Search

A unique collaboration of multi-disciplinary experts from the European Association of Dermato-Oncology (EADO), the European Dermatology Forum (EDF), and the European Organization of Research and Treatment of Cancer (EORTC) was formed to make recommendations on cutaneous melanoma diagnosis and treatment, based on systematic literature reviews and the experts' experience. Cutaneous melanomas are excised with one to two-centimeter safety margins. For a correct stage classification and treatment decision, a sentinel lymph node biopsy shall be offered in patients with tumor thickness ≥ 1.0 mm or ≥ 0.8 mm with additional histological risk factors, although there is as yet no clear survival benefit for this approach. Therapeutic decisions should be primarily made by an interdisciplinary oncology team ("Tumor Board"). Adjuvant therapies can be proposed in completely resected stage IIB-IV. In stage II only PD-1 inhibitors are approved. In stage III anti-PD-1 therapy or dabrafenib plus trametinib for patients with BRAFV600 mutated melanoma can be discussed. In resected stage IV, nivolumab can be offered, as well as ipilimumab and nivolumab, in selected, high-risk patients. In patients with clinically detected macroscopic, resectable disease, neoadjuvant therapy with ipilimumab plus nivolumab followed complete surgical resection and adjuvant therapy according to pathological response and BRAF status can be offered. Neoadjuvant therapy with pembrolizumab followed by complete surgical resection and adjuvant pembrolizumab is also recommended. For patients with disease recurrence after (neo) adjuvant therapy, further treatment should consider the type of (neo) adjuvant therapy received as well as the time of recurrence, i.e., on or off therapy. In patients with irresectable stage III/IV disease systemic treatment is always indicated. For first line treatment PD-1 antibodies alone or in combination with CTLA-4 or LAG-3 antibodies shall be considered. In stage IV melanoma with a BRAFV600 mutation, first-line therapy with BRAF/MEK inhibitors can be offered as an alternative to immunotherapy, in selected cases. In patients with primary resistance to immunotherapy and harboring a BRAFV600 mutation, this therapy shall be offered as second line. Other second line therapies include therapy with tumor infiltrating lymphocytes and combinations of immune checkpoint inhibitors not used in first line. This guideline is valid until the end of 2026., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Amaral reports personal fees for advisory board membership from Delcath and Philogen; personal fees as an invited speaker from BMS, Neracare, Novartis and Pierre Fabre; personal fees for a writing engagement from CeCaVa and Medtrix; institutional fees as local principal investigator (PI) from Agenus Inc., AstraZeneca, BioNTech, BMS, HUYA Bioscience, Immunocore, IO Biotech, MSD, Pfizer, Philogen, Regeneron, Roche and University Hospital Essen; institutional fees as coordinating PI from Unicancer; institutional research grants from iFIT and Novartis; institutional funding from MNI - Naturwissenschaftliches und Medizinisches Institut, Neracare, Novartis, Pascoe, Sanofi and Skyline-Dx; non-remunerated membership of the American Society of Clinical Oncology (ASCO) and the Portuguese Society for Medical Oncology; and a role as clinical expert in the area of medical oncology for Infarmed. Dr. Arenberger reports personal fees from BMS, personal fees from MSD, personal fees from Novartis, personal fees from Sanofi, outside the submitted work. Dr Basset-Seguin has nothing to disclose. Dr. Bastholt reports personal fees for advisory boards from Bristol Myers-Squibb, Pierre Fabre, Merck MSD, Novartis and Roche, outside the submitted work. Dr. Bataille has nothing to disclose.Dr. Brochez has nothing to disclose.Dr. del Marmol reports grants and personal fees from BMS, grants and personal fees from SANOFI, personal fees from LEO Pharma, grants and personal fees from ALMIRALL, outside the submitted work.Dr. Dreno reports personal fees from MSD, grants and personal fees from BMS, grants and personal fees from Roche, grants and personal fees from Fabre , outside the submitted work. Dr. Eggermont reports Consultant for: Agenus, Boehringer Ingelheim, BioInvent, BioNTech, Brenus, CatalYm, Eurobio, GenOway,IO Biotech, Imcheck, IQVIA, Merck&Co/MSD, Pfizer, QBiotics, Regeneron, Sairopa BV, ScanCell,Scorpion Therapeutics, Secarna, SkylineDx BV, Thermosome, Trained Immunity DiscoverySpeaker engagements: Merck/MSD, SkylineDx BVEquity: IO Biotech, Sairopa BV, SkylineDX BV. Dr. Fargnoli reports grants and personal fees from Almirall, personal fees from Leo Pharma, grants and personal fees from Janssen, personal fees from Novartis, personal fees from Lilly, personal fees from Sanofi, personal fees from UCB, personal fees from Abbvie, personal fees from AMGEN, personal fees from Pierre Fabre, grants and personal fees from Galderma, personal fees from Sun Pharma, personal fees from BMS, personal fees from Kyowa Kyrin, personal fees from Pfizer, personal fees from MSD, outside the submitted work.Dr. Forsea has nothing to disclose.Dr. Garbe reports personal fees from CeCaVa, personal fees from MSD, personal fees from NeraCare, personal fees from Philogen, outside the submitted work.Dr. Hauschild reports grants and personal fees from Amgen, grants and personal fees from BMS, grants and personal fees from MerckPfizer, grants and personal fees from MSD/Merck, grants and personal fees from Philogen, grants and personal fees from Pierre Fabre, grants and personal fees from Regeneron, personal fees from Roche, grants and personal fees from Sanofi-Genzyme, grants and personal fees from Novartis Pharma, personal fees from Eisai, personal fees from Immunocore, grants and personal fees from Replimune, personal fees from Seagen, personal fees from IO Biotech, personal fees from Dermagnostix, personal fees from Incyte, grants and personal fees from NeraCare, grants from Huya Biosciences, personal fees from Kyowa Kirin, personal fees from Highlight Therapeutics, personal fees from Iovance, personal fees from CureVac, personal fees from Xenthera, peronal fees from Agenus, personal fees from Almirall, and personal fees from Sun Pharma, outside the submitted work.Dr. Hoeller reports personal fees from Amgen, personal fees from Almirall, personal fees from BMS, personal fees from MSD, personal fees from Novartis, personal fees from Pierre Fabre, personal fees from Roche, personal fees from Sanofi, outside the submitted work.Dr. Kandolf reports personal fees for advisory boards from Bristol Myers-Squibb, MSD, Novartis Roche, Janssen, Abbvie, outside the submitted work.Dr. Kaufmann reports other from Abbvie, other from Almirall, other from Amgen, other from Astra Zeneca, other from Bionteck, other from BMS, other from Galderma, other from Incyte, other from Janssen , other from Leo, other from MSD, other from Novartis, other from Pfizer, other from Roche, other from Sanofi, outside the submitted work.Dr. Kelleners-Smeets reports personal fees from Sanofi, personal fees from Novartis, personal fees from MSD, personal fees from Sun Pharma, outside the submitted work.Dr. Lallas reports personal fees from Avene, personal fees from MSD, personal fees from Regeneron, personal fees from BMS, outside the submitted work.Dr. Lebbe reports personal fees from MSD, personal fees from Pierre Fabre, personal fees from BMS, personal fees from Sanofi, personal fees from immunocore, outside the submitted work.Dr. Leiter reports personal fees from Regeneron, Sanofi, personal fees from MSD, personal fees from Novartis, Almirall Hermal, personal fees from Sun Pharma, outside the submitted work.Dr. Longo has nothing to disclose.Dr. Lorigan reports grants and personal fees from Pierre Fabre, personal fees from MSD, grants and personal fees from BMS, personal fees from MLA diagnostics, outside the submitted work.Dr. Malvehy reports grants and personal fees from Almirall, personal fees from MSD, personal fees from Pierre Fabre, grants from Philogen, grants from Castle biosciences, grants from BMS, grants and personal fees from ISDIN, grants and personal fees from La Roche Posay, non-financial support and other from Vivascope, non-financial support and other from Damae medical, non-financial support and other from Canfield, non-financial support and other from Fotofinder, outside the submitted work.Dr. Mandala reports personal fees from BMS, personal fees from MSD, personal fees from Novartis, personal fees from Regeneron, personal fees from Sun Pharma, outside the submitted work.Dr. Moreno-Ramírez has nothing to disclose.Dr. Nathan reports personal fees from Novartis, grants and personal fees from Immunocore, personal fees from BMS, personal fees from SunPharma, personal fees from MSD, outside the submitted work;Dr. Pellacani has nothing to disclose.Dr. Peris reports personal fees from Abbvie, personal fees from Lilly, personal fees from Leo Pharma, personal fees from Sanofi, personal fees from Almirall, personal fees from Novartis, personal fees from Boehringer, personal fees from Amgen, outside the submitted work.Dr. Saiag reports personal fees from Novartis, MSD, NeraCare, BMS, Pierre Fabre, Merck, personal fees and grants from Damae Medical, outside the submitted work.Dr. Stockfleth has nothing to disclose.Dr. Stratigos reports personal fees from Sanofi, personal fees from Janssen CILAG, personal fees and non-financial support from Novartis, grants from Genesis Pharma, grants from Abbvie, grants and personal fees from BMS, personal fees from Regeneron, grants from Leo-Pharma, grants from Lilly, outside the submitted work.Dr. van Akkooi reports grants and personal fees from Amgen, personal fees from Bristol-Myers Squibb, personal fees from Novartis, personal fees from MSD-Merck, grants and personal fees from Merck-Pfizer, personal fees from Pierre Fabre, personal fees from Sanofi, personal fees from Sirius Medical, personal fees from 4SC, personal fees from Genmab, personal fees from Menarini Silicon Biosystems, from Skyline Dx, outside the submitted work.Dr. Vieira has nothing to disclose.Dr. Zalaudek reports personal fees from Philogen, personal fees from MSD, personal fees from Novartis, personal fees from Sanofi, personal fees from La Roche Posay, personal fees from Sunpharma, personal fees from Biogena, personal fees from Cieffe Derma, outside the submitted work., (Copyright © 2024. Published by Elsevier Ltd.)

This guideline was developed in close collaboration with multidisciplinary experts from the European Association of Dermato-Oncology (EADO), the European Dermatology Forum (EDF) and the European Organization for Research and Treatment of Cancer (EORTC). Recommendations for the diagnosis and treatment of melanoma were developed on the basis of systematic literature research and consensus conferences. Cutaneous melanoma (CM) is the most dangerous form of skin tumor and accounts for 90 % of skin cancer mortality. The diagnosis of melanoma can be made clinically and must always be confirmed by dermoscopy. If melanoma is suspected, a histopathological examination is always required. Sequential digital dermoscopy and whole-body photography can be used in high-risk patients to improve the detection of early-stage melanoma. If available, confocal reflectance microscopy can also improve the clinical diagnosis in special cases. Melanoma is classified according to the 8th version of the American Joint Committee on Cancer classification. For thin melanomas up to a tumor thickness of 0.8 mm, no further diagnostic imaging is required. From stage IB, lymph node sonography is recommended, but no further imaging examinations. From stage IIB/C, whole-body examinations with computed tomography or positron emission tomography CT in combination with magnetic resonance imaging of the brain are recommended. From stage IIB/C and higher, a mutation test is recommended, especially for the BRAF V600 mutation. It is important to perform a structured follow-up to detect relapses and secondary primary melanomas as early as possible. A stage-based follow-up regimen is proposed, which in the experience of the guideline group covers the optimal requirements, although further studies may be considered. This guideline is valid until the end of 2026., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Amaral reports personal fees for advisory board membership from Delcath and Philogen; personal fees as an invited speaker from BMS, Neracare, Novartis and Pierre Fabre; personal fees for a writing engagement from CeCaVa and Medtrix; institutional fees as local principal investigator (PI) from Agenus Inc., AstraZeneca, BioNTech, BMS, HUYA Bioscience, Immunocore, IO Biotech, MSD, Pfizer, Philogen, Regeneron, Roche and University Hospital Essen; institutional fees as coordinating PI from Unicancer; institutional research grants from iFIT and Novartis; institutional funding from MNI - Naturwissenschaftliches und Medizinisches Institut, Neracare, Novartis, Pascoe, Sanofi and Skyline-Dx; non-remunerated membership of the American Society of Clinical Oncology (ASCO) and the Portuguese Society for Medical Oncology; and a role as clinical expert in the area of medical oncology for Infarmed. Dr. Arenberger reports personal fees from BMS, personal fees from MSD, personal fees from Novartis, personal fees from Sanofi, outside the submitted work. Dr Basset-Seguin has nothing to disclose. Dr. Bastholt reports personal fees for advisory boards from Bristol Myers-Squibb, Pierre Fabre, Merck MSD, Novartis and Roche, outside the submitted work. Dr. Bataille has nothing to disclose. Dr. Brochez has nothing to disclose. Dr. del Marmol reports grants and personal fees from BMS, grants and personal fees from SANOFI, personal fees from LEO Pharma, grants and personal fees from ALMIRALL, outside the submitted work. Dr. Dreno reports personal fees from MSD, grants and personal fees from BMS, grants and personal fees from Roche, grants and personal fees from Fabre, outside the submitted work. A. Eggermont Consultant for: Agenus, Boehringer Ingelheim, BioInvent, BioNTech, Brenus, CatalYm, Eurobio, GenOway, IO Biotech, Imcheck, IQVIA, Merck&Co/MSD, Pfizer, QBiotics, Regeneron, Sairopa BV, ScanCell, Scorpion Therapeutics, Secarna, SkylineDx BV, Thermosome, Trained Immunity Discovery Speaker engagements: Merck/MSD, SkylineDx BVEquity: IO Biotech, Sairopa BV, SkylineDX BV. Dr. Fargnoli reports grants and personal fees from Almirall, personal fees from Leo Pharma, grants and personal fees from Janssen, personal fees from Novartis, personal fees from Lilly, personal fees from Sanofi, personal fees from UCB, personal fees from Abbvie, personal fees from AMGEN, personal fees from Pierre Fabre, grants and personal fees from Galderma, personal fees from Sun Pharma, personal fees from BMS, personal fees from Kyowa Kyrin, personal fees from Pfizer, personal fees from MSD, outside the submitted work. Dr. Forsea has nothing to disclose. Dr. Garbe reports personal fees from CeCaVa, personal fees from MSD, personal fees from NeraCare, personal fees from Philogen, outside the submitted work. Dr. Hauschild reports grants and personal fees from Amgen, grants and personal fees from BMS, grants and personal fees from MerckPfizer, grants and personal fees from MSD/Merck, grants and personal fees from Philogen, grants and personal fees from Pierre Fabre, grants and personal fees from Regeneron, personal fees from Roche, grants and personal fees from Sanofi-Genzyme, grants and personal fees from Novartis Pharma, personal fees from Eisai, personal fees from Immunocore, grants and personal fees from Replimune, personal fees from Seagen, personal fees from IO Biotech, personal fees from Dermagnostix, personal fees from Incyte, grants and personal fees from NeraCare, grants from Huya Biosciences, personal fees from Kyowa Kirin, personal fees from Highlight Therapeutics, personal fees from Iovance, personal fees from CureVac, personal fees from Xenthera, peronal fees from Agenus, personal fees from Almirall, and personal fees from Sun Pharma, outside the submitted work. Dr. Hoeller reports personal fees from Amgen, personal fees from Almirall, personal fees from BMS, personal fees from MSD, personal fees from Novartis, personal fees from Pierre Fabre, personal fees from Roche, personal fees from Sanofi, outside the submitted work. Dr. Kandolf reports personal fees for advisory boards from Bristol Myers-Squibb, MSD, Novartis Roche, Janssen, Abbvie, outside the submitted work. Dr. Kaufmann reports other from Abbvie, other from Almirall, other from Amgen, other from Astra Zeneca, other from Bionteck, other from BMS, other from Galderma, other from Incyte, other from Janssen, other from Leo, other from MSD, other from Novartis, other from Pfizer, other from Roche, other from Sanofi, outside the submitted work. Dr. Kelleners-Smeets reports personal fees from Sanofi, personal fees from Novartis, personal fees from MSD, personal fees from Sun Pharma, outside the submitted work. Dr. Lallas reports personal fees from Avene, personal fees from MSD, personal fees from Regeneron, personal fees from BMS, outside the submitted work. Dr. Lebbe reports personal fees from MSD, personal fees from Pierre Fabre, personal fees from BMS, personal fees from Sanofi, personal fees from immunocore, outside the submitted work. Dr. Leiter reports personal fees from Regeneron, Sanofi, personal fees from MSD, personal fees from Novartis, Almirall Hermal, personal fees from Sun Pharma, outside the submitted work. Dr. Longo has nothing to disclose. Dr. Lorigan reports grants and personal fees from Pierre Fabre, personal fees from MSD, grants and personal fees from BMS, personal fees from MLA diagnostics, outside the submitted work. Dr. Malvehy reports grants and personal fees from Almirall, personal fees from MSD, personal fees from Pierre Fabre, grants from Philogen, grants from Castle biosciences, grants from BMS, grants and personal fees from ISDIN, grants and personal fees from La Roche Posay, non-financial support and other from Vivascope, non-financial support and other from Damae medical, non-financial support and other from Canfield, non-financial support and other from Fotofinder, outside the submitted work. Dr. Mandala reports personal fees from BMS, personal fees from MSD, personal fees from Novartis, personal fees from Regeneron, personal fees from Sun Pharma, outside the submitted work. Dr. Moreno-Ramírez has nothing to disclose. Dr. Nathan reports personal fees from Novartis, grants and personal fees from Immunocore, personal fees from BMS, personal fees from SunPharma, personal fees from MSD, outside the submitted work; Dr. Pellacani has nothing to disclose. Dr. Peris reports personal fees from Abbvie, personal fees from Lilly, personal fees from Leo Pharma, personal fees from Sanofi, personal fees from Almirall, personal fees from Novartis, personal fees from Boehringer, personal fees from Amgen, outside the submitted work. Dr. Saiag reports personal fees from Novartis, MSD, NeraCare, BMS, Pierre Fabre, Merck, personal fees and grants from Damae Medical, outside the submitted work. Dr. Stockfleth has nothing to disclose. Dr. Stratigos reports personal fees from Sanofi, personal fees from Janssen CILAG, personal fees and non-financial support from Novartis, grants from Genesis Pharma, grants from Abbvie, grants and personal fees from BMS, personal fees from Regeneron, grants from Leo-Pharma, grants from Lilly, outside the submitted work. Dr. van Akkooi reports grants and personal fees from Amgen, personal fees from Bristol-Myers Squibb, personal fees from Novartis, personal fees from MSD-Merck, grants and personal fees from Merck-Pfizer, personal fees from Pierre Fabre, personal fees from Sanofi, personal fees from Sirius Medical, personal fees from 4SC, personal fees from Genmab, personal fees from Menarini Silicon Biosystems, from Skyline Dx, outside the submitted work. Dr. Vieira has nothing to disclose. Dr. Zalaudek reports personal fees from Philogen, personal fees from MSD, personal fees from Novartis, personal fees from Sanofi, personal fees from La Roche Posay, personal fees from Sunpharma, personal fees from Biogena, personal fees from Cieffe Derma, outside the submitted work., (Copyright © 2024. Published by Elsevier Ltd.)

Background: In patients with atherosclerotic occlusive diseases, systematic reviews and meta-analyses of randomized controlled trials (RCTs) report that antiplatelets, statins, and antihypertensives reduce the risk of major adverse cardiac events, need for revascularization procedures, mortality, and health care resource use. However, evidence suggests that these patients are not prescribed these medications adequately or do not adhere to them once prescribed., Objective: We aim to systematically review and meta-analyze RCTs examining the effectiveness of implementation or adherence-supporting strategies for improving health care provider prescription of, or patient adherence to, guideline-recommended cardiovascular medications in patients with atherosclerotic occlusive disease., Methods: We designed and reported the protocol according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis-Protocols) statement. We will search MEDLINE, Embase, The Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL from their inception. RCTs examining implementation or adherence-supporting strategies for improving prescription of, or adherence to, guideline-recommended cardiovascular medications in adults with cerebrovascular disease, coronary artery disease, peripheral artery disease, or polyvascular disease (>1 of these diseases) will be included. Two investigators will independently review identified titles/abstracts and full-text studies, extract data, assess the risk of bias (using the Cochrane tool), and classify implementation or adherence-supporting strategies using the refined Cochrane Effective Practice and Organization of Care (EPOC) taxonomy (for strategies aimed at improving prescription) and Behavior Change Wheel (BCW; for adherence-supporting strategies). We will narratively synthesize data describing which implementation or adherence-supporting strategies have been evaluated across RCTs, and their reported effectiveness at improving prescription of, or adherence to, guideline-recommended cardiovascular medications (primary outcomes) and patient-important outcomes and health care resource use (secondary outcomes) within refined EPOC taxonomy levels and BCW interventions and policies. Where limited clinical heterogeneity exists between RCTs, estimates describing the effectiveness of implementation or adherence-supporting strategies within different refined EPOC taxonomy levels and BCW interventions and policies will be pooled using random-effects models. Stratified meta-analyses and meta-regressions will assess if strategy effectiveness varies by recruited patient populations, prescriber types, clinical practice settings, and study design characteristics. GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) will be used to communicate evidence certainty., Results: The search was completed on June 6, 2023. Database searches and the PubMed "related articles" feature identified 4319 unique citations for title/abstract screening. We are currently screening titles/abstracts., Conclusions: These studies will identify which implementation and adherence-supporting strategies are being used (and in which combinations) across RCTs for improving the prescription of, or adherence to, guideline-recommended cardiovascular medications in adults with atherosclerotic occlusive diseases. They will also determine the effectiveness of currently trialed implementation and adherence-supporting strategies, and whether effectiveness varies by patient, prescriber, or clinical practice setting traits., Trial Registration: PROSPERO CRD42023461317; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=461317; PROSPERO CRD42023461299; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=461299., (©Aidan M Kirkham, Dean A Fergusson, Justin Presseau, Daniel I McIsaac, Risa Shorr, Derek J Roberts. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 16.01.2025.)

Air pollution, especially particulate matter (PM), is one of the most common risk factors for global burden of disease. However, its effect on the risk of digestive diseases is unclear. Herein, we attempt to explore this issue by reviewing the existing evidence from published meta-analyses. We conducted a systematic literature search to identify all relevant meta-analyses regarding the association of air pollution with digestive diseases, and summarize their major findings. We assessed the methodological quality and evidence quality of the included meta-analyses using the AMSTAR-2 and GRADE tools, respectively, and the overlap of primary studies was assessed by the GROOVE tool. Nine meta-analyses were included in our analysis, containing 43 primary studies with high overlap. In the included meta-analyses, the methodological quality was from critically low to moderate, and the evidence quality was from very low to moderate. The exposure was primarily PM 2.5 . Seven, four, and one meta-analysis investigated the effect of air pollution on liver diseases, gastrointestinal diseases, and pancreatic diseases, respectively. PM 2.5 exposure was significantly associated with liver dysfunction, chronic liver diseases, liver cancer, and colorectal cancer, but not oesophagus cancer, gastric cancer, or pancreatic cancer. Based on very low to moderate quality evidence from meta-analyses, PM 2.5 exposure may contribute to the development of some digestive diseases, especially liver diseases., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Introduction: The pharmacological management of inflammatory arthritis often requires choices that involve trade-offs between benefits, risks and other attributes such as administration route, frequency and cost. This living systematic review aims to inform international clinical guidelines on inflammatory arthritis by creating an evidence map of patient preference studies concerning the trade-offs in pharmacological management of inflammatory arthritis., Methods and Analysis: We will include published and peer-reviewed full-text studies in any language that quantitatively assess preferences of patients for the pharmacological management of inflammatory arthritis (rheumatoid arthritis, spondyloarthritis and juvenile idiopathic arthritis). Studies must use either stated or revealed preference methods to assess preferences and provide a quantitative assessment of relevant characteristics, such as benefits, risks, costs and process attributes. Articles will identified through Medline and EMBASE database searches from inception using search terms that combine keywords and subject headings for inflammatory arthritis and preference-based methods, and a search in the Health Preference Study and Technology Registry using keywords for the populations of interest. Two independent reviewers will perform abstract and full-text screening. Risk of bias will be assessed using the GRADE risk of bias tool. An evidence map will be generated to summarise included studies and their assessments of each trade-off. The search will be conducted every 6 months with new studies added to the inventory., Ethics and Dissemination: Ethics approval is not required. Results from the base review will be published in a peer-reviewed journal and findings will be presented at conferences. In the living model, we will publish updates and datasets on an Open Science Framework page, with periodic updates in peer-reviewed journals., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.)

Introduction: Pulmonary arterial hypertension (PAH) is a complex condition affecting quality of life, characterised by high blood pressure in the pulmonary arteries leading to heart strain. PAH's impact extends beyond physical symptoms, influencing emotional and social well-being, particularly in women where it affects sexual health and pregnancy outcomes. Despite medical advancements, the disease's full impact on women's lives is under-researched, especially regarding sexual experiences and health. This systematic review and qualitative meta-synthesis aim to address this gap by examining women's experiences with PAH, informing clinical practice and patient-centred care. The protocol outlines a methodology for synthesising qualitative research to amplify women's voices and enhance our understanding of PAH's impact on female patients., Methods and Analysis: Search strategy : A systematic review and thematic meta-synthesis of qualitative research studies and qualitative components of mixed-methods studies will be conducted. The systematic review will be guided by the Joanna Briggs Institute methodological framework. A comprehensive search will encompass seven electronic databases and search engines (Ovid Medline, CINAHL, EMBASE, APA PsycINFO, Cochrane Database of Systematic Reviews, PubMed, Scopus) and grey literature sources (ProQuest Dissertations, ClinicalTrials.gov). Building on insights from previous reviews centred on symptom-related experience and sexual health. Two review authors will independently conduct the screening and data extraction processes. Discrepancies will be resolved through consensus or discussion with a third review author. The review will include English studies from database inception. Findings will be presented graphically and tabularly, together with a narrative description. Assessment of confidence and data synthesis : The meta-synthesis used thematic analysis, importing study transcripts and notes into NVivo software. Data-derived codes formed categories, which were then iteratively refined into broader themes reflecting women's experiences with sex and childbirth while living with PAH., Ethics and Dissemination: External ethical approval is not required as this review is a retrospective review, which is undertaking secondary analysis of publicly available primary data. The results will be disseminated in peer-reviewed journals and presented in conference papers and elsewhere. This protocol is registered with PROSPERO prospective database of systematic review., Prospero Registration Number: CRD42024529342., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: Although existing disease preparedness and response frameworks provide guidance about strengthening emergency response capacity, little attention is paid to health service continuity during emergency responses. During the 2014 Ebola outbreak, there were 11,325 reported deaths due to the Ebola virus and yet disruption in access to care caused more than 10,000 additional deaths due to measles, HIV/AIDS, tuberculosis, and malaria. Low- and middle-income countries account for the largest disease burden due to HIV, tuberculosis, and malaria and yet previous responses to health emergencies showed that HIV, tuberculosis, and malaria service delivery can be significantly disrupted. To date, there has not been a systematic synthesis of interventions implemented to maintain the delivery of these services during emergencies., Objective: This study aimed to synthesize the interventions implemented to maintain HIV/AIDS, tuberculosis, and malaria services during public health emergencies in low- and middle-income countries., Methods: The systematic review was registered in the international register for prospective systematic reviews. It will include activities undertaken to improve human health either through preventing the occurrence of HIV, tuberculosis, or malaria, reducing the severity among patients, or promoting the restoration of functioning lost as a result of experiencing HIV, tuberculosis, or malaria during health emergencies. These will include policy-level (eg, development of guidelines), health facility-level (eg, service rescheduling), and community-level interventions (eg, community drug distribution). Service delivery will be in terms of improving access, availability, use, and coverage. We will report on any interventions to maintain services along the care cascade for HIV, tuberculosis, or malaria. Peer-reviewed study databases including MEDLINE, Web of Science, Embase, Cochrane, and Global Index Medicus will be searched. Reference lists from global reports on HIV/AIDS, tuberculosis, or malaria will also be searched. We will use the GRADE-CERQual (Grading of Recommendations Assessment, Development, and Evaluation-Confidence in Evidence from Reviews of Qualitative Research) approach to report on the quality of evidence in each paper. The information from the studies will be synthesized at the disease or condition level (HIV/AIDS, tuberculosis, and malaria), implementation level (policy, health facility, and community), and outcomes (improving access, availability, use, or coverage). We will use the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist to report findings and discuss implications for strengthening preparedness and response, as well as strengthening health systems in low- and middle-income countries., Results: The initial search for published literature was conducted between January 2023 and March 2023 and yielded 8119 studies. At the time of publication, synthesis and interpretation of results were being concluded. Final results will be published in 2025., Conclusions: The findings will inform the development of national and global guidance to minimize disruption of services for patients with HIV/AIDS, tuberculosis, and malaria during public health emergencies., Trial Registration: PROSPERO CRD42023408967; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=408967., International Registered Report Identifier (irrid): PRR1-10.2196/64316., (©Steven Ndugwa Kabwama, Rhoda K. Wanyenze, Helena Lindgren, Neda Razaz, John M Ssenkusu, Tobias Alfvén. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 15.01.2025.)

Background: The Patient Education Materials Assessment Tool (PEMAT) is a reliable and validated instrument for assessing the understandability and actionability of patient education materials. It has been applied across diverse cultural and linguistic contexts, enabling cross-field and cross-national material quality comparisons. Accumulated evidence from studies using the PEMAT over the past decade underscores its potential impact on patient and public action., Objective: This systematic review aims to investigate how the quality of patient education materials has been assessed using the PEMAT., Methods: This review protocol follows PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines. PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), APA PsycInfo, and Web of Science Core Collection will be searched systematically for articles published since September 2014. Two independent reviewers will conduct the search to yield a list of relevant studies based on the inclusion and exclusion criteria. Rayyan QCRI software will be used for screening and data extraction., Results: The results will be included in the full systematic review, which is expected to start in September 2024 and be completed to be submitted for publication by early 2025., Conclusions: The findings are expected to identify the quality of materials evaluated by the PEMAT and the areas under evaluation. This review can also highlight gaps that exist in research and practice for improving the understandability and actionability of the materials, offering deeper insights into how existing materials can facilitate patient and public action., International Registered Report Identifier (irrid): PRR1-10.2196/63489., (©Emi Furukawa, Tsuyoshi Okuhara, Mingxin Liu, Hiroko Okada, Takahiro Kiuchi. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 15.01.2025.)

Background: To successfully design, develop, implement, and deliver digital health services that provide value, they should be cocreated with patients. However, occasionally, the value may also be codestructed. In the field of health care, the concepts of value cocreation and codestruction still need to be better established within emerging digital health services. Studying these concepts is essential for developing effective and sustainable patient-centered care., Objective: The aim of the study is (1) to understand the antecedents, decisions, and outcomes of value cocreation and codestruction in digital health services, (2) to define the dynamics between value cocreation and codestruction, and (3) to map future research areas of value cocreation and codestruction within digital health services., Methods: The systematic review will be conducted in accordance with the Joanna Briggs Institute methodology for mixed method systematic reviews and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The review considers scientific qualitative, quantitative, or mixed method studies published in English, Finnish, or Swedish that concern either value cocreation or codestruction in digital health services. Studies focusing on physical robotics and online health communities, as well as non-peer-reviewed and nonscientific papers, will be excluded. The searches were conducted using Scopus and MEDLINE during this protocol creation. Critical appraisal will be done using suitable checklists for qualitative, quantitative, and mixed method studies. The review will adhere to a convergent integrated approach as outlined in the Joanna Briggs Institute methodology for mixed methods systematic reviews., Results: The searches resulted in a total of 837 records. The antecedents, decisions, and outcomes of value cocreation and codestruction in the context of digital health services will be described in a finalized systematic review. In the outcomes, our main interest is the effect on patient outcomes and experiences and professional experiences., Conclusions: Since our study involves diverse scientific fields, there is a risk that our search does not capture all relevant papers. To mitigate this risk, we used 2 large databases for the searches. In addition, the value cocreation or codestruction terms may not have been used in all studies focusing on the collaborative roles of patients and providers, especially in the medical field, and that may be difficult to capture. The review reveals the current understanding of value cocreation and codestruction in digital health services and shapes the research agenda for these phenomena. Value cocreation can be used to both design and efficiently use digital health services trying to maximize the value for patients., International Registered Report Identifier (irrid): DERR1-10.2196/63015., (©Elina Laukka, Tuure Tuunanen, Miia Jansson, Minna Vanhanen, Nina Hirvonen, Jenni Palukka, Märt Vesinurm, Paulus Torkki. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 14.01.2025.)

Introduction: Sedation ensures a child remains motionless during a procedure and decreases anxiety. Several pharmacologic regimes exist for paediatric sedation. However, often, intravenous cannulation is required, causing distress for the child. Creating a low-stress environment for children during medical procedures is crucial. Intranasal dexmedetomidine offers a promising alternative by either removing the need for intravenous cannulation or significantly reducing stress and anxiety when cannulation is necessary. We aim to investigate the safety and efficiency of sedating children with intranasal dexmedetomidine., Methods and Analysis: We will systematically search MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), CENTRAL, Clinicaltrials.gov, and the WHO ICTRP portal. We will include all randomized controlled trials (RCT) that investigate the use of intranasal dexmedetomidine compared to alternative sedatives for premedication or sedation of children. Two researchers will independently screen title/abstract and full-text articles for eligibility using Covidence. Our primary outcome is sedation success rate. RCTs that meet the inclusion criteria will form the unit of analysis. Data extracted from each study will be presented in table format (S2 Table). Information on parameters that describe safety and efficiency outcomes will be extracted and analysed. Outcome data will be reported as risk ratios and 95% confidence intervals (CI) for dichotomous outcomes or mean and standardized mean differences with 95% CI for continuous outcomes. The assessment of statistical heterogeneity will be examined using Chi2- and I2-statistics. PROSPERO registration number CRD42024532993., Discussion: Sedation with intranasal dexmedetomidine is not common practice in all countries, though the medicament has the potential to provide a child-friendly approach to sedation and premedication. Reviews on the area are conflicting, and new RCT studies have been published. Our systematic review aims to comprehensively assess intranasal paediatric sedation, focusing on dexmedetomidine and guiding clinicians in daily decision-making for optimal paediatric sedation., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Nissen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The lung environment harbours a community of microbes that play a significant role in health and disease, including innate protection against pathogenic microorganisms. Infection with Mycobacterium tuberculosis, psychological stress associated with the tuberculosis (TB) disease, and the metabolites from the rifampicin treatment regimen have been reported to induce hyperglycemia and consequently type 2 diabetes mellitus (T2DM) in individuals not previously diabetic. The high glucose concentration is proposed to alter the composition of the lung microbiota and airway homeostasis, exerting an influence on TB disease and treatment outcomes. In this systematic review, we propose to synthesize literature on TB-induced hyperglycemia and its impact on lung microbiota and secretion of airway mucus in individuals not previously diabetic. A systematic search will be carried out on PubMed, EMBASE, MEDLINE, PROQUEST, Cochrane, SCOPUS, and manually on Google Scholar and references of relevant articles to identify other studies. We will review published articles that include studies on TB-induced hyperglycemia, pulmonary microbiome, mucin secretion, and (or) airway surface liquid upon TB diagnosis and during treatment. The quality of the study articles will be assessed using the modified Newcastle-Ottawa Scale (NOS). Meta-analysis will be conducted using random effect model for heterogeneity to pool estimates on microbial diversity. Egger's test will be performed to explore any selective reporting bias. The findings of the systematic review and the meta-analysis will be reported as per the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol guidelines. This protocol was developed and uploaded onto the International Prospective Register of Systematic Reviews (PROSPERO) database, registration number: CRD42024482248., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Musyoki et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: The link between parent-child separation through child welfare systems and negative health and social outcomes is well documented. In contrast, despite the over-representation of Indigenous children and youth in child welfare systems, the relationship between child welfare system involvement and health and social outcomes among Indigenous populations has not been systematically reviewed. Our objective is to assess whether Indigenous People who have been exposed to a child welfare system personally or intergenerationally (ie, parents and/or grandparents) within Canada, Australia, New Zealand and the USA (CANZUS countries) and the circumpolar region are at an increased risk for negative health and social outcomes compared with other exposed and non-exposed groups., Methods and Analysis: We will undertake a comprehensive exploration of literature documenting health and social outcomes for Indigenous individuals with personal or intergenerational exposure to a child welfare system. The search will encompass nine databases, including Ovid MEDLINE, APA PsycINFO, Bibliography of Native North Americans, CINAHL, EMBASE, Public Affairs Index, Scopus, Social Work Abstracts and Sociological Abstracts. Additionally, reference lists of included studies will be examined. The literature search will include studies up to 4 October 2024 and will adhere to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Findings will be presented in summary tables through narrative synthesis, and if feasible, a meta-analysis will quantify the impact of child welfare exposure on health and social outcomes., Ethics and Dissemination: The results of this systematic review will synthesise current evidence regarding health and social outcomes related to personal and intergenerational child welfare exposure among Indigenous populations in CANZUS countries and circumpolar regions. This information could help support future policy and practice decision-making. Findings will be widely disseminated through peer-review publications and community presentations aimed at various interested parties, including policymakers, professional practitioners and clinicians, and service users (ie, clients, family members, caregivers)., Prospero Registration Number: CRD42023434543., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Introduction: Research on telework has grown dramatically in recent years, leading to a fragmented set of findings on its effect on workers' well-being. One of the most studied social mechanisms concerns how telework alters the transmission of social support between family members and coworkers, which turns out to be a mediating factor between teleworking and well-being. This research contributes to the understanding of this issue by analysing the existing evidence on the effect of telework on social support and well-being before, during and after the pandemic., Methods and Analysis: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we will systematically synthesise evidence about the mediating effect of social support in the relation between telework and well-being. Three databases will be used to search the literature addressing this issue: Social Sciences Citation Index (Web of Science), Sociological Abstracts (PROQUEST) and SocINDEX with full text (EBSCOhost). Quantitative and qualitative studies published in peer-reviewed journals, in English and French, from January 2000 to June 2024 will be included in this systematic review. Double screening procedure with data quality assessments will be carried out by three researchers independently for up to 20% of the studies. Conflicts will be resolved for the completion of the remaining 80% of the studies by two researchers. The literature review aims to systematise the links between telework, social support and well-being by identifying the different dimensions and mechanisms that link these three aspects. The information will be synthesised using Qualitative Content Analysis. Additional analysis will be performed using the term frequency-inverse document frequency (TF-IDF)., Ethics and Dissemination: This is a protocol for a systematic review. Aggregate published data is used; therefore, no ethical approval is required. The results of the review will be disseminated through peer-reviewed journals and presentations at conferences., Prospero Registration Number: CRD42024554590., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Introduction: Work engagement enhances nurses' physical and mental health, well-being, job performance and satisfaction. This reduces turnover rates and improves patient care quality, making work engagement a crucial factor in the nursing workplace. However, no systematic review or meta-analysis has explored the effects of randomised controlled trial (RCT) interventions aimed at improving nurses' work engagement. This study aimed to evaluate the effectiveness of these interventions, providing healthcare organisations with evidence-based recommendations for enhancing work engagement among nurses., Methods and Analysis: This systematic review and meta-analysis will use the PICO criteria: (P) nurses, (I) psychosocial interventions, (C) no intervention or non-work engagement interventions and (O) work engagement as a primary outcome. Published studies will be searched by September 2025 using databases such as the Cochrane Central Register of Controlled Trials, PubMed (MEDLINE), Embase, CINAHL, PsycINFO, PsycARTICLES and the Japan Medical Abstracts Society. Eligible studies must use RCT designs, assess the impact of interventions on nurses' work engagement and provide adequate data (sample sizes, means and SDs) to calculate effect sizes with 95% CIs. Publications must be written in English or Japanese as original articles. Two reviewers will independently select studies and assess the risk of bias. The methodological quality of the included studies will be evaluated using the Grading of Recommendation Assessment, Development and Evaluation approach. A meta-analysis will be conducted for statistical synthesis and publication bias will be assessed using Egger's test and a visual funnel plot. Heterogeneity will be evaluated using Q statistics., Ethics and Dissemination: This systematic review and meta-analysis are based on existing studies and do not require ethical approval. The findings will be shared through publications in peer-reviewed international journals and presentations at relevant conferences, symposia and seminars., Prospero Registration Number: CRD42024510479., Competing Interests: Competing interests: KI and NK are employed at the Department of Digital Mental Health, an endowment department supported with an unrestricted grant from 15 enterprises (https://dmh.m.u-tokyo.ac.jp/c) outside the submitted work. NK obtained personal fees from the Junpukai Foundation outside the submitted work. Other authors did not have any statements., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Introduction: Mobile technology has revolutionised the way people interact with others and gain access to healthcare services. Given that cultural background is a strong moderator for technology penetration, this systematic review aims to examine end-user perceptions and design recommendations for mobile health applications among Asian older people., Methods and Analysis: Five electronic databases (PubMed, CINAHL, PsycINFO, Medline and Cochrane Central Register of Controlled Trials) will be searched until May 2025. Studies conducted on Asian older people aged 60+ years, with English/Chinese full text available, will be included. Narrative approaches and effect direction plots will be used for data analyses. Risk of bias across studies will be examined using Cochrane Risk of Bias 2 and Risk of Bias in Nonrandomised Studies of Interventions, whereas the quality of evidence will be assessed by Shekelle's classification scheme., Ethics and Dissemination: No ethical approval will be required. The findings will be disseminated through peer-reviewed journal articles., Prospero Registration Number: CRD42024562861., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: Early child development sets the course for optimal outcomes across life. Increasing numbers of children worldwide are exposed to opioids in pregnancy and frequently live in environments associated with adverse developmental outcomes. Although multiple systematic reviews have been published in this area, they use different exposures and different types of outcomes. This umbrella review aims to bring together these systematic reviews to provide a comprehensive overview of the evidence around the association between prenatal opioid exposure and preschool developmental outcomes., Methods: PubMed, MedLine, PsycInfo and Google Scholar were searched up to July 2024. Eligible studies were systematic reviews, meta-analyses or scoping reviews exploring prenatal opioid exposure (illicit opioids and prescribed treatments for opioid dependence) and developmental outcomes up to age 5. Reviews were screened by two authors. Quality assessment was undertaken using the Joanna Briggs Institute checklist for umbrella reviews. Degree of overlap was examined. Due to heterogeneity within the sample, no meta-analyses were undertaken and results were synthesised narratively., Results: 11 reviews were included containing 478 individual papers. The overlap was slight (corrected cover area=5%). Developmental outcomes associated with prenatal opioid exposure included visual function, motor skills, externalising problems and language difficulties. No conclusive evidence was available for cognitive development or internalising symptoms. In cognitive, and motor, skills, findings differed by age, with later preschool findings being weaker. Authors frequently highlighted issues with poor quality research in the original studies, including small sample sizes and lack of controlling for confounding., Conclusions: Multiple areas of child development were associated with prenatal opioid exposure; however, evidence was weak. Robust research, with larger sample sizes and adequate accounting for confounding, is needed to provide accurate information for women of childbearing age and practitioners to guide policy and ensure that appropriate funding, support and follow-up are in place., Prospero Registration Number: CRD42022307992., Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/disclosure-of-interest/ and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.)

Unplanned extubation (UPE), defined as accidental removal of the endotracheal tube during mechanical ventilation or its replacement due to suspected obstruction or inadequate diameter, is considered the fourth most common adverse event in neonatal intensive care units (NICU). This study aimed to describe a systematic review and meta-analysis protocol that will identify and assess the effect of primary intervention measures designed to prevent UPE in NICU. A search will be carried out in the following databases: PubMed/Medline, EMBASE, Scopus, CINAHL, Cochrane Library, SciELO, and LILACS. Reviewers, in pairs and independently, will select the studies, perform data extraction and assess the methodological quality of the included studies using preestablished tools according to the type of study. The systematic review will provide evidence to present the main intervention measures used in the prevention of UPE during the care of critical neonatal patients. The systematic review and meta-analysis resulting from this protocol may provide important information regarding UPE in the neonatal population, which will help with decision-making and the implementation of safer clinical practices that focus on the reduction of adverse events, contributing to the improvement of service management and the safety of neonatal patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Pontes et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Extended reality (XR) technologies are increasingly being used to reduce health and procedural anxieties. The global effectiveness of these interventions is uncertain, and there is a lack of understanding of how patient outcomes might vary between different contexts and modalities., Objective: This research used panoramic meta-analysis to synthesize evidence across the diverse clinical contexts in which XR is used to address common outcomes of health and procedural anxiety., Methods: Review-level evidence was obtained from 4 databases (MEDLINE, Embase, APA PsycINFO, and Epistemonikos) from the beginning of 2013 until May 30, 2023. Reviews that performed meta-analysis of randomized controlled trials relating to patient-directed XR interventions for health and procedural anxiety were included. Studies that analyzed physiological measures, or focused on technologies that did not include meaningful immersive components, were excluded. Furthermore, data were only included from studies that compared intervention outcomes against no-treatment or treatment-as-usual controls. Analyses followed a preregistered, publicly available protocol. Trial effect sizes were extracted from reviews and expressed as standardized mean differences, which were entered into a 3-level generalized linear model. Here, outcomes were estimated for patients (level 1), studies (level 2), and anxiety indications (level 3), while meta-regressions explored possible influences of age, immersion, and different mechanisms of action. Where relevant, the quality of reviews was appraised using the AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews, Revised Instrument) tool., Results: Data from 83 individual trials were extracted from 18 eligible meta-analyses. Most studies involved pediatric patient groups and focused on procedural, as opposed to general, health anxieties (eg, relating to needle insertion, dental operations, and acute surgery contexts). Interventions targeted distraction-, education-, and exposure-based mechanisms, and were provided via a range of immersive and nonimmersive systems. These interventions proved broadly effective in reducing patient anxiety, with models revealing significant but heterogeneous effects for both procedural (d=-0.75, 95% CI -0.95 to -0.54) and general health (d=-0.82, 95% CI -1.20 to -0.45) indications (when compared with nontreatment or usual-care control conditions). For procedural anxieties, effects may be influenced by publication bias and appear more pronounced for children (vs adults) and nonimmersive (vs immersive) technology interventions, but they were not different by indication., Conclusions: Results demonstrate that XR interventions have successfully reduced patient anxiety across diverse clinical contexts. However, significant uncertainty remains about the generalizability of effects within various unexplored indications, and existing evidence is limited in methodological quality. Although current research is broadly positive in this area, it is premature to assert that XR interventions are effective for any given health or procedural anxiety indication., (©Tom Arthur, GJ Melendez-Torres, David Harris, Sophie Robinson, Mark Wilson, Sam Vine. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 08.01.2025.)

Introduction: Cervical cancer is the most diagnosed cancer and the leading cause of cancer-related death in 36 low- and middle-income countries, with the majority located in sub-Saharan Africa (SSA), South America and Southeastern Asia. The highest regional incidence and mortality occur in SSA. Despite the high efficacy and cost-effectiveness of the human papillomavirus (HPV) vaccine in preventing cervical cancer, its uptake remains unacceptably low in SSA. This scoping review aims to integrate evidence from SSA on social determinants of HPV vaccine uptake with complementary evidence on interventions to promote its uptake., Methods and Analysis: The proposed review will be conducted following the guidelines of the Joanna Briggs Institute Scoping Review Methodology Group. Additionally, a sequential explanatory design will guide the integration of determinant evidence with intervention evidence. This scoping review will be reported per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews checklist. Six databases, PubMed/MEDLINE, LIVIVO, Google Scholar, BASE (Grey Literature), preprint databases (eg, OSF and medRxiv) and African Journals Online will be searched, with results limited to English language publications and those published from 2006 to 2024. Two forms will be used for data extraction from determinant and intervention studies by two independent reviewers. A narrative summary of evidence from both determinant and intervention studies will be conducted. Furthermore, a multilevel analysis will be conducted to explore the intersections of determinants across socioecological levels of health behaviour. A further integrative cross-study analysis of results from determinant and intervention studies will be conducted, where the determinant evidence will be used to interrogate the intervention evidence. Data will be presented in tables and matrices., Ethics and Dissemination: No ethical approval will be required for this study because it will be based on data collected from publicly available records. The review results will be disseminated widely through a peer-reviewed publication and other forums such as workshops, conferences and meetings with local health administrators, policymakers and other wider stakeholder engagements., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and risks of early versus late initiation of oral anticoagulation (vitamin K antagonists or NOACs) in people with non-valvular atrial fibrillation-related ischaemic stroke., (Copyright © 2025 The Authors. Cochrane Database of Systematic Reviews published by John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration.)

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To determine the effects of psychological interventions for depression in people with diabetes mellitus., (Copyright © 2025 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Background: Kangaroo mother care (KMC) is a care of preterm and low birthweight infants carried skin-to-skin contact with the mother's chest and breastfeeding when possible. KMC has been proven to reduce mortality and morbidity in these infants. However, research on KMC has been limited by significant variability and inconsistency in reported outcomes across studies. These discrepancies hinder the inclusion of KMC clinical research in systematic reviews or meta-analyses, reducing its research value, leading to resource wastage and raising concerns about selective reporting biases. A core outcome set (COS), which defines a list of critical outcomes, can help harmonise the outcomes reported across studies in the same healthcare field. Further, how these outcomes should be measured and/or reported is defined in a core measurement set (CMS). This study aims to develop both a COS and a CMS for KMC to standardise outcome reporting, improve the quality assessments in clinical trials and facilitate data integration. This protocol outlines the methodology for developing a COS and CMS for KMC., Methods and Analysis: The development of the COS and CMS for KMC will follow six phases: (1) a systematic review, (2) semistructured interviews, (3) merging outcomes, (4) two/three rounds of international Delphi survey, (5) a consensus meeting and (6) development of the CMS. In phases 1 and 2, we will conduct a systematic review and semistructured interviews to identify potential core outcomes and measurements, which will form an initial outcome pool. In phase 3, these outcomes will be categorised into domains based on the core outcome measures for effectiveness (COMET) classification, creating a long list of outcomes for the Delphi survey. In phase 4, the Delphi survey will involve two/three rounds with key stakeholders, including neonatal clinical experts (including doctors and nurses), users of COS (including editors, public health experts, experts in evidence-based medicine and researchers), parents of neonates and policymakers, to refine the candidate core outcomes and measurements. In phase 5, an online consensus meeting with representatives of all stakeholders will finalise the COS. In phase 6, the CMS will be following Consensus-based Standards for the selection of health Measurement Instruments guidelines, which involve conceptual considerations, finding existing outcome measurement instruments, assessing their quality and selecting appropriate instruments for the COS. Parents of neonates will participate in phases 2, 4 and 5., Ethics and Dissemination: Ethical approval of this study has been granted by the Medical Ethics Committee of West China Second University Hospital (Medical Research 2024 ethics approval no. 167). The finalised COS and CMS will be disseminated through publication in peer-reviewed journals., Trial Registration Number: We have registered the COS in the COMET database (http://www.comet-initiative.org/Studies/Details/2940)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Introduction: Bronchoscopy is a routine clinical examination that can cause discomfort and anxiety in patients. This paper presents a protocol for a systematic review and meta-analysis aiming to assess the effect of music on anxiety and physiological outcomes in patients undergoing bronchoscopy., Methods: The protocol adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines and has been registered in PROSPERO (CRD42024567398). Our documentary research strategy will involve four databases: PubMed, Google Scholar, Scopus, and the Cochrane Library. In addition, manual searches will be conducted through related articles and references. We will include randomized controlled trials that evaluate the effect of music on patients undergoing bronchoscopy. The primary outcome will be the anxiety level and the secondary outcome will include physiological outcomes. Study selection, data extraction, and quality assessment will be carried out independently by two reviewers. Any discrepancies will be resolved through consultation with a third reviewer. The quality and the risk of bias in the studies will be evaluated using The Joanna Briggs Institute critical appraisal tool. The results of this systematic review will be synthesized to provide an overview on the effectiveness of music on anxiety and physiological parameters in patients during bronchoscopy. If the results are considered acceptable and sufficiently homogeneous, a meta-analysis will be performed to synthesize the findings., Conclusion: The systematic review produced from this protocol will provide evidence on the effectiveness of music for patients undergoing bronchoscopy and will contribute to strengthening the existing body of knowledge on non-pharmacological interventions for anxiety management during medical procedures., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Kacem et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Global disparities in HIV prevalence among transgender women are well documented. However, current epidemiological literature on HIV disparities demonstrates gaps in research that include the diversity within transgender populations-for example, transgender men and non-binary trans people across global regions. This systematic review and meta-analysis protocol aims to summarise global HIV inequities among all transgender and non-binary (trans) populations. The objectives of this review are to estimate pooled HIV prevalence and prevention outcomes (pre-exposure prophylaxis and antiretroviral therapy) and differences by gender identity, global regions and self-report versus lab-confirmed findings among trans adults worldwide., Methods and Analysis: We will conduct a systematic review of all studies on HIV outcomes among trans youth and adults (aged 15+ years) published between 2000 and 2024, following the Preferred Reporting Items for Systematic Review and Meta-Analysis Prereporting guidelines. We will use Covidence software for the title and abstract screening, full-text review and data abstraction processes. We will summarise the study's descriptive statistics and conduct meta-analyses of extracted data points to calculate and synthesise pooled findings and effect size. Specifically, we will use the Mantel-Haenszel method with random effects to model our meta-analyses and the DerSimonian and Laird Q test for heterogeneity testing. We will conduct a narrative synthesis on the areas of research that have been conducted to improve HIV prevention and treatment among trans populations and summarise their findings. Subgroup analyses by gender identity, global regions and self-report versus lab-confirmed findings will be conducted., Ethics and Dissemination: Ethics approval is not applicable for this review since we will not be collecting primary data. The results will be disseminated through peer-reviewed publications and conference presentations., Prospero Registration Number: The protocol is registered in the International Prospective Register of Systematic Reviews database (PROSPERO ID: CRD42022357285)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Introduction: Accreditation in Health Professions Education is a pivotal process to ensure the quality of medical institutions and health professionals. ' Equity' is an umbrella term reflecting the principles of justice and support to disadvantaged entities according to their needs. While commonly applied to various domains in medical education, there is potential to determine how ' equity' is considered or discussed while practically implementing accreditation standards for Basic Medical Education (BME) globally., Methods and Analysis: The scoping review protocol has been drafted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Protocol (PRISMA-P) checklist. We will conduct a planned scoping review according to the Joanna Briggs Institute (JBI) guidelines for scoping review and adhere to the PRISMA-Scoping Review extension (PRISMA-ScR) checklist. A systematic literature search, from inception to May 2024, will be conducted across search engines and databases including Google Scholar, PubMed, Web of Science, Wiley Online Library and ProQuest, in collaboration with a qualified librarian. Peer-reviewed research articles, commentaries, opinion papers and reviews that explicitly or implicitly discuss equity in reference to accreditation standards will be eligible for inclusion. A qualitative inductive thematic analysis will be employed to systematically identify categories and themes from the extracted data and draw conclusions.The review team anticipates the development of a conceptual map that will evolve during the synthesis of the literature, as a description of the term ' equity' in the implementation of BME accreditation standards. We also anticipate finding any methodological or theoretical framework that is used in the literature to discuss the concept of ' equity' in the implementation of BME accreditation standards., Ethics and Dissemination: This scoping review aims to systematically map the literature on the burgeoning domain of accreditation in BME. The scoping review entails the collection and synthesis of literature and does not require ethical approval as per local regulations, as it does not involve primary data collection or interaction with human participants. The research findings will be disseminated through peer-reviewed publications, social media platforms, and academic presentations at workshops and conferences., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Introduction: Emulating the vast inclusion of advanced technology in everyday practice, the medical world is no exception to its implementation, in particular, virtual reality (VR). Initially, its introduction as a therapy was accompanied by high aspirations and expectations for its growth and potential. Motivation is said to be the most associated benefit; although it is imperative to note that there exists a paucity of research that specifically quantifies its tangible impact on cerebral palsy (CP). There has yet to be a systematic review of the instruments used to precisely measure motivation and examine its association with the benefits of VR for children with cerebral palsy., Methods and Analysis: This review will evaluate comparative studies that used VR therapy as part of interventions for children with CP. Qualitative studies, single-case studies, systematic reviews, literature reviews and guideline audits will be excluded. This review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA-P) guidelines. The methodological protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). The following electronic databases will be used to access related studies published between January 2012 and December 2023: MEDLINE (via EBSCOhost), Web of Science, Scopus, PubMed and Cochrane. The Peer Review of Electronic Search Strategies checklist will be employed to develop database search strategies., Ethics and Dissemination: This review does not require ethical approval as it uses secondary data. The findings will be published in a scientific journal. We intend to contribute to the expansion of knowledge concerning the motivational implications of VR on children with CP., Prospero Registration Number: International Prospective Register of Systematic Reviews (identification number CRD42023401079)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: Leptospirosis is a zoonotic bacterial infection occurring worldwide. It is of particular public health concern due to its global distribution, epidemic potential and high mortality without appropriate treatment. The method for the management of leptospirosis, particularly in severe disease, is clouded by methodological inconsistency and a lack of standardized outcome measures. The study this protocol details aims to develop a core outcome set (COS) for leptospirosis research. A COS is a set of outcomes with international consensus as a minimum for reporting in future studies focusing on leptospirosis. Establishing a COS will contribute to harmonizing Leptospirosis treatment research and will be instrumental in constructing a high-quality evidence base to feed into a planned future rigorous international clinical trial on leptospirosis., Methods: The COS-LEP study will employ a COS development methodology standardized by the COMET initiative framework. This includes (1) a systematic review of available quantitative and qualitative literature reporting therapeutic response and safety outcomes and measures; (2) focused interviews with healthcare professional and people treated for leptospirosis exploring outcomes of interests using qualitative methodology; (3) narrowing the choice of outcomes by international consensus using a Delphi survey process; and (4) undertaking a hybrid consensus meeting with key stakeholders to build the final COS., Discussion: This protocol describes the method to develop the first core outcome set for use in human leptospirosis studies. This will not only be a key feature in the design of a future definitive randomized controlled trial, but also provide a structure for clinicians and researchers collecting treatment cohort data in the various settings where leptospirosis is a public health issue., Competing Interests: Declarations. Ethics approval consent to participate: Ethical approval has been received by the LSHTM Observational Research Ethics Committee (LSHTM Ethics Ref 29935). Approval for Phase 3 qualitative studies will be sought from relevant institutional review boards (IRB) prior to initiating study activities. Any planned protocol amendments will be communicated directly to the LSHTM Observational Research Ethics Committee and relevant local IRBs, with approval for amendments completed prior to any changes being instituted. Consent for publication: Not applicable Competing interests: The authors declare that they have no competing interests., (© 2025. The Author(s).)

Background: Road traffic injury is the leading cause of death among young people globally, with motor vehicle collisions often resulting in severe injuries and entrapment. Traditional extrication techniques focus on limiting movement to prevent spinal cord injuries, but recent findings from the EXIT project challenge this approach. This paper presents updated recommendations from the Faculty of Pre-Hospital Care (FPHC) that reflect the latest evidence on extrication practices., Methods: A systematic scoping review identified 170 relevant articles from 7083 records. Findings, together with EXIT project data, informed the development of 12 core and supplemental statements on extrication. In April 2024, 43 subject matter experts from diverse backgrounds participated in a consensus process. Statements were discussed, voted on, and synthesised into the updated statement, ratified by FPHC., Results: Consensus was achieved for all 12 statements, emphasising self-extrication as a preferred, primary approach, reducing extrication time, and moving away from absolute movement minimisation. The U-STEP OUT algorithm was endorsed as a decision-making tool. Key themes included interdisciplinary collaboration, use of operational and clinical decision aids, and enhanced training., Conclusions: This consensus statement marks a paradigm shift in extrication practice, moving away from traditional movement minimisation to a focus on time-sensitive, patient-centred care. The findings advocate for empowering both clinical and non-clinical responders and improving interdisciplinary training and communication. Further research is needed to assess the broader implementation of this statement and to explore the psychological impacts of entrapment and extrication on patients., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Introduction: Medicine quality can be influenced by environmental factors. In low- and middle-income countries (LMICs) with tropical climates, storage facilities of medicines in healthcare settings and homes may be suboptimal. However, knowledge of the effects of temperature and other climatic and environmental factors on the quality of medicines is limited. A better understanding of the effects of climates may assist in the development of control strategies to help reduce factors contributing to poor-quality medicines. Therefore, this systematic review aims to synthesise data from published studies describing the effects of storage conditions on the quality of antibiotic medicines commonly used in LMICs., Methods and Analysis: We will search literature from databases, including the PubMed, Web of Science, Scopus and Google Scholar, and grey literature between 1987 and 2022. Experimental studies that evaluate the influence of temperature, humidity and sunlight on the quality of antibiotics applicable to Africa and South Asia will be included. Experimental studies that assess naturally occurring and simulated storage conditions and medicines prepared from powder with water and stored in hospitals or at home to be used across several doses will be also included. The key search terms related to the tropical climate, quality and commonly used antibiotics, such as temperature, storage condition, humidity, sunlight and moisture; quality, assay, purity, dissolution, disintegration, hardness, friability, weight variation, weight uniformity, degradation, impurities and stability; and amoxicillin, ceftriaxone, azithromycin, ciprofloxacin, doxycycline, metronidazole, trimethoprim-sulfamethoxazole, erythromycin, ampicillin and gentamicin, respectively, will be connected using the appropriate Boolean operators (OR, AND). The search terms will be used in correspondence with Medical Subject Heading terms by keyword arrangement. The available evidence for the poor quality of commonly used antibiotics is summarised by the type of diagnosis, type of drug and region. Meta-analysis using random effects will be performed using RevMan software to determine the pooled effects of environmental exposures. The degree of heterogeneity will be evaluated by the inverse of variance (I 2 ). Forest plots will be used to present the meta-analysis data., Ethics and Dissemination: Ethical approval is not required as the study is a systematic review. This review will be disseminated through open-access peer-reviewed publication., Prospero Registration Number: CRD42023432848., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: Type 1 diabetes is a serious, chronic disorder with an increasing incidence among children and adolescents. Glycemic control in individuals with type 1 diabetes is better managed through a basal-bolus regimen with either regular human or rapid-acting insulin analogues administered as a bolus at mealtimes. Rapid-acting insulin analogues have been hypothesized to cause optimal glycemic control and less risk of hypoglycemic episodes compared to regular human insulins. However, this has never been systematically assessed in children and adolescents with type 1 diabetes. Therefore, this systematic review aims to assess the beneficial and harmful effects of regular human insulins versus rapid-acting insulin analogues in children and adolescents., Methods: This is a protocol for a systematic review. A search in major medical databases (e.g., MEDLINE, EMBASE, CENTRAL) and clinical trial registries will be performed by a search specialist. We will include published and unpublished randomized clinical trials comparing regular human insulins versus rapid-acting insulin analogues (lispro, aspart, or glulisine). Two review authors will independently extract data and conduct risk of bias assessments. Primary outcomes will be severe hypoglycemia, ketoacidosis, and serious adverse events. Secondary outcomes will be quality of life, HbA1c, and non-serious adverse events. Data will be analyzed using fixed-effect meta-analyses, random-effects meta-analyses, and Trial Sequential Analysis. Several subgroup analyses are planned. Risk of bias will be assessed with the Cochrane Risk of Bias tool-version 2, an eight-step procedure will be used to assess if the thresholds for clinical significance are crossed, and the certainty of the evidence will be assessed by Grading of Recommendations, Assessment, Development and Evaluations (GRADE)., Discussion: The beneficial and adverse effects of regular human insulins versus rapid-acting insulin analogues have not been systematically assessed in children and adolescents. There is a need for a comprehensive systematic review of the current evidence., Systematic Review Registration: PROSPERO: CRD42024508625., Competing Interests: Ethics approval and consent to participate: Not applicable. Consent for publication: All authors approve publication of the protocol. Competing interests: CDBS’s husband is employed at Novo Nordisk, Kalundborg, Denmark, as “facility manager” since September 1, 2024., (© 2025. The Author(s).)

Background: Animal systematic reviews are critical to inform translational research. Despite their growing popularity, there is a notable lack of information on their quality, scope, and geographical distribution over time. Addressing this gap is important to maintain their effectiveness in fostering medical advancements., Objective: This study aimed to assess the quality and demographic trends of animal systematic reviews in neuroscience, including changes over time., Methods: We performed an umbrella review of animal systematic reviews, searching Medline and Embase for reviews until January 27, 2023. A data mining method was developed and validated to automatically evaluate the quality of these reviews., Results: From 18'065 records identified, we included 1'358 animal systematic reviews in our study. These reviews commonly focus on translational research but with notable topical gaps such as schizophrenia, other psychiatric disorders, and brain tumours. They originate from 64 countries, with the United States, China, the UK, Brazil, and Iran being the most prolific. The automated quality assessment indicated high reliability, with F1-scores over 80% for most criteria. Overall, the reviews were of high quality and the quality improved over time. However, many systematic reviews did not report a pre-registered study protocol. Reviews with a pre-registered protocol generally scored higher in quality. No significant differences in quality were observed between countries., Conclusion: Animal systematic reviews in neuroscience are of overall of high quality. Our study highlights specific areas for enhancement such as the recommended pre-publication of study protocols. It also identifies under-represented topics that could benefit from further investigation to inform translational research. Such measures can contribute to the effective translation of animal research findings to clinical applications., Competing Interests: Declarations. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests. Ethical approval and consent to participate: Not applicable., (© 2024. The Author(s).)

Introduction: Until now, the thyroid cancer case number has increased, and it is not entirely possible to attribute this continuous growth to more meticulous thyroid nodule selection and more accurate diagnostic techniques. While there is currently no conclusive evidence linking dietary factors to thyroid cancer, certain dietary patterns seem to have an impact on the development of the disease. There are interesting connections among diet, environment, metabolism and thyroid carcinogenesis; a deeper comprehension of the underlying mechanisms should help the identification of modifiable risk factors for thyroid cancer. This protocol aims to guide a systematic review and meta-analysis of the literature to search for an association between dietary pattern and risk of thyroid cancer., Methods and Analysis: The databases to search for observational studies will be PubMed, Embase, Scopus, Web of Science and LILACS, from inception to 10 December 2024. No language limitation or publication period will be imposed. The outcome will be the patients with thyroid cancer. Three impartial reviewers will choose the studies and extract data from the original publications. The Newcastle-Ottawa Quality Scale will assess the risk of bias, and the certainty of the evidence will be achieved by using the Grading of Recommendations Assessment, Development and Evaluation. The R (V.4.3.1) will be performed for data synthesis, and to measure heterogeneity, we will compute the I 2 statistics. Additionally, a quantitative synthesis will be performed if the included studies are sufficiently homogenous., Ethics and Dissemination: It is not necessary to acquire ethical approval, as this study will be a review of the published data. A peer-reviewed publication will publish the systematic review's findings., Prospero Registration Number: International Prospective Register of Systematic Reviews (PROSPERO) CRD 42023463802., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: Muscarinic receptor agonism and positive allosteric modulation is a promising mechanism of action for treating psychosis, not present in most D2R-blocking antipsychotics. Xanomeline, an M1/M4-preferring agonist, has shown efficacy in late-stage clinical trials, with more compounds being investigated. Therefore, we aim to synthesize evidence on the preclinical efficacy of muscarinic receptor agonists and positive allosteric modulators in animal models of psychosis to provide unique insights and evidence-based information to guide drug development., Methods: We plan a systematic review and meta-analysis of in vivo animal studies comparing muscarinic receptor agonists or positive allosteric modulators with control conditions and existing D2R-blocking antipsychotics in animals subjected to any method that induces behavioural changes of relevance for psychosis. We will identify eligible studies by searching multiple electronic databases. At least two independent reviewers will conduct the study selection and data extraction using prespecified forms and assess the risk of bias with the SYRCLE's tool. Our primary outcomes include locomotor activity and prepulse inhibition measured with standardized mean differences. We will examine other behavioural readouts of relevance for psychosis as secondary outcomes, such as social interaction and cognitive function. We will synthesize the data using multi-level meta-analysis with a predefined random-effects structure, considering the non-independence of the data. In meta-regressions we will explore potential sources of heterogeneity from a predefined list of characteristics of the animal population, model, and intervention. We will assess the confidence in the evidence considering a self-developed instrument thatconsiders the internal and external validity of the evidence., Protocol Registration: PROSPERO-ID: CRD42024520914., Competing Interests: Competing interests: Spyridon Siafis: None. Nobuyuki Nomura: N.N. has received manuscript fees from Sumitomo Pharma. Johannes Schneider-Thoma: None. Irene Bighelli: None. Alexandra Bannach-Brown: None. Fiona J. Ramage: None. Francesca Tinsdeall: None. Ioannis Mantas: None. Sameer Jauhar: SJ has received honoraria for educational talks given for Boehringer Ingelheim, Lundbeck, Janssen, and Sunovion, and has advised on antipsychotics to LB Pharmaceuticals. Sridhar Natesan: None. Anthony Vernon: ACV has received research support from UCB S.A and Bit.Bio (https://www.bit.bio/) and has received honoraria for seminars at GlaxoSmithKline. Andrea de Bartolomeis: AdB has received research support from Janssen, Lundbeck, and Otsuka and lecture fees for educational meeting from Chiesi, Lundbeck, Roche, Sunovion, Vitria, Recordati, Angelini and Takeda; he has served on advisory boards for Eli Lilly, Jansen, Lundbeck, Otsuka, Roche, and Takeda, Chiesi, Recordati, Angelini, Vitria. Sabine M. Hölter: None. Natascha I. Drude: None. Ulf Tölch: None. Wulf-Peter Hansen: None. Virginia Chiocchia: None. Oliver Howes: ODH has received investigator-initiated research funding from and/or participated in advisory/speaker meetings organised by Angellini, Autifony, Biogen, Boehringer-Ingelheim, Eli Lilly, Elysium, Heptares, Global Medical Education, Invicro, Jansenn, Karuna, Lundbeck, Merck, Neurocrine, Ontrack/ Pangea, Otsuka, Sunovion, Recordati, Roche, Rovi and Viatris/ Mylan. He was previously a part-time employee of Lundbeck A/v. Dr Howes has a patent for the use of dopaminergic imaging. Josef Priller: None. Georgia Salanti: None. Malcolm R. Macleod: None. Stefan Leucht: SL has received received honoraria for advising/consulting and/or for lectures and/or for educational material from Angelini, Boehringer Ingelheim, Eisai, Ekademia, GedeonRichter, Janssen, Karuna, Kynexis, Lundbeck, Medichem, Medscape, Mitsubishi, Otsuka, NovoNordisk, Recordati, Rovi, Teva., (Copyright: © 2025 Siafis S et al.)

Background: Multimorbidity, the co-existence of two or more conditions within an individual at any one time, is globally increasing and forecasted to rise. This poses a significant challenge for current models of healthcare delivery, which are now ill-equipped to meet the future population health needs. Interprofessional collaborative practice is a specific way professionals work closely together and with patients and their families to improve patient outcomes. Evidence suggests it can improve outcomes for people living with a single condition. What remains unknown is if interprofessional collaborative practice has been used to improve the outcomes of people living with multimorbidity, and if so, to what extent?, Methods: A scoping review is proposed to identify prior peer-reviewed research and grey literature related to interprofessional collaborative practice for multimorbidity in health and social care settings. A search strategy will identify primary, peer-reviewed research and grey literature. An initial limited search will be conducted to identify relevant existing systematic reviews. Their methods will be examined and their search terms scrutinised. A second comprehensive search will be used to interrogate four databases, looking back 10 years, seeking articles published in English, French, Spanish or Portuguese. Hand searching will be performed on all included full-text articles for any articles missing from the two steps above. Critical data will be extracted by adapting existing data abstraction forms based on the needs of the research objectives. These forms will be piloted before use. The results will be analysed descriptively. If appropriate, qualitative content analysis may be undertaken. Where sufficient numbers of homogeneous interventions exist, meta-analysis techniques will be applied. Results will be presented in tabular, graphic, and diagrammatic information displays., Discussion: This scoping review will provide an overview of the current evidence base of interprofessional collaborative practice used internationally for people living with multimorbidity in health and social care settings. These findings will provide valuable information to improve health and social care practice as well as change systems and policy to meet the population need of multimorbidity., Systematic Review Registration: The protocol was submitted to Open Science Framework on 19 December 2023 and registered on OSF Registries. Registration DOI: https://doi.org/10.17605/OSF.IO/UXHG3 ., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests., (© 2024. The Author(s).)

Background: The implementation of computerised clinical decision support systems has the potential to enhance healthcare by improving patient safety, practitioner performance, and patient outcomes. Notwithstanding the numerous advantages, the uptake of clinical decision support systems remains constrained, thereby impeding the full realisation of their potential. To ensure the effective and successful implementation of these systems, it is essential to identify and analyse the reasons for their low uptake and adoption. This protocol outlines an umbrella review, which will synthesise the findings of existing literature reviews to generate a comprehensive overview of the barriers and facilitators to the implementation and adoption of decision support systems across healthcare settings., Methods: This umbrella review protocol was developed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. Searches for eligible articles will be conducted in four electronic bibliographic databases, including PubMed/MEDLINE, IEEE Xplore, Scopus, and Web of Science. Obtained results will be independently screened by four reviewers based on pre-defined eligibility criteria. The risk of bias will be assessed for all eligible articles. Data on barriers and facilitators to the implementation and adoption of clinical decision support systems will be extracted, summarised, and further categorised into themes that aim to describe the originating environment or concept of the respective factor. The frequency of all identified barriers and facilitators within the group of included reviews will be determined in order to establish a prioritisation of the factors., Discussion: This umbrella review protocol presents a methodology for the systematic synthesis of barriers and facilitators to the implementation and adoption of clinical decision support systems across healthcare settings. The umbrella review will enable the development of novel implementation and adoption strategies that reinforce the identified facilitators and circumvent barriers, thereby promoting the use-oriented evaluation and effective utilisation of clinical decision support systems., Systematic Review Registration: PROSPERO CRD42024507614., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests., (© 2024. The Author(s).)

Introduction: It is complicated and time-consuming to care for tracheostomised patients, and many informal caregivers are said to feel a variety of burdens, although we are unsure of the specifics of this burden. This scoping review aims to identify and examine the caregiver burden encountered by informal caregivers of patients with tracheostomy., Methods and Analysis: This scoping review will be carried out in accordance with Arksey and O'Malley and its extended framework, along with adherence to the guidelines provided by the Joanna Briggs Institute. Reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review checklists. Searches will be conducted in PubMed, PsycINFO via EBSCO, Embase, Web of Science and CINAHL via EBSCO databases, as well as grey literature sources from the inception of the databases to July 2024. Additionally, reference lists of included studies will be manually reviewed for further sources. The quality of included studies will be assessed using the Crowe Critical Appraisal Tool, involving at least two reviewers in all steps of the review process. Data charting will be conducted in a narrative format, encompassing the study's objectives and questions. This review will also aim to identify any existing research gaps., Ethics and Dissemination: This review protocol does not involve ethical disclosure. This scoping review will identify the burden for informal caregivers of tracheostomy-dependent people and share the results via professional organisations, conferences and scholarly publications., Trial Registration Number: This protocol was preregistered with the Open Science Framework (CENTER FOR OPEN SCIENCE), with Registration DOI (https://doi.org/10.17605/OSF.IO/YCWXR)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: While research has explored the connection between addiction and personality, no systematic study has examined how substance use disorders (SUD) and behavioral addictions specifically relate to the HEXACO model of personality. This systematic review and meta-analysis aim to fill this gap by investigating the association between HEXACO personality traits and various addictions, including illegal substances (e.g., narcotics and cannabis) and behavioral addictions (e.g., gambling, gaming, social media addiction, and compulsive sexual behavior disorder) across different populations., Methods: The protocol is in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) statement. Searches will be conducted in databases including APA PsycINFO (Ovid), MEDLINE (Ovid), ProQuest, Web of Science, CINAHL, Wiley Online Library, and Google Scholar. Empirical studies published as full papers in peer-reviewed journals or as full dissertations, in English, other European languages, or Persian, investigating the association between HEXACO personality traits and addictive disorders are eligible. Two reviewers will independently screen all citations and full-text articles, and extract data using the Covidence software. They will further assess the risk of bias and quality of the studies using the Newcastle-Ottawa Scale (NOS) for longitudinal and cohort studies, an adapted version of the NOS for cross-sectional studies. Publication bias will be evaluated using funnel plots, Egger's test, and trim and fill analysis. In addition to a narrative summary, meta-analyses will be conducted if data are sufficient. Random effects models will be used to pool effect sizes. Subgroup analyses and meta-regression will be performed to investigate potential sources of heterogeneity. Sensitivity analyses will examine the robustness of the results. Data analysis will be conducted using Comprehensive Meta-Analysis (CMA), version 4., Discussion: This review and meta-analysis will be the first to systematically explore and integrate the evidence available on the association between the HEXACO personality traits and SUD and behavioral addictions. By consolidating information, the study will enhance our understanding of the role of personality traits in the development, maintenance, and treatment of SUD and behavioral addictions., Systematic Review Registration: PROSPERO CRD42023468153., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests., (© 2024. The Author(s).)

Introduction: Sarcopenia and Osteoporosis are two prevalent conditions in the older population and are defined by low strength, muscle quality/volume and low Bone Mineral Density, respectively. When there is a concomitant presence of both, there is a novel musculoskeletal condition called Osteosarcopenia. These conditions adversely affect quality of life and elevate the risk of fractures, disability, and mortality among older individuals. Dysbiosis of the gut microbiota is the impairment of the mutualistic relationship between microorganisms, metabolic products and the host's immune system. Gut microbiota dysbiosis could be intricately linked to sarcopenia and osteoporosis, shedding light on the complex microbiota-gut-bone-muscle axis. Furthermore, the intestinal microbiota experiences a notable decline in beneficial microorganisms as part of the aging process. The relationship between dysbiosis of the intestinal microbiota in older people and sarcopenia, osteoporosis or osteosarcopenia is still unclear. This review protocol aims to systematically review the literature and compile evidence on the influence of gut microbiota dysbiosis on musculoskeletal function in older people with sarcopenia, osteoporosis or osteosarcopenia., Methods/analysis: This systematic review will analyze observational studies that have investigated the relationship between the effects of gut microbiota dysbiosis and sarcopenia, osteoporosis and osteosarcopenia in older people aged 65 and over. Studies will be retrieved from PubMed/MEDLINE, EMBASE, Scopus, Web of Science and the Cochrane Library. Outcome measures will include body composition for diagnosing osteoporosis and screening for sarcopenia/osteosarcopenia by any criteria. Data synthesis will involve quantitative analysis using summary measures. If sufficient studies, homogeneity and heterogeneity analysis will be performed to conduct Meta-analysis and pooled OR, RR and HR measures will be provided., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 José Neto et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The incidence and mortality of lung cancer is the highest among malignant tumors worldwide, and it seriously threatens human life and health. Surgery is the primary radical treatment for lung cancer. However, patients often experience discomfort, changes in social roles, economic pressures, and other postsurgical challenges. These factors frequently cause various psychological disorders such as anxiety and depression, significantly diminishing the quality of life and elevating the risks of recurrence, metastasis, and mortality. Therefore, effective strategies for mental function rehabilitation should be urgently developed. Traditional Chinese medicine can significantly improve psychological function and physical symptoms after lung cancer surgery, and prolong patient survival. However, its effectiveness for mental function rehabilitation after lung cancer surgery remains unclear. This study aimed to investigate the effects of Chinese medicine on mental function recovery after lung cancer surgery through a systematic review and meta-analysis., Methods: This study will systematically search the following databases: PubMed, Cochrane Library, EMBASE, Web of Science, ClinicalTrials.gov, China National Knowledge Infrastructure, Wanfang database, VIP database, and Chinese BioMedical Literature database. Search for studies published from the inception of each database until April 22, 2024. This study will be limited to clinical randomized controlled trials (RCTs). The primary outcome will be depression or anxiety, as indicated by the scale score. Data analysis will be performed using RevMan 5. The Cochrane Risk of Bias Assessment Tool will be used to evaluate the quality of included studies. Finally, the quality of the evidence will be classified using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) System., Results: This meta-analysis aims to offer comprehensive evidence of the effectiveness of traditional Chinese medicine in mental function rehabilitation after lung cancer surgery. The study will assess the quality of the reports and conduct a subgroup analysis based on various postoperative stages, intervention measures, intervention duration, and sex to gather more evidence to fill the gap in psychological function rehabilitation after lung cancer surgery. These data can be used to guide clinical practice and inform future studies. More importantly, the results of this study will provide evidence to support the development of expert consensus and clinical guidelines in the field of mental function rehabilitation after lung cancer surgery., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Systematic reviews (SRs) contribute to implementing the 3Rs in preclinical research. With the ever-increasing amount of scientific literature, SRs require increasing time investment. Thus, using the most efficient review tools is essential. Most available software tools aid the screening process; tools for data extraction and/or multiple review phases are relatively scarce. Using a single platform for all review phases allows auto-transfer of references from one phase to the next and enables work on multiple phases at the same time. We performed succinct formal tests of four multiphase review tools that are free or relatively affordable: Covidence, Eppi, SRDR+ and SYRF. Our tests comprised full-text screening, sham data extraction, and discrepancy resolution in the context of parts of a systematic review. Screening was performed as per protocol. Sham data extraction comprised free text, numerical and categorial data. Both reviewers logged their experiences with the platforms throughout. These logs were qualitatively summarized and supplemented with further user experi­ences. We show value of all tested tools in the SR process. Which tool is optimal depends on multiple factors, comprising previous experience with the tool but also review type, review questions, and review team member enthusiasm.

Background: Although high-quality nutrition systematic reviews (SRs) are important for clinical decision making, there remains debate on their methodological quality and reporting transparency., Objectives: The objective of this study was to assess the reliability and reproducibility of a sample of SRs produced by the Nutrition Evidence Systematic Review (NESR) team to inform the 2020-2025 Dietary Guidelines for Americans (DGAs)., Methods: We evaluated a sample of 8 SRs from the DGA dietary patterns subcommittee for methodological quality using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) tool and for reporting transparency using the PRISMA 2020 and PRISMA literature search extension (PRISMA-S) checklists. We assessed the quality and reproducibility of the original search strategy of one selected SR using the Peer Review of Electronic Search Strategies checklist. The reporting transparency of the SR's narrative data synthesis was assessed using the Synthesis Without Meta-Analysis (SWiM) checklist. Interpretation bias was evaluated using existing spin bias classifications in systematic reviews., Results: The AMSTAR 2 assessment identified critical methodological weaknesses, and all included SRs were judged to be of critically low quality. Overall, 74% of the PRISMA 2020 checklist items and 63% of the PRISMA-S checklist items were satisfactorily fulfilled. We identified several errors and inconsistencies in the search strategy and could not reproduce searches within a 10% margin of the original results. The SWiM assessment identified concerns regarding the reporting transparency of the narrative data synthesis, but the spin bias assessment revealed no evidence of interpretation bias., Conclusions: Several methodological quality and reporting concerns were identified, which could lead to reliability and reproducibility issues should a full reproduction attempt be made. However, additional research is needed to confirm the impact of these findings on conclusions statements and their generalizability across the NESR team SRs. This study was registered in the Open Science Framework (https://osf.io/ns6a9/)., Competing Interests: Conflict of interest DB was a member of the 1995 DGAC. He has also published an opinion piece on the process [24]. All other authors report no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: The objective of this systematic review is to understand the experiences of care partner engagement in patient safety at the direct care level from the perspective of care partners, patients, and health care professionals., Introduction: Care partner engagement is a strategy for promoting patient safety in hospitals at the direct care level (ie, at the point where patient care is delivered). When present, care partners can increase safety by watching, listening, and taking action to protect admitted patients. To improve care partner presence policies and safety engagement strategies within hospitals, a comprehensive understanding of the current qualitative evidence about the breadth of experiences of care partner engagement in patient safety is required., Inclusion Criteria: This review will include qualitative studies that consider the experiences of care partners, adult patients, and health care professionals. The engagement of care partners in patient safety within pediatric hospital settings will not be considered., Methods: This review will follow the JBI methodology for systematic reviews of qualitative evidence. A preliminary literature search was conducted in MEDLINE and a full search strategy was developed for MEDLINE, Embase, CINAHL, and PsycINFO (all via Ovid), as well as the Cochrane Database of Systematic Reviews and JBI Evidence Synthesis . The JBI approach to study selection, critical appraisal, data extraction, data synthesis, and assessment of confidence will be followed. Two reviewers will test the screening criteria and data extraction protocol., Review Registration: PROSPERO CRD42023476286., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2025 JBI.)

We are grateful to the Editors of TVA for the opportunity to respond to the commentary on our systematic review of the sex trafficking of minors, specifically regarding the initial recruitment location. Upon revisiting the 7 out of 23 reviewed studies that address recruitment locations, we find that the discrepancy with the commentators' views stems from differing interpretations of the term "initial." We affirm that these seven studies, which include the internet as a prominent initial recruitment site, are valid and appropriate for inclusion. We also emphasize that, irrespective of recruitment location, we and the commentators share deep concerns about the severe impact of sex trafficking on minors, recognizing it as a heinous crime against vulnerable populations. Traffickers use both online and in-person methods to manipulate and exploit youth. Our review highlights the internet as a primary platform for traffickers to form relationships with minors, comparable in danger to in-person interactions. The 23 reviewed papers focus on documenting these predatory relationships and the critical role of supportive, healing relationships in prevention and intervention., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Protocol Registration: PROSPERO (CRD42023408899).

Background: The provision of speech intervention in children requires personalized, child-tailored approaches. Different speech-intervention approaches exist to eliminate cleft-related speech errors in children with a cleft palate. However, it is unclear what approach works best for the subtypes of cleft-related speech errors., Aims: To describe a protocol for a systematic review that provides speech-language pathologists with the current literature concerning more individualized speech intervention in children with a cleft palate., Methods & Procedures: A systematic literature review was performed following the preferred reporting items for systematic reviews and meta-analyses. Two speech-language pathologists with clinical and scientific experience in cleft speech searched different electronic databases for relevant studies. No limit regarding publication date was set. Specific eligibility criteria were defined and used to include or exclude the studies. All included studies were evaluated with a risk-of-bias assessment tool and levels of evidence. Relevant data were extracted from the studies (study design, study population characteristics, intervention characteristics and outcome characteristics) and a narrative synthesis was performed., Conclusions & Implications: The findings of this systematic review will significantly contribute to the evidence on personalized speech intervention in children with a cleft palate. The study will inform speech-language pathologists on the possibilities to tailor treatment plans more to the specific subtype of cleft-related speech errors. The planned systematic review also makes recommendations for further cleft speech intervention research., What This Paper Adds: What is already known on this subject At present, there is growing evidence for different speech therapy approaches in children with a cleft palate. Despite the recognized need for personalized, child-tailored therapy, there is no consensus on the best speech therapy approach per different subtype of compensatory cleft speech characteristic. What this study adds to the existing knowledge This paper provides a protocol for a systematic literature review of this topic. Specifically, it searches the literature for the use of personalized speech therapy approaches in children with different subtypes of compensatory cleft speech characteristics. What are the practical and clinical implications of this work? The systematic literature review provides speech-language pathologists with the current literature concerning personalized, performance-specific speech intervention in children with a cleft palate. Besides, the results will support therapy decision-making in children with a cleft palate in different speech-related clinical contexts., (© 2024 Royal College of Speech and Language Therapists.)

Objective: This umbrella review aims to consolidate the evidence concerning the influence of exercise on depressive symptoms and cognitive performance in adults diagnosed with depression., Methods: An umbrella review of systematic reviews with meta-analyses investigating the effect of exercise on depression and cognition was performed. Databases (PubMed, Cochrane Library, Web of Science, Embase) were searched from inception until February 2024 for reviews of randomized controlled trials. Overlap within included reviews was assessed using the corrected covered area method (CCA). A random effects model was used to calculate overall pooled effect size with sub-analyses., Results: This study included 27 reviews, encompassing 190 experiments. In patients with depression, compared to the control group, exercise demonstrated a moderate effect size in reducing depressive symptoms (SMD = -0.67; SE = 0.04; p < 0.0001), with a Number Needed to Treat (NNT) of 2.78. When analyses were limited to data from studies with a low risk of bias, the effect on depressive symptoms was smaller (SMD = -0.38; SE = 0.07; p < 0.0001; NNT = 4.72). Exercise had a small effect on cognitive functions (SMD = 0.12; SE = 0.03; p < 0.0001), with an NNT for cognitive function treatment of 14.79., Conclusions: All forms of exercise benefit patients with depression. However, for optimal intervention outcomes, it is essential to customize the intensity and type of exercise according to the specific characteristics of the patient's depressive symptoms and cognitive functions. It is recommended to implement a phased treatment approach for patients based on the intensity of exercise., Competing Interests: Declaration of competing interest No conflict of interest to declare., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Postherpetic neuralgia (PHN) is the most common complication of herpes zoster infection and affects patients' quality of life. Acupuncture therapy is regarded as a competitive method of treatment for analgesia., Objective: To summarize evidence from systematic reviews (SRs) and evaluate the effectiveness and safety of different acupuncture therapies for treating PHN., Methods: Eight electronic databases were searched from their inception to August 5, 2022, including 4 international electronic databases (PubMed, EMBASE, the Cochrane Library, and Web of Science) and 4 Chinese databases (Chinese Biomedical Database, China National Knowledge Infrastructure, VIP Database and Wanfang Database). Methodological quality was assessed by A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). The Risk of Bias in Systematic Review (ROBIS) tool was used to assess the risk of bias in SRs. Evidence level was assessed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach., Results: Totally, 7 SRs were included, including 128 studies and 9,792 patients. In AMSTAR 2, most of the SRs were of low or critically low levels since they had more than 1 critical deficiency. In ROBIS, 1 SR (14.29%) was rated as high risk, and the other 6 (85.71%) were rated as low risk. In the GRADE system, 9 outcomes (28.13%) were valued as high level, 5 (15.63%) as moderate level, 1 (3.13%) as low, and 17 (53.13%) as very low. In the effectiveness of acupuncture therapy, the group "moxibustion vs. original medical treatment" [mean difference (MD)=-1.44, 95% confidence interval (CI): -1.80 to -1.08, I 2 =99%, P<0.00001] was of the highest heterogeneity and the group "bloodletting vs. original medical treatment" (MD=-2.80, 95% CI: -3.14 to -2.46, I 2 =0, P<0.00001) was of the lowest heterogeneity. Six SRs have reported the safety of their studies and no serious events were shown in the treatment and control groups., Conclusions: Acupuncture therapy seems to be effective in treating PHN. Despite the evidence that suggested the advantages of acupuncture therapy in relieving pain and promoting efficacy and safety, the methodological quality was quite low. Further studies should pay more attention to the quality of original studies and evidence for SRs to confirm these findings. (PROSPERO registration No. CRD42022344790)., Competing Interests: Conflict of Interest. The authors declare that they have no conflicts of interest., (© 2023. The Chinese Journal of Integrated Traditional and Western Medicine Press and Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: This systematic review examines the evidence on the incidence and prevalence of inborn errors of metabolism (IEMs) in low- and middle-income countries (LMICs)., Introduction: IEMs are a set of conditions that can either be inherited or result from spontaneous mutations. Although each condition is rare in isolation, various specific disorders within the IEM group have an estimated global prevalence of 50.9 per 100,000 live births. A precise estimate of the prevalence and incidence of IEMs in LMICs can help determine the necessity for extensive newborn screening programs., Inclusion Criteria: This review will cover studies conducted in LMICs, reporting on IEMs in infants and children under the age of 5 years. Studies that calculate birth prevalence and incidence of IEMs will be included. Studies that provide information on the causes, clinical characteristics, treatment, case fatality rates, mortality rates, and other outcomes will also be considered., Methods: The databases to be searched include PubMed, MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Scopus, and gray literature sources. No date or language restrictions will be applied. Our search will encompass analytical and descriptive observational studies, which will be critically appraised by 2 independent reviewers. Data will be extracted using JBI data extraction tools. If sufficient data are available, a meta-analysis will be performed. Alternatively, if data are limited, we will present our findings in narrative format using tables and figures., Review Registration: PROSPERO CRD42023457421., (Copyright © 2025 JBI.)

Objective: This review will analyze the effectiveness of early childhood education interventions to improve complementary feeding practices in children aged 4 to 36 months., Introduction: Healthy eating habits, which start with food introduction, can influence children's growth and development. Educational actions carried out at school for children who are beginning to eat, involving families and school staff who attend daycare centers, can serve as strategies to improve complementary feeding practices., Inclusion Criteria: The review will consider randomized clinical trials, cluster-randomized clinical trials, and controlled clinical trials that evaluate the effectiveness of early childhood education interventions involving children aged 4 to 36 months, their families, or school staff to improve complementary feeding. In their absence, observational cohort, case-control, and cross-sectional studies may be considered., Methods: This review will be conducted in line with the JBI methodology for systematic reviews of effectiveness. The search for relevant studies will be conducted in PubMed, Embase (Ovid), BIREME, Scopus, the Cochrane Library (Cochrane Central Register of Controlled Trials CENTRAL and Cochrane Database of Systematic Reviews), CINAHL (EBSCOhost), and the ProQuest Databases (ProQuest Central). No date or language limitations will be applied. Two independent reviewers will select studies by screening titles, abstracts, and keywords against the inclusion criteria. This will be followed by full-text screening. Two independent reviewers will then evaluate the quality of the sources and perform data extraction. GRADEpro will be used to assess the certainty in the findings, which will be reported in the systematic review and, if possible, grouped in a meta-analysis., Review Registration: PROSPERO CRD42022384704., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2025 JBI.)