increased statistically significantly relative and absolute risks of myopathy (RR 1.08, 1.01-1.15; Risk difference [RD] 13, 2-24 per 10,000 person-years); renal dysfunction (RR 1.12, 1.00-1.26; RD 16, 0-36 per 10,000 person-years); and hepatic dysfunction (RR 1.16, 1.02-1.31; RD 8, 1-16 per 10,000 person-years). The drug-level network meta-analyses showed that atorvastatin and rosuvastatin were most effective in reducing CVD events while atorvastatin appeared to have the best safety profile.Conclusions: All statins showed statistically significant risk reduction of CVD and all-cause mortality in primary prevention populations while increasing the risk for some harm risks. However, the benefit-harm profile differed by statin type. A quantitative assessment of the benefit-harm balance is thus needed since meta-analyses alone are insufficient to inform whether statins provide net benefit. [ABSTRACT FROM AUTHOR]

Highlights • Regular expert MS care is recommended, also to check eligibility for new treatments. • Out of 1038 Swiss MS patients, 89% reported being in regular neurological care. • Of the remainder, 5% reported only being in GP care, and 6% not being in care. • Newly diagnosed or primary progressive patients less frequently saw a neurologist. • There was no indication for systematic access barriers to neurological care. • All MS patients should be motivated to seek expert MS care. Abstract Background Current guidelines recommend regular neurological MS care in persons diagnosed with MS, but little is known about implementation of this recommendation or potential access barriers. This study examined disease-specific and sociodemographic differences between MS patients in Neurological Care (NeC), General Practitioner Care (GPC), or no Physician Care (NoPC) to identify group differences and characteristics that may suggest care access barriers. Methods Patient-reported data were analyzed from 1038 Swiss Multiple Sclerosis Registry participants by means of multivariable regression to identify systematic differences across the three care groups. Assessments included comprehensive data on clinical, sociodemographic, and geographic factors. Results 89% reported being in regular care by a neurologist (56% in private practices, 44% in hospitals), 5% were in GPC, and 6% reported No Physician Care (NoPC). Compared with the NeC group, patients not seeing a neurologist included two subgroups, one consisting of persons with a primary progressive MS (PPMS) and/or an extended MS history. The second subgroup included persons with a recent MS diagnosis within the last 2 years. Within the NeC group, the patients seen in private practices were of older age and more frequently female compared to those at clinics, but no differences were detected with regard to disability status, MS type, or treatment patterns. Conclusions Access to neurological care is high in Switzerland. Given the emerging paradigm for early treatment and new drugs for progressive MS, regular neurology visits should be promoted among patient groups currently less in neurological care such as persons with PPMS or recently diagnosed. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is available in the text Objective: The aim of this study was to identify a readily available, reproducible, and internationally applicable cost assessment tool for surgical procedures. Summary of Background Data: Strong economic pressure exists worldwide to slow down the rising of health care costs. Postoperative morbidity significantly impacts on cost in surgical patients. The comprehensive complication index (CCI®), reflecting overall postoperative morbidity, may therefore serve as a new marker for cost. Methods: Postoperative complications and total costs from a single tertiary center were prospectively collected (2014 to 2016) up to 3 months after surgery for a variety of abdominal procedures (n = 1388). CCI® was used to quantify overall postoperative morbidity. Pearson correlation coefficient (r pears) was calculated for cost and CCI®. For cost prediction, a linear regression model based on CCI®, age, and type of surgery was developed and validated in an international cohort of patients. Results: We found a high correlation between CCI® and overall cost (r pears = 0.75) with the strongest correlation for more complex procedures. The prediction model performed very well (R 2 = 0.82); each 10-point increase in CCI® corresponded to a 14% increase to the baseline cost. Additional 12% of baseline cost must be added for patients older than 50 years, or 24% for those over 70 years. The validation cohorts showed a good match of predicted and observed cost. Conclusion: Overall postoperative morbidity correlates highly with cost. The CCI® together with the type of surgery and patient age is a novel and reliable predictor of expenses in surgical patients. This finding may enable objective cost comparisons among centers, procedures, or over time obviating the need to look at complex country-specific cost calculations (www.assessurgery.com). [ABSTRACT FROM AUTHOR]

Highlights • Depending on the disease course, quality of life is affected by different symptoms. • For RRMS, gait and balance problems, and fatigue affect most quality of life. • For progressive MS, spasticity and paralysis affect most quality of life. • When measuring with a visual analogue scale, different symptoms gain importance. Abstract Background MS symptoms affect many functional domains. Knowing the specific impact of symptoms on health-related quality of life (HRQoL) is vital for successful disease and symptom management in MS. We aimed at investigating how specific MS symptoms contribute to the disease burden in individuals and from a population perspective. Methods We included 855 Swiss Multiple Sclerosis Registry participants with a relapsing-remitting form (RRMS) or a progressive form (PMS). HRQoL was measured with the EuroQol 5-Dimension EQ-5D-index and EQ-Visual Analogue Scale (EQ-VAS) on 0–100% scales. Their associations with 20 symptoms, socio-demographic and clinical information were explored in median regression models, stratified by RRMS and PMS. Results We included 611 participants with RRMS and 244 with PMS. In RRMS, gait (−6.5%) and balance problems (−5.1%) had the largest EQ-5D-index reductions, and were also important at the population level (frequencies 45% and 52%). Fatigue, depression, and spasticity (frequencies 74.1%, 31%, 38%) also contributed to the population disease burden. In PMS, spasticity, paralysis, and bowel problems had the largest impact on EQ-5D-index, both at the individual and population levels. The largest impact on EQ-VAS at population level was associated in RRMS with balance problems, depression, dizziness, and spasticity, while in PMS with weakness, pain, and paralysis. Conclusions While HRQoL at population level is most affected by balance problems, spasticity, and depression in RRMS, the biggest HRQoL losses in PMS are caused by spasticity, paralysis, weakness, and pain. Many symptoms with the largest effects in individuals substantially contribute to the population disease burden. [ABSTRACT FROM AUTHOR]

Background In multiple sclerosis (MS) rehabilitation, most currently used outcome measures were validated in patients with a relapsing remitting MS and mild to moderate impairments. We aimed to assess whether these measures were also adequate in more impaired patients, frequently encountered in those with progressive MS (PMS). Methods Outcome measurements were extracted from medical records of 229 patients with PMS undergoing 3 weeks of routine inpatient rehabilitation between 2011 and 2015. We assessed the acceptability of Nine-Hole Peg Test (9HPT), Timed 25-Foot Walk (T25FW), 2-Minute Walk Test (2MWT), Rivermead Mobility Index (RMI) and the Functional Independence Measure (FIM) by analysing their statistical distributions, concurrent validity by comparing Spearman correlations with pre-specified hypotheses, and responsiveness across impairment status by calculating standardized response means. Results Our concurrent validity hypotheses were mainly satisfied. However, all outcome measures had skewed distributions, showed low variability, and thus were inadequately discriminative. Moreover, 9HPT was never responsive across the impairment states, whereas the T25FW was responsive for mildly impaired patients, and the 2MWT for mild to moderate MS, respectively. Generic multi-items measures such as RMI and FIM-motor were adequately responsive for all severity levels. Conclusions Currently used outcome measures are inadequate for patients with impaired mobility, and there is a dire need of specifically designed outcome measures for routine care that are less burdensome and short-term responsive. [ABSTRACT FROM AUTHOR]

The availability of geo-referenced data increased dramatically in recent years, motivating the use of spatial statistics in a variety of research fields, including epidemiology, environmental science, remote sensing, and economics. Combining data measured at both point and areal support can improve parameter estimation and increase prediction accuracy. We propose a new generalized spatial fusion model framework for jointly analyzing point and areal data. Assuming a common latent spatial process, we take a Bayesian hierarchical approach to model both types of data without distributional constraints. The models are implemented with nearest neighbor Gaussian process in Stan modeling language to increase computational efficiency and flexibility. Our simulation study shows that generalized fusion models under this framework model the latent process better than spatial process models. We identify scenarios where fusion models can offer large improvements. We then apply the framework to epidemiological data to identify the spatial risk pattern of respiratory diseases and lung cancer in Canton of Zurich, Switzerland. [ABSTRACT FROM AUTHOR]

Background New research methods offer opportunities to investigate the influence of environment on health during travel. Our study uses data from a smartphone application to describe spatial and environmental patterns in health among travellers. Methods A prospective cohort of travellers to Thailand used a smartphone application during their trips to 1) answer a daily questionnaire about health behaviours and events, and 2) collect streaming data on environment, itinerary, and weather. Incidence of health events was described by region and trip type. The relationship between environmental factors and health events was modelled using a logistic mixed model. Results The 75/101 (74.3%) travellers that completed the study answered 940 questionnaires, 796 (84.7%) of which were geolocated to Southeast Asia. Accidents occurred to 20.0% of participants and were mainly in the Thai islands, while self-rated “severe” mental health events (21.3%) were centred in Bangkok. The odds of a health event were higher in Chiang Mai (2.34, 95% CI: 1.08, 5.08) and on rainy days (1.86, 95% CI: 1.03, 3.36). Conclusions Distinct patterns in spatial and environmental risk factors emerged in travellers to Thailand. Location based tracking could identify “hotspots” for health problems and update travel advice to target specific risk groups and regions. [ABSTRACT FROM AUTHOR]

• Covid-19 vaccine hesitancy in surveyed persons with MS in Switzerland was very low. • Hesitation to vaccinate was most often a personal preference. • Older age and regular visits to healthcare professionals were negatively associated with hesitancy. • A history of positive Covid-19 test was positively associated with hesitancy. • Covid-19 vaccination usually had mild side effects and rarely affected MS symptoms. Despite strong recommendations for coronavirus disease 2019 (Covid-19) vaccination by multiple sclerosis (MS) organizations, some persons with MS (pwMS) remain vaccine hesitant. The Swiss MS Registry conducted a survey to explore Covid-19 vaccine hesitancy, self-reported side effects and changes in MS symptoms following vaccination in adult pwMS. Self-reported data were analyzed cross-sectionally. Multivariable logistic regression was used to explore participant characteristics associated with Covid-19 vaccine hesitancy. Of 849 respondents, 73 (8.6%) were unvaccinated. Hesitation to vaccinate was most often a personal preference (N = 42, 57.53%). Factors negatively associated with vaccine hesitancy included older age (OR = 0.97 per year, 95% CI [0.94, 0.99]) and regularly seeing healthcare professionals (OR = 0.25, 95% CI [0.07, 0.85]). A history of confirmed Covid-19 infection (OR = 3.38, 95% CI [1.69, 6.77]) and being underweight (OR = 4.50, 95% CI [1.52, 13.36]) were positively associated with vaccine hesitancy. Of 768 participants who provided information, 320 (41.2%) and 351 (45.2%) reported vaccination side effects after the first and second vaccinations, respectively. Changes in MS symptoms were reported by 49 (6.3%) participants after the first and 67 (9.0%) participants after the second vaccination, and were most often described as increased or new-onset fatigue (N = 17/49 (34.7%) after the first and N = 21/67 (31.3%) after the second dose). Covid-19 vaccine hesitancy was low among surveyed pwMS. The risk of vaccine hesitancy was higher among younger pwMS, those with a history of Covid-19 infection, and those without regular contact with healthcare professionals. [ABSTRACT FROM AUTHOR]

Objective: To explore the added value of the comprehensive complication index (CCI®) to standard assessment of postoperative morbidity, and to clarify potential controversies for its application. Background: The CCI® was introduced about 3 years ago as a novel metric of postoperative morbidity, integrating in a single formula all complications by severity, ranging from 0 (uneventful course) to 100 (death). It remains unclear, how often the CCI® adds to standard reporting of complications and how to apply it in complex postoperative courses. Methods: CCI® data were prospectively collected over a 1-year period at our institution. The proportion of patients with more than 1 complication and the severity of those complications were assessed to determine the additional value of the CCI® compared to the Clavien--Dindo classification. Complex and controversial cases were presented to 90 surgeons worldwide to achieve consensus in weighing each postoperative event. Descriptive statistics were used to evaluate agreement among surgeons and to suggest solutions for consistent use of the CCI®. Results: Complications were identified in 24% (290/1212) of the general surgical population. Of those, 44% (127/290) developed more than 1 complication by the time of discharge, and thereby CCI® added information to the standard grading system of complications. Information gained by the CCI® increased with the complexity of surgery and observation time. Conclusions: The CCI® adds information on postoperative morbidity in almost half of the patients developing complications, with particular value following extensive surgery and longer postoperative observation up to 3 months. Each single complication, independently of their inter-connection, should be included in the CCI® calculation to best mirror the patients' postoperative morbidity. [ABSTRACT FROM AUTHOR]

Summary Background Increasing numbers of confirmed cases of Zika virus (ZIKV) infection resulting from non-mosquito-borne transmission have been reported. Methods We performed a systematic literature review (PRISMA guidelines) on intrauterine, intrapartum, sexual and animal bite ZIKV transmission. The presence of the virus in breast milk, urine, saliva and blood transfusions was also reviewed. Results The search resulted in 285 papers of possible relevance, of which we included 53 in the systematic review. Mother-to-child transmission was most frequently described with adverse infant outcomes including microcephaly, intracranial calcification and fetal death. Zika virus RNA has been detected in amniotic fluid, breast milk, seminal fluid, saliva, urine and blood. Semen and blood products have proved to be infectious. Male-to-female and male-to-male ZIKV transmission is documented. There are contradictory results concerning the infectiousness of breast milk and urine and data on saliva, animal bites, transplantation, needlestick injury and laboratory work are inconclusive. Conclusions Our systematic analysis shows that non-vector-borne ZIKV transmission plays a role in the spread of ZIKV and has great societal impact. It has important public health implications for the prevention and control of ZIKV globally and will be a basis for policy and further research. [ABSTRACT FROM AUTHOR]

Summary Background In the last decades, there have been several natural disasters and global catastrophies with a steady increase in humanitarian relief work. This has resulted in increased research in the field of humanitarian aid, however the focus is mostly on the victims of the disasters and not on the individuals and organisations providing aid. Objectives The intent of this research is to review the information available on pre-deployment interventions and recommendations such as vaccinations and other health preserving measures in volunteers and professionals deploying abroad in humanitarian relief missions. Methods We performed a systematic literature review of papers written in English, French, Italian or German. We searched the following databases: Cochrane, PubMed, CINAHL, EMBASE and also hand searched reference lists. The cut-off date for the publication search was November 20th, 2014. In addition to the literature search we also sent a questionnaire to 30 organisations to detail their approach to preparing relief workers. Results We identified 163 papers of possible relevance and finally included 35 papers in the systematic review. Six organisations provided information on pre-deployment preparation of aid workers. Identified papers show that pre-deployment physical and mental fitness are paramount for success in humanitarian missions. However, in many settings, pre-travel medical and psychological assessments and/or training/education sessions are not mandatory. We identified high-risk hazards for aid workers (often location specific), these included: travellers׳ diarrhoea, vector-borne infections, accidents, violence, tuberculosis, HIV, hepatitis A, leptospirosis, typhoid fever, seasonal and H1N1 influenza. Conclusions The medical evaluation can identify problems or risk factors, such as psychological frailty, that can be exacerbated by the stressful settings of humanitarian missions. In this pre-travel setting, the status of routine vaccinations can be controlled and completed, medication dispensed and targeted preventive advice provided. A mission specific first-aid kit can be recommended. There is a lack of evidence-based literature on the theme of pre-travel advice guidelines for humanitarian workers. We propose a shared database of literature on this topic as a resource and suggest that some standardization of guidelines would be useful for future planning. [ABSTRACT FROM AUTHOR]