Search

Summary: Background: Three to 4-weekly intramuscular injections of benzathine penicillin G (BPG) for a prolonged period (e.g., 10 years, until age 40 years, or lifelong) are recommended for preventing group A streptococcal infections that cause recurrent acute rheumatic fever (ARF) and potential progression to rheumatic heart disease (RHD). The duration of treatment, frequency and local pain associated with BPG injections may lead to reduced compliance. Shorter courses of BPG are recommended for the treatment of syphilis and Streptococcal infections. We aimed to assess the effects of local anaesthesia in reducing injection pain in patients who are being treated with BPG. Methods: In this systematic review and meta-analysis, we searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Conference Proceedings Citation Index-Science and LILACS from database inception up to May 4, 2024, and performed additional searches for grey literature. Randomised controlled trials comparing BPG vs. BPG administered alongside local anaesthetics were included. Randomized controlled trials using BPG, irrespectively of indication, and testing any local anaesthetic agent for pain alleviation were considered eligible. We applied GRADE to assess the quality of evidence. Summary data were extracted from included trials. The primary outcome was injection pain, assessed through mean differences. A random-effects model was utilized to account for study heterogeneity. This study is registered with PROSPERO, CRD42022342437. Findings: Database searches identified a total of 3958 records, and 3 additional records were retrieved from grey literature searches. After removal of duplicates, screening of abstracts and full-text review, eight trials were included, combining a total of 489 patients (151 patients with RHD). Immediate pain level, as reported by patients, was of high intensity in most studies. Low intensity pain was still reported at 24 h. Administration of lidocaine mixed with BPG was associated with a significant reduction in immediate post-injection pain (mean difference −3.84, 95% confidence interval −6.19 to −1.48, P = 0.0001; 4 studies; I2 = 98%; GRADE: moderate quality), pain at 5 min (mean difference −2.85, 95% CI confidence interval −3.78 to −1.92, P

Background People who have had a stroke or a Transient Ischaemic Attack (TIA) can experience psychological and/or cognitive difficulties. The body of research for psychological and neuropsychological interventions after stroke is growing, however, published systematic reviews vary in scope and methodology, with different types and severity of strokes included, and at times, diverse conclusions drawn about the effectiveness of the interventions evaluated. In this umbrella review, we aim to systematically summarise the existing systematic reviews evaluating psychological interventions for mood and cognition post-stroke/TIA. Methods We will conduct this umbrella review according to the JBI Manual for Evidence Synthesis. The following databases will be searched from inception: Cochrane Database of Systematic Reviews, Database of Reviews of Effects (DARE), MEDLINE, Embase, CINAHL, PsycINFO, and Epistemonikos. Systematic reviews with or without meta-analysis published until the search date will be included. Reviews including psychological interventions addressing mood and/or cognition outcomes for any stroke type or severity will be screened for eligibility. A narrative synthesis, including content analysis, will be used. Each stage of the review will be processed by two independent reviewers and a third reviewer will be considered to resolve disagreements. The methodological quality of the included reviews will be assessed using AMSTAR 2. Discussion Existing systematic reviews provide varied evidence on the effectiveness of psychological interventions post-stroke/TIA. This umbrella review aims to summarise knowledge and evidence on different types of psychological and neuropsychological interventions targeting mood and cognition. Findings will highlight important knowledge gaps and help prioritise future research questions. Systematic Review Registration This protocol was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) on November 15, 2022; PROSPERO CRD42022375947.

Background: Rheumatic Heart Disease (RHD) is the most common cause of valvular heart disease worldwide. Undiagnosed or untreated RHD can complicate pregnancy and lead to poor maternal and fetal outcomes and is a significant factor in non-obstetric morbidity. Echocardiography has an emerging role in screening for RHD. We aimed to critically analyse the evidence on the use of echocardiography for screening pregnant women for RHD in high-prevalence areas. Methods: We searched MEDLINE and Embase to identify the relevant reports. Two independent reviewers assessed the reports against the eligibility criteria in a double-blind process. Results: The searches (date: 4 April 2023) identified 432 records for screening. Ten non-controlled observational studies were identified, five using portable or handheld echocardiography, comprising data from 23,166 women. Prevalence of RHD varied across the studies, ranging from 0.4 to 6.6% (I2, heterogeneity >90%). Other cardiac abnormalities (e.g., congenital heart disease and left ventricular systolic dysfunction) were also detected

Background: Despite the development of patient-centred or patient-reported outcome measures (PCOMs or PROMs) in palliative and end-of-life care over recent years, their routine use in practice faces continuing challenges. Objective: To update a highly cited literature review, identify and synthesise new evidence on facilitators, barriers, lessons learned, PCOMs used, models of implementation, implementation outcomes, costs, and consequences of implementing PCOMs in palliative care clinical practice. Methods: We will search MEDLINE, PsycINFO, CINAHL, Embase, Emcare, SCI-Expanded, SSCI, ESCI, and BNI. The database search will be supplemented by a list of studies from the expert advisory committee, hand-searching of reference lists for included articles, and citations of the original review. We will include primary studies using a PCOM during clinical care of adult patients with advanced disease in palliative care settings and extract data on reported models of implementation, PCOMs, facilitators, barriers, lessons learned, costs, and implementation outcomes. Gough’s Weight of Evidence Framework will be used to assess the robustness and relevance of the studies. We will narratively synthesise and tabulate the findings. This review will follow PRISMA, PRISMA-Abstract, PRISMA-P, and PRISMA-Search as the reporting guidelines. Source of funding: Marie Curie. The funder is not involved in designing or conducting this study. Protocol registration: CRD42023398653 (13/02/2023)

Abstract Background Mental disorders affect about one in seven children and adolescents worldwide. Investment in effective child and adolescent mental health prevention, promotion and care is essential. To date, however, the evidence from this field is yet to be comprehensively collected and mapped. Objectives The objective of this evidence and gap map (EGM) is to provide an overview of the existing evidence on the effectiveness of interventions aimed at promoting mental health and reducing or preventing mental health conditions among children and adolescents in lower‐middle‐income countries (LMICs). Search Methods We searched for studies from a wide range of bibliographic databases, libraries and websites. All searches were conducted in December 2021 and covered the period between 2010 and 2021. Selection Criteria We included evidence on the effectiveness of any Mental Health and Psychosocial Support (MHPSS) interventions targeting children and adolescents from 0 to 19 years of age in LMICs. The map includes systematic reviews and effectiveness studies in the form of randomised control trials and quasi‐experimental studies, and mixed‐methods studies with a focus on intervention effectiveness. Data Collection and Analysis A total of 63,947 records were identified after the search. A total of 19,578 records were removed using machine learning. A total of 7545 records were screened independently and simultaneously by four reviewers based on title and abstract and 2721 full texts were assessed for eligibility. The EGM includes 697 studies and reviews that covered 78 LMICs. Main Results School‐based interventions make up 61% of intervention research on child and adolescent mental health and psychosocial support. Most interventions (59%) focusing on treating mental health conditions rather than preventing them or promoting mental health. Depression (40%, N = 282) was the most frequently researched outcome sub‐domain analysed by studies and reviews, followed by anxiety disorders (32%, N = 225), well‐being (21%, N = 143), and post‐traumatic stress disorder (18%, N = 125). Most included studies and reviews investigated the effectiveness of mental health and psychosocial support interventions in early (75%, N = 525) and late adolescence (64%, N = 448). Conclusions The body of evidence in this area is complex and it is expanding progressively. However, research on child and adolescent MHPSS interventions is more reactive than proactive, with most evidence focusing on addressing mental health conditions that have already arisen rather than preventing them or promoting mental health. Future research should investigate the effectiveness of digital mental health interventions for children and adolescents as well as interventions to address the mental health and psychosocial needs of children in humanitarian settings. Research on early childhood MHPSS interventions is urgently needed. MHPSS research for children and adolescents lacks diversity. Research is also needed to address geographical inequalities at the regional and national level. Important questions also remain on the quality of the available research—is child and adolescent MHPSS intervention research locally relevant, reliable, well‐designed and conducted, accessible and innovative? Planning research collaborations with decision‐makers and involving experts by experience in research is essential.

Abstract Background Goal setting and goal-focused work is widely used in young people’s mental health settings. However, little is known about how, why or for whom this is helpful. This study aims to explore the mechanisms of collaborative goal setting as part of therapeutic relationships: is it helpful for young people experiencing anxiety and/or depression, how and why/not, for whom, and under what circumstances? Methods Online database searches generated 10,907 records. Seven unique studies are included, combined with insight analysis from directed discussions with international advisors with lived experience of anxiety and/or depression and therapy (N = 8; mean age = 20.8), and mental health academics/clinicians (N = 6). Results Findings are presented as a narrative synthesis and suggest that goal setting is helpful to young people experiencing anxiety and/or depression because it helps build good therapeutic relationships through open communication and building trust. Goal setting helps make things more manageable, enabling young people to feel supported and have ownership of their care. Individual preferences, or high levels of distress, trauma, low confidence, hopelessness, negative past experiences of goal setting, perfectionism, and rumination are considered limiting factors to goal setting. Additionally, contextual factors including country and long-term therapy are explored. Conclusion Whilst the resultant sample is small, emphasis on the voices of young people in the research is both prominent and of paramount importance. Several key literature gaps are identified, including evidenced links to the reduction in symptoms. Priority must be given to researching unhelpful mechanisms of goal setting for young people experiencing anxiety and/or depression, to avoid any potential iatrogenic effects.

This systematic review aimed to address the existing evidence gaps, and guide policy decisions on the settings within which to treat infants

Systematic literature reviews play a vital role in identifying the best available evidence for health and social care research, policy, and practice. The resources required to produce systematic reviews can be significant, and a key to the success of any review is the search strategy used to identify relevant literature. However, the methods used to construct search strategies can be complex, time consuming, resource intensive and error prone. In this review, we examine the state of the art in resolving complex structured information needs, focusing primarily on the healthcare context. We analyse the literature to identify key challenges and issues and explore appropriate solutions and workarounds. From this analysis we propose a way forward to facilitate trust and to aid explainability and transparency, reproducibility and replicability through a set of key design principles for tools to support the development of search strategies in systematic literature reviews.

Objectives To systematically review academic literature for studies on any processes, procedures, methods or approaches to purchasing high-cost medical devices and equipment within hospitals in high-income countries.Methods On 13 August 2020, we searched the following from inception: Cost-Effectiveness Analysis Registry, EconLit and ProQuest Dissertations & Theses A&I via ProQuest, Embase, MEDLINE, and MEDLINE in Process via Ovid SP, Google and Google Scholar, Health Management and Policy Database via Ovid SP, IEEE Xplore Digital Library, International HTA Database, NHS EED via CRD Web, Science Citation Index-Expanded, Conference Proceedings Citation Index-Science, and Emerging Sources Citation Index via Web of Science, Scopus, and Zetoc conference search. Studies were included if they described the approach to purchasing (also known as procurement or acquisition) of high-cost medical devices and/or equipment conducted within hospitals in high-income countries between 2000 and 2020. Studies were screened, data extracted and results summarised in tables under themes identified.Results Of 9437 records, 24 were included, based in 12 different countries and covering equipment types including surgical robots, medical imaging equipment, defibrillators and orthopaedic implants. We found heterogeneity in methods and approaches; including descriptions of processes taking place within or across hospitals (n=14), out of which three reported cost savings; empirical studies in which hospital records or participant data were analysed (n=8), and evaluations or pilots of proposed purchasing processes (n=2). Studies emphasise the importance of balancing technical, financial, safety and clinical requirements for device selection through multidisciplinary involvement (especially clinical engineers and clinicians) in decision-making, and the potential of increasing evidence-based purchasing decisions using approaches such as hospital-based health technology assessments, ergonomics and device ‘user trials’.Conclusions We highlight the need for more empirical work that evaluates purchasing approaches or interventions, and greater specificity in study reporting (eg, equipment type, evaluation outcomes) to build the evidence base required to influence policy and practice for medical equipment purchasing.Protocol registration This review was registered in Open Science Framework: Shokraneh F, Hinrichs-Krapels S, Chalkidou A et al. Purchasing high-cost medical equipment in hospitals in OECD countries: A systematic review. Open Science Framework 2021; doi:10.17605/OSF.IO/GTXN8. Available at: https://osf.io/gtxn8/ (accessed 12 February 2022).

Summary: Background: Mental health is a public health issue for European young people, with great heterogeneity in resource allocation. Representative population-based studies are needed. The Global Burden of Disease (GBD) Study 2019 provides internationally comparable information on trends in the health status of populations and changes in the leading causes of disease burden over time. Methods: Prevalence, incidence, Years Lived with Disability (YLDs) and Years of Life Lost (YLLs) from mental disorders (MDs), substance use disorders (SUDs) and self-harm were estimated for young people aged 10-24 years in 31 European countries. Rates per 100,000 population, percentage changes in 1990-2019, 95% Uncertainty Intervals (UIs), and correlations with Sociodemographic Index (SDI), were estimated. Findings: In 2019, rates per 100,000 population were 16,983 (95% UI 12,823 – 21,630) for MDs, 3,891 (3,020 - 4,905) for SUDs, and 89·1 (63·8 - 123·1) for self-harm. In terms of disability, anxiety contributed to 647·3 (432–912·3) YLDs, while in terms of premature death, self-harm contributed to 319·6 (248·9–412·8) YLLs, per 100,000 population. Over the 30 years studied, YLDs increased in eating disorders (14·9%;9·4-20·1) and drug use disorders (16·9%;8·9-26·3), and decreased in idiopathic developmental intellectual disability (–29·1%;23·8-38·5). YLLs decreased in self-harm (–27·9%;38·3-18·7). Variations were found by sex, age-group and country. The burden of SUDs and self-harm was higher in countries with lower SDI, MDs were associated with SUDs. Interpretation: Mental health conditions represent an important burden among young people living in Europe. National policies should strengthen mental health, with a specific focus on young people. Funding: The Bill and Melinda Gates Foundation

Abstract This is the protocol for a Campbell evidence and gap map. The objective of this evidence and gap map is to provide an overview of the existing evidence on the effectiveness of interventions aimed at promoting mental health and reducing or preventing mental health conditions among children and adolescents in low‐ and middle‐income countries.

Abstract Background Much effort is made to ensure Cochrane reviews are based on reliably extracted data. There is a commitment to wide access to these data—for novel processing and/or reuse—but delivering this access is problematic. Aim To describe a proof-of-concept programme to extract, curate and structure data from Cochrane reviews. Methods One student of Applied Sciences (16 weeks full time), access to pre-publication review files and use of ‘Eclipse’ to create an open-access tool (RAPTOR) using the programming language Java. Results The final software batch processes hundreds of reviews in seconds, extracting all study data and automatically tidying and unifying presentation of data for return into the source review, reuse, or export for novel analyses. Conclusions This software, despite being limited, illustrates how the efforts of reviewers meticulously extracting study data can be improved, disseminated and reused with little additional effort.

Abstract Background Maintained study-based registers (SBRs) have, at their core, study records linked to, potentially, multiple other records such as references, data sets, standard texts and full-text reports. Such registers can minimise and refine searching, de-duplicating, screening and acquisition of full texts. SBRs can facilitate new review titles/updates and, within seconds, inform the team about the potential workload of each task. Methods We discuss the advantages/disadvantages of SBRs and report a case of how such a register was used to develop a successful grant application and deliver results—reducing considerable redundancy of effort. Results SBRs saved time in question-setting and scoping and made rapid production of nine Cochrane systematic reviews possible. Conclusion Whilst helping prioritise and conduct systematic reviews, SBRs improve quality. Those funding information specialists for literature reviewing could reasonably stipulate the resulting SBR to be delivered for dissemination and use beyond the life of the project.

Implementing any linear transformation matrix through the optical channels of an on-chip reconfigurable multiport interferometer has been emerging as a promising technique for various fields of study, such as information processing and optical communication systems. Recently, the use of multiport optical interferometric-based linear structures in neural networks has attracted a great deal of attention. Optical neural networks have proven to be promising in terms of computational speed and power efficiency, allowing for the increasingly large neural networks that are being created today. This paper demonstrates the experimental analysis of programming a 4 × 4 reconfigurable optical processor using a unitary transformation matrix implemented by a single layer neural network. To this end, the Mach-Zehnder interferometers (MZIs) in the structure are first experimentally calibrated to circumvent the random phase errors originating from fabrication process variations. The linear transformation matrix of the given application can be implemented by the successive multiplications of the unitary transformation matrices of the constituent MZIs in the optical structure. The required phase shifts to construct the linear transformation matrix by means of the optical processor are determined theoretically. Using this method, a single layer neural network is trained to classify a synthetic linearly separable multivariate Gaussian dataset on a conventional computer using a stochastic optimization algorithm. Additionally, the effect of the phase errors and uncertainties caused by the experimental equipment inaccuracies and the device components imperfections is also analyzed and simulated. Finally, the optical processor is experimentally programmed by applying the obtained phase shifts from the matrix decomposition process to the corresponding phase shifters in the device. The experimental results show that the optical processor achieves 72% classification accuracy compared to the 98.9% of the simulated optical neural network on a digital computer.

Introduction: There is still controversy about the effect of early hypothermia on the outcome of spinal cord injury (SCI). The aim of this review article is to investigate the effect of local or general hypothermia on improving the locomotion after traumatic SCI. Methods: Electronic databases (Medline and Embase) were searched from inception until May 7, 2018. Two independent reviewers screened and summarized the relevant experimental studies on hypothermia efficacy in traumatic SCI. The data were analyzed and the findings were presented as pooled standardized mean difference (SMD) and 95% confidence interval (95% CI). Results: 20 papers containing 30 separate experiments were included in meta-analysis. The onset of hypothermia varied between 0 and 240 minutes after SCI. Administration of hypothermia has a positive effect on locomotion following SCI (SMD=0.56 95% CI: 0.18-0.95, p=0.004). Subgroup analysis showed that general hypothermia improves locomotion recovery (SMD =0.89, 95% CI: 0.42 to 1.36; p

Background: Post-stroke fatigue (PSF) is one of the most common and frustrating outcomes of stroke. It has a high prevalence and it can persist for many years after stroke. PSF itself contributes to a wider range of undesirable outcomes that affect all aspects of daily life. The aim of this review was to identify and summarise the most recent research on PSF, in order to update the evidence base. Methods: We updated an existing review (Hinkle et al. 2017) systematically searching CINAHL, MEDLINE, PsycINFO, and PubMed to cover new research studies between 1st March 2016 and the search date (19th January 2020). We included interventional and observational research, and clinical practice guidelines that were not covered in the original review. After duplicate removal in EndNote, two reviewers screened the search results in Rayyan, and data from eligible full texts were extracted onto an Excel spreadsheet. Finally, we used RobotReviewer and a human reviewer to assess the risk of bias of randomised trials for this scoping review. Results: We identified 45 records for 30 studies (14 observational, 10 interventional studies, and 6 guidelines). Apart from one, the interventional studies were single-centred, had high risk of bias and small sample size (median 50). They investigated exercise, pharmacotherapy, psychotherapy, education, and light therapy. Observational studies mainly reported the factors related to PSF including co-morbidities, depression and anxiety, quality of life, activities of daily living, stroke severity, medication use and polypharmacy, polymorphism, pain, apathy, limb heaviness, neuroticism, mobility, and thyroid-stimulating hormone. Guidelines either did not report on PSF or, when reported, their recommendations were supported by little or low level of evidence. Conclusion: Although we identified a number of recent studies which have added to our current knowledge on PSF, none are robust enough to change current clinical practice.

There are limited data on the lesion volume changes following spinal cord injury (SCI). In this study, a meta-analysis was performed to evaluate the volume size changes of the injured spinal cord over time among animal studies in traumatic SCI. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a comprehensive electronic search of English literature of PubMed and EMBASE databases from 1946 to 2015 concerning the time-dependent changes in the volume of the spinal cord following mechanical traumatic SCI. A hand-search was also performed for non-interventional, non-molecular, and non-review studies. Quality appraisal, data extraction, qualitative and quantitative analyses were performed afterward. Of 11,561 articles yielded from electronic search, 49 articles were assessed for eligibility after reviewing of titles, abstracts, and references. Ultimately, 11 articles were eligible for quantitative synthesis. The ratio of lesion volume to spinal cord total volume increased over time. Avascularity appeared in spinal cord 4 hours after injury. During the first week, the spinal subarachnoid space decreased. The hemorrhagic lesion size peaked in 1 week and decreased thereafter. Significant loss of gray and white matter occurred from day 3 with a slower progression of white matter damage. Changes of lesion extent over time is critical in pathophysiologic processes after SCI. Early avascularity, rapid loss of gray matter, slow progression of white matter damage, and late cavitation are the pathophysiologic key points of SCI, which could be helpful in choosing the proper intervention on a timely basis.

Objective: To estimate the summation of mortality rate and the contributing factors in patients with traumatic thoracolumbar spinal cord injuries (TLSCI).Methods: A systematic search of observational studies that evaluated the mortality associated with TLSCI in MEDLINE and EMBASE was conducted. The study quality was evaluated using a modified quality assessment tool previously designed for observational studies.Results: Twenty-four observational studies involving 11,205 patients were included, published between January 1, 1997, and February 6, 2016. Ten studies were of high quality, thirteen were of moderate quality, and one study was of low quality. Seventeen reports described risk factors for mortality and eleven of these studies used a multiple regression models to adjust for confounders.The reported mortality rate ranged from 0 to 37.7% overall and between 0 and 10.4% in-hospital. The sum of mortality for in-hospital, 6-month, and 12-month were 5.2%, 26.12%, 4.3%, respectively. The mortality at 7.7 years follow-up was 10.07% and for 14 years follow-up reports ranged from 13.47% to 21.46%. Associated data such as age at injury, male to female ratio, pre-existing comorbidities, concomitant injuries, duration of follow-up, and cause of death have been underreported in studies investigating the mortality rate after TLSCI.Conclusion: Currently no study has accurately assessed mortality in the thoracolumbar spine, while there is general agreement that traumatic thoracolumbar spinal cord injuries are important.

Objective(s): To reach an evidence-based knowledge in the context of the temporal-spatial pattern of neuronal death and find appropriate time of intervention in order to preserve spared neurons and promote regeneration after traumatic spinal cord injury (TSCI). Materials and Methods: The study design was based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-guided systematic review. PubMed and EMBASE were searched (24 October, 2015) with no temporal or linguistic restrictions. Hand-search was performed in the bibliographies of relevant articles. Non-interventional animal studies evaluating time-dependent neuronal death following acute mechanical trauma to the spinal cord were included. We separately evaluated the fate of various populations of neurons including propriospinal neurons, ventral motor neurons, Clarke’s column neurons, and supraspinal neurons.Results: We found 11,557 non-duplicated studies. Screening through the titles and abstracts led to 549 articles, 49 of which met the inclusion criteria. Both necrotic and apoptotic neuronal deaths occur after TSCI, though necrosis is the prominent mechanism. There are differences in the responses of intrinsic neurons of the spinal cord to the TSCI. Also, the extent of neuronal death in the supraspinal neurons depends on the anatomical location of their axons. Conclusion: In order to develop new therapies, selection of the injury model and time of intervention has a crucial role in the efficacy of therapy. In addition, examining the safety and efficacy of an intervention by reliable methods not confounded by the injury-related changes would promote translation of therapies to the clinical application.

Introduction: Despite years of use of study-based registers for storing reports of randomized controlled trials (RCTs), the methodology used in developing such registers/databases has not been documented. Such registers are integral to the process of scientific reviewing. We document and discuss methodological aspects of the development and use of study-based registers. Although the content is focused on the study-based register of randomized/controlled clinical trials, this work applies to developers of databases of all sorts of studies related to the human, animals, cells, genes, and molecules. Methods: We describe necessity, rationale, and steps for the development, utilization and maintenance of study-based registers as well as the challenges and gains for the organizations supporting systematic reviews of the published and unpublished literature. Conclusion: The ultimate goal of having a study-based register is to facilitate efficient production of systematic reviews providing rapid, yet accurate, evidence for the decision-makers. We argue that moving towards study-based registers is an inevitable welcome direction and that infrastructures are ready for such movement.

Purpose: Alcohol consumption can lead to risky driving and increase the frequency of traffic accidents, injuries and mortalities. The main purpose of our study was to compare simulated driving performance between two groups of drivers, one consumed alcohol and the other not consumed, using a systematic review. Methods: In this systematic review, electronic resources and databases including Medline via Ovid SP, EMBASE via Ovid SP, PsycINFO via Ovid SP, PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINHAL) via EBSCOhost were comprehensively and systematically searched. The randomized controlled clinical trials that compared simulated driving performance between two groups of drivers, one consumed alcohol and the other not consumed, were included. Lane position standard deviation (LPSD), mean of lane position deviation (MLPD), speed, mean of speed deviation (MSD), standard deviation of speed deviation (SDSD), number of accidents (NA) and line crossing (LC) were considered as the main parameters evaluating outcomes. After title and abstract screening, the articles were enrolled for data extraction and they were evaluated for risk of biases. Results: Thirteen papers were included in our qualitative synthesis. All included papers were classified as high risk of biases. Alcohol consumption mostly deteriorated the following performance outcomes in descending order: SDSD, LPSD, speed, MLPD, LC and NA. Our systematic review had troublesome heterogeneity. Conclusion: Alcohol consumption may decrease simulated driving performance in alcohol consumed people compared with non-alcohol consumed people via changes in SDSD, LPSD, speed, MLPD, LC and NA. More well-designed randomized controlled clinical trials are recommended.

Abstract Background Experiencing mental ill health adds a layer of complexity for individuals in touch with the justice system and for those responsible for working in the justice service with these individuals, such as frontline police officers. In England and Wales, there are three commonly used but not necessarily commonly designed or operated, mental health interventions associated with policing, Liaison and Diversion, Street Triage and specialist staff embedded in Police Contact Control Rooms. A fourth US designed model, Crisis Intervention Teams (CITs), is now attracting some interest in England and Wales, and these four are to be considered in this review. A fifth intervention, Mental Health Courts, was trialed but has now been abandoned in England and Wales and so has been excluded, but remains in use elsewhere. In recent years, there has been an increase in the level of investment related to these intervention options. This has largely been without an evidence base being available to aid design, structure, and consistency of approach. The review will address this gap and provide a systematic review of each of these options. This will provide a baseline of research evidence for those who commission and provide services for individuals experiencing mental ill health and who are in contact with the justice system. Methods Twenty-nine relevant databases and sources have been selected which will be systematically searched to locate relevant studies. These studies have to meet the set inclusion criteria which require them to report an objective outcome measure(s) in respect of offending or mental health outcomes and to have an experimental or quasi-experimental design including a comparator group(s) or a pre/post comparison. The review will exclude PhD theses, papers in non-English languages and papers published prior to 1980. Keywords have been collected through canvassing experts’ opinion, literature review, controlled vocabulary and reviewing the results of a primary scoping review carried out to aid the development of the PICO, composed of Population/Participants, Intervention/Indicator, Comparator/Control, and Outcomes. For the proposed review, the key elements of the PICO are the following: persons with mental health problems, symptoms or diagnoses who come into contact with the police; interventions involving partnership working between police and mental health nurses and related professionals to divert those with mental health problems away from criminal justice processes; comparisons with control groups or areas where such interventions have not been introduced; and outcomes concerning criminal justice and health outcomes. The results of the searches will be screened using the set criteria and the selected papers reviewed and analysed to allow findings regarding these interventions to be reported. Discussion The objectives of the review are firstly to identify and report research on the relevant interventions, nationally and internationally and then secondly to consider, when possible, which interventions or aspects of those interventions are effective. This is judged with regard to changes in mental health status or service use and future offending behaviour. The approaches to be considered have gained a good deal of support and funding over recent years, and this review will provide a systematic review of the underpinning research evidence to inform future commissioning, service design and investment decisions.

We present use of a simple formula to calculate the number of pairwise comparisons of interventions within a single trial or network meta-analyses. We used the data from our previous network meta-analysis to build a study-based register and enumerated the direct pairwise comparisons from the trials therein. We then compared this with the number of comparisons predicted by use of the formula and finally with the reported number of comparisons (indirect or direct) within the network meta-analysis. A total of 133 trials of 8 interventions were selected which included 163 comparisons. The network of these showed 16 unique direct comparisons. The formula predicted an expected 28 indirect or direct comparisons and this is the number that were indeed reported. The formula produces an accurate enumeration of the potential comparisons within a single trial or network meta-analysis. Its use could help transparency of reporting should a shortfall occur between comparisons actually used and the potential total.

We present use of a simple formula to calculate the number of pairwise comparisons of interventions within a single trial or network meta-analyses. We used the data from our previous network meta-analysis to build a study-based register and enumerated the direct pairwise comparisons from the trials therein. We then compared this with the number of comparisons predicted by use of the formula and finally with the reported number of comparisons (indirect or direct) within the network meta-analysis. A total of 133 trials included in the network generated 163 comparisons (16 unique direct comparisons for 8 interventions). The formula predicted an expected 28 indirect or direct comparisons and this is the number that were indeed reported. The formula produces an accurate enumeration of the potential comparisons within a single trial or network meta-analysis. Its use could help transparency of reporting should a shortfall occur between comparisons actually used and the potential total.

Abstract Data extraction is one of the most time-consuming tasks in performing a systematic review. Extraction is often onto some sort of form. Sharing completed forms can be used to check quality and accuracy of extraction or for re-cycling data to other researchers for updating. However, validating each piece of extracted data is time-consuming and linking to source problematic. In this methodology paper, we summarize three methods for reporting the location of data in original full-text reports, comparing their advantages and disadvantages.

مقدمه: عفونت روتاویروسی عامل بسیاری از گاستروانتریت‌های حاد در بین کودکان زیر 5 سال در کشورهایی است که برنامه‌ی معمول واکسیناسیون روتاویروس را اجرا نکردند. هدف این مطالعه، مرور سیستماتیک شواهد موجود در زمینه‌ی کارایی و ایمنی دو واکسن روتاتک و روتاریکس می‌باشد. روش‌ها: یک مرور نظام‌مند بین کارآزمایی‌های بالینی تصادفی شده و مطالعات تجربی بر روی کودکان زیر 5 سال جمعیت عمومی انجام شده است. پایگاه‌های اطلاعاتی پزشکی Medline، Ovid، Cochranel proquest، Scopus، DARE، HTA و NH SEED جستجو گردیدند. هتروژنیسیتی مطالعات با انجام متاآنالیز ارزیابی شد. به منظور برآورد تجمیعی کارایی واکسن روتاویروس (روتاریکس ®و روتاتک ®) از مدل تصادفی استفاده شده است و سوگرایی انتشار نیز با آزمون‌های Egger و Begg ارزیابی شد. یافته‌ها: 12 مطالعه مطابق با معیارهای ورود جهت تحلیل نهایی به دست آمد. برآورد ترکیبی کارایی برای تمام پیامدها برای روتاتک و روتاریکس به ترتیب 70/0 (85/0-65/0 :CI 95 درصد)، 80/0 (87/0-68/0 :CI 95 درصد) محاسبه گردید. نسبت خطر محاسبه شده‌ی عوارض در گروه مورد نسبت به گروه شاهد بین 20/1-83/0 قرار داشت. نتیجه‌گیری: واکسیناسیون روتاویروس سبب پیشگیری قابل توجهی از موارد حاد و غیر حاد اسهال روتاویروسی در کودکان می‌شود و می‌تواند بار قابل انتساب به بیماری را کاهش دهد. انجام مطالعات هزینه- اثربخشی برای اجرای برنامه‌ی معمول واکسیناسیون روتاویروس در ایران ضروری به نظر می‌رسد.

Background: Currently, endoscopic retrograde cholangiopancreatography (ERCP) is one of the most practical measures in the diagnosis and management of various pancreatobiliary diseases. Difficult cannulation which contributes to developing side effects of ERCP, is influenced by many factors, one of which is anatomic variants such as periampullary diverticulum (PAD). The purpose of current systematic review study was the investigation of the effect of periampullary diverticulum on technical success rate of endoscopic cholangiopancreatography. The general conclusion would be presented based on statistical analysis. Methods: In the current study, MEDLINE, PubMed and EMBASE databases were searched in February 30th, 2012 using a sensitive search strategy to retrieve relevant studies in English language. The data met the inclusion criteria were selected for the study. Statistical analysis was carried out using CMA.2 software. Findings: Eleven articles with a total sample size of 12243 and an average consensus of 88% among researchers entered into the survey and all of the necessary data were obtained. The results of statistical analysis indicated low success rate of cannulatoin in patients with PAD in comparison with those without it (OR = 0.502؛ CI 95% (0.262-0.961); P < 0.038). Conclusion: Performing ERCP cannulation in patients with and without PAD carries a lower success rate respectively. Nevertheless, the recent studies which employ new methodology does not demonstrate this low success rate.

Circulatory system disease raise third highest disability-adjusted life years among Iranians and ischemic cardiac diseases are main causes for such burden. Despite available evidences on risk factors of the disease, no effective intervention was implemented to control and prevent the disease. This paper non-systematically reviews available literature on the problem, solutions, and barriers of implementation of knowledge translation in Iran. It seems that there are ignored factors such as cultural and motivational issues in knowledge translation interventions but there are hopes for implementation of started projects and preparation of students as next generation of knowledge transferors.

Introduction: while internet and web could bridge over time and place barriers of educa-tion, some websites developed educational programs in different fields. The nation-wide Darsnameh e-Learning System is one of the accepted and popular services basically for ICT education and other miscellaneous topics. Here, we try to collect the characteristics of this system to assess the feasibility of its adaptation for medical education. Methods: we considered five aspects (infrastructure, registration, content, timing, and user) and two criteria (user-friendliness and reliability) to assess the adaptation of Darsnameh model for medical education. Assessment team consisted of a software engineer, a medical librarian, and a medical education expert each of them voluntarily and optionally registered in one of the Darsnameh courses and finished it. Passing each course took 43 days on average. Three two-hour meetings were held to assess the system in group discussions. All discus-sions were recorded and their contents were analyzed to form the assessment concepts and categories. To determine adoptability of the system for medical education, scores of 0-7 was considered. Results: in Categories of infrastructure, registration, content, timing, and users were scored 6, 2, 6, 4, and 4 respectively. Also, user-friendliness and reliability criteria were scored 6 and 1. Except reliability criteria, other characteristics were consi-dered as adoptable for medical education. But reliability of the registration information, content, exam results, course certification, and affiliation of developers remained unreliable. Conclusion: implementation of e-learning for medical education through email could be considered as a new developmental approach, however because of limitations of current study, it should be evaluated for a large number of subjects such as general practitioners.

Introduction: selection of journal for publication purpose is one of concerns of biomedical researchers. They apply various criteria to choose appropriate journal. Here, we have tried to collect main criteria biomedical researchers use to select a journal to submit their work. Methods: we collected these criteria through focus group conversations with researchers during our careers, feedbacks from participants of our scientific writing workshops and non-systematic reviewing of some related literature. Results: we have presented a summative and informative guidance in selection of biomedical journals for biomedical paper submission and publication. Conclusion: Categorized criteria as a mnemonic tool for authors may help the authors in journal selection process.

Background: The primary goal of wound management is to achieve a functional closure with minimal scarring. One of the ways of wound management is to prescribe prophylactic antibiotics. This study compared single-dose intravenous (IV) prophylactic antibiotic with the common five-day treatment in simple traumatic and contaminated wounds. Methods: All patients with simple traumatic and contaminated wounds that were sutured and determined to have indications for prophylactic antibiotic therapy by a physician at emergency wards of Shohadaye Haftom-e-Tir and Rasoul-Akram Hospitals during working shifts of researchers were divided into two groups. The first group received a single-dose of IV cefazolin and the second group was treated with oral cephalexin for five days. Infection symptoms such as erythema, pus secretion and swelling were described to the patients. Patients were suggested to inform the researchers whenever they saw the symptoms before the exact date of suture removal. Findings: In this research, 150 patients were studied in two groups of 75. The first group received a single-dose IV antibiotic while the second received five days of antibiotic. Infection was observed in 6 (8%) and 7 (9.33%) patients in the first and second group, respectively. However, the two groups were not significantly different in terms of infection rate. Conclusion: The period of prophylactic antibiotic therapy does not seem to make significant differences in treatment of wounds. Therefore, based on the findings of previous studies, as well as ours, it can be concluded that using a single-dose IV prophylactic antibiotic might be preferable because it is more acceptable by patients and has fewer side effects.

Background: Aluminium phosphide (AlP) is used as a fumigant. It produces phosphine gas which is a mitochondrial poison. Although this poisoning has been repeatedly reported in literature with a high mortality rate, there is no known antidote for AlP intoxication. In the present study, we studied the effects of hyperbaric oxygenation (HBO) on the survival time of AlP intoxicated rats. Methods: Intoxicated rats with AlP (11.5 mg/kg, oral gavage) were placed in hyperbaric oxygenation with different concentrations of compressed air and oxygen. Results: All the animals exposed to AlP died within 5 days. The mean survival times of rats exposed to AlP without any intervention, treated with hyperbaric condition by compressed air, and treated with hyperbaric condition by pure O2 were 91 ± 1, 262 ± 8, and 276 ± 6 minutes, respectively. In analysis of survival times, there was a significant difference between Group 2 which received AlP and the groups which underwent intervention (Groups 2 and 3, p < 0.001; Groups 2 and 4, p < 0.001). Conclusions: Hyperbaric oxygenation may probably improve the survival time of the intoxicated rats with aluminium phosphide, but it may not decrease the mortality rate.

No abstract

Background People who have had a stroke or a Transient Ischaemic Attack (TIA) can experience psychological and/or cognitive difficulties. The body of research for psychological and neuropsychological interventions after stroke is growing, however, published systematic reviews vary in scope and methodology, with different types and severity of strokes included, and at times, diverse conclusions drawn about the effectiveness of the interventions evaluated. In this umbrella review, we aim to systematically summarise the existing systematic reviews evaluating psychological interventions for mood and cognition post-stroke/TIA. Methods We will conduct this umbrella review according to the JBI Manual for Evidence Synthesis. The following databases will be searched from inception: Cochrane Database of Systematic Reviews, Database of Reviews of Effects (DARE), MEDLINE, Embase, CINAHL, PsycINFO, and Epistemonikos. Systematic reviews with or without meta-analysis published until the search date will be included. Reviews including psychological interventions addressing mood and/or cognition outcomes for any stroke type or severity will be screened for eligibility. A narrative synthesis, including content analysis, will be used. Each stage of the review will be processed by two independent reviewers and a third reviewer will be considered to resolve disagreements. The methodological quality of the included reviews will be assessed using AMSTAR 2. Discussion Existing systematic reviews provide varied evidence on the effectiveness of psychological interventions post-stroke/TIA. This umbrella review aims to summarise knowledge and evidence on different types of psychological and neuropsychological interventions targeting mood and cognition. Findings will highlight important knowledge gaps and help prioritise future research questions. Systematic Review Registration This protocol was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) on November 15, 2022; PROSPERO CRD42022375947.

مقدمه: چکیده‌ی مقاله برای بیشتر پزشکان، معیار بررسی و مطالعه‌ی متن کامل مقاله است. چکیده‌ها حاوی اطلاعات اصلی و مهم مقاله هستند که خواننده را به محتوای اطلاعاتی مقاله راهنمایی می‌کنند. از این رو پایگاه‌های اطلاعاتی نمایه‌ساز به ساختار و محتوای اطلاعاتی چکیده‌ی مقالات، با افزایش انتشار مقالات و تنوع موضوعی مجلات بیش از پیش تأکید می‌كنند. مقاله‌ی حاضر به ارزیابی چکیده‌ی مقالات کارآزمایی‌های بالینی تصادفی کنترل شده که در PubMed نمایه شده‌اند، با استفاده از چک‌لیست CONSORT پرداخته است. روش بررسی: این پژوهش از نوع مقطعی توصیفی بود. جامعه‌ی پژوهش شامل 314 چکیده‌ی مقاله از نوع کارآزمایی بالینی تصادفی کنترل شده، با وابستگی سازمانی به دانشگاه علوم پزشکی تهران (249) و دانشگاه علوم پزشکی ایران سابق (65) بود که در PubMed تا پایان سال 2010 نمایه شده بودند. داده‌ها با استفاده از نرم‌افزار آماری 16SPSS و با استفاده از روش‌های آماری توصیفی مورد تجزیه و تحلیل قرار گرفت. یافته‌ها: در تمام چکیده‌ی مقالات از میان موارد در نظر گرفته شده در چک‌لیست، فقط مداخله‌ی به کار برده شده در هر دو گروه به طور کامل بیان شده است. ذکر روش تصادفی‌سازی مشارکت کنندگان به گروه‌های درگیر در مطالعه، نوع طراحی کارآزمایی بالینی تصادفی کنترل شده و تعداد افرادی که در آنالیز شرکت داشتند، از مواردی است که بسیار ضعیف گزارش شده‌اند. از میان انواع مداخلات، دارو با 2/68 درصد بیشتر از سایر مداخلات به کار برده شده است. شیوه دوسو کور از میان شیوه‌های کورسازی بیشتر استفاده شده است. نتیجه‌گیری: کیفیت گزارش روش‌شناسی در مقالات کارآزمای بالینی تصادفی کنترل شده، در حد مناسبی نیست. برای گزارش بهتر نتایج باید آموزش‌های لازم به پژوهشگران و نویسندگان مقالات داده شود. علاوه بر این سردبیران مجلات باید دستورالعمل گزارش صحیح این نوع از مطالعات را در راهنمای نگارش مقالات مجلات درج نمایند تا شاهد هر چه بهتر شدن گزارش این دست از مطالعات توسط نویسندگان باشند. واژه‌های کلیدی: ارزیابی؛ کارآزمایی بالینی تصادفی کنترل شده؛ پایگاه‌های اطلاعاتی؛ چکیده‌ی مقالات.

Background People who have had a stroke or a Transient Ischaemic Attack (TIA) can experience psychological and/or cognitive difficulties. The body of research for psychological and neuropsychological interventions after stroke is growing, however, published systematic reviews vary in scope and methodology, with different types and severity of strokes included, and at times, diverse conclusions drawn about the effectiveness of the interventions evaluated. In this umbrella review, we aim to systematically summarise the existing systematic reviews evaluating psychological interventions for mood and cognition post-stroke/TIA. Methods We will conduct this umbrella review according to the JBI Manual for Evidence Synthesis. The following databases will be searched from inception: Cochrane Database of Systematic Reviews, Database of Reviews of Effects (DARE), MEDLINE, Embase, CINAHL, PsycINFO, and Epistemonikos. Systematic reviews with or without meta-analysis published until the search date will be included. Reviews including psychological interventions addressing mood and/or cognition outcomes for any stroke type or severity will be screened for eligibility. A narrative synthesis, including content analysis, will be used. Each stage of the review will be processed by two independent reviewers and a third reviewer will be considered to resolve disagreements. The methodological quality of the included reviews will be assessed using AMSTAR 2. Discussion Existing systematic reviews provide varied evidence on the effectiveness of psychological interventions post-stroke/TIA. This umbrella review aims to summarise knowledge and evidence on different types of psychological and neuropsychological interventions targeting mood and cognition. Findings will highlight important knowledge gaps and help prioritise future research questions. Systematic Review Registration This protocol was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) on November 15, 2022; PROSPERO CRD42022375947.

Background Per- and polyfluoroalkyl substances (PFAS) were used or are being used in the manufacturing of products, including consumer-use products. The resulting environmental contamination has led to widespread human exposure. This review aimed to scope the characteristics of evidence covered and applied methodology of evidence to understand -- regardless of any results on the association of gestational diabetes mellitus (GDM) and PFAS -- if a new systematic review would be justified. Methods We systematically identified reports investigating associations of PFAS with GDM following a pre-specified and pre-registered PECO framework and protocol. Results The previous systematic reviews included 8-11 reports and either conducted meta-analyses stratified by comparator, analyzed results based on only high and low exposure categories, or pooled results across comparators. Included 20 reports presented data on 24 PFAS with PFOA, PFOS, PFHxS, PFNA, and PFDA being examined in almost all. The comparators employed were heterogeneous across the reports. Conclusions Because data from at least one new report on GDM is available since the previous systematic reviews and heterogeneous comparators, an updated systematic review using SWiM could add value to the literature.

Background Since fatigue is shared across many conditions, understanding and managing fatigue requires cross-condition collaboration. The current analysis, focusing on fatigue in patients with inflammatory bowel diseases (IBD), aimed to take the first steps towards building such collaboration by identifying potential members, presenting a map of studied topics and remaining gaps, and highlighting potential funders. Methods This study used components of scientometrics, content analysis, systematic review, and gap analysis using four data sources. Results We identified research teams on IBD fatigue in six countries with 23 authors who have published on fatigue in more than one condition, with chronic fatigue syndrome as the dominant topic of interest among the researchers. Crohn’s & Colitis UK and AbbVie were the main funders of research on IBD fatigue. Most publications were observational studies and respectively focused on psychological problems, physical problems, and outcomes (quality of life followed by severity of illness index) associated with IBD fatigue. A triad with King’s College London + Crohn’s & Colitis UK + University College London was the main active research network. In co-authorship network analysis, the collaboration across countries was more visible in a wired or star-shaped network with multiple core points; however, the collaboration in the largest cluster showed a neuron- or loop-shaped collaboration across the most active institutes. Conclusions This research took a mixed methods approach to initiating a collaboration by identifying members and building a map of recent research and gaps in order to tackle fatigue as a complex, cross-condition, and multi-disciplinary problem. Interventional and qualitative studies, along with systematic reviews to fill the research gaps, are needed. An international collaboration among institutes could provide support for large initiatives such as the release of standards of best practice, clinical practice guidelines, and consensus-based definitions of fatigue.

Background: Despite the development of patient-centred or patient-reported outcome measures (PCOMs or PROMs) in palliative and end-of-life care over recent years, their routine use in practice faces continuing challenges. Objective: To update a highly cited literature review, identify and synthesise new evidence on facilitators, barriers, lessons learned, PCOMs used, models of implementation, implementation outcomes, costs, and consequences of implementing PCOMs in palliative care clinical practice. Methods: We will search MEDLINE, PsycINFO, CINAHL, Embase, Emcare, SCI-Expanded, SSCI, ESCI, and BNI. The database search will be supplemented by a list of studies from the expert advisory committee, hand-searching of reference lists for included articles, and citations of the original review. We will include primary studies using a PCOM during clinical care of adult patients with advanced disease in palliative care settings and extract data on reported models of implementation, PCOMs, facilitators, barriers, lessons learned, costs, and implementation outcomes. Gough’s Weight of Evidence Framework will be used to assess the robustness and relevance of the studies. We will narratively synthesise and tabulate the findings. This review will follow PRISMA, PRISMA-Abstract, PRISMA-P, and PRISMA-Search as the reporting guidelines. Source of funding: Marie Curie. The funder is not involved in designing or conducting this study. Protocol registration: CRD42023398653 (13/02/2023)

Background: Despite the development of patient-centred or patient-reported outcome measures (PCOMs or PROMs) in palliative and end-of-life care over recent years, their routine use in practice faces continuing challenges. Objective: To update a highly cited literature review, identify and synthesise new evidence on facilitators, barriers, lessons learned, PCOMs used, models of implementation, implementation outcomes, costs, and consequences of implementing PCOMs in palliative care clinical practice. Methods: We will search MEDLINE, PsycINFO, CINAHL, Embase, Emcare, SCI-Expanded, SSCI, ESCI, and BNI. The database search will be supplemented by a list of studies from the expert advisory committee, hand-searching of reference lists for included articles, and citations of the original review. We will include primary studies using a PCOM during clinical care of adult patients with advanced disease in palliative care settings and extract data on reported models of implementation, PCOMs, facilitators, barriers, lessons learned, costs, and implementation outcomes. Gough’s Weight of Evidence Framework will be used to assess the robustness and relevance of the studies. We will narratively synthesise and tabulate the findings. This review will follow PRISMA, PRISMA-Abstract, PRISMA-P, and PRISMA-Search as the reporting guidelines. Source of funding: Marie Curie. The funder is not involved in designing or conducting this study. Protocol registration: CRD42023398653 (13/02/2023)

Background: Post-stroke fatigue (PSF) is one of the most common and frustrating outcomes of stroke. It has a high prevalence and it can persist for many years after stroke. PSF itself contributes to a wider range of undesirable outcomes that affect all aspects of daily life. The aim of this review was to identify and summarise the most recent research on PSF, in order to update the evidence base. Methods: We updated an existing review (Hinkle et al. 2017) systematically searching CINAHL, MEDLINE, PsycINFO, and PubMed to cover new research studies between 1 st March 2016 and the search date (19 th January 2020). We included interventional and observational research, and clinical practice guidelines that were not covered in the original review. After duplicate removal in EndNote, two reviewers screened the search results in Rayyan, and data from eligible full texts were extracted onto an Excel spreadsheet. Finally, we used RobotReviewer and a human reviewer to assess the risk of bias of randomised trials for this scoping review. Results: We identified 45 records for 30 studies (14 observational, 10 interventional studies, and 6 guidelines). Apart from one, the interventional studies were single-centred, had high risk of bias and small sample size (median 50). They investigated exercise, pharmacotherapy, psychotherapy, education, and light therapy. Observational studies mainly reported the factors related to PSF including co-morbidities, depression and anxiety, quality of life, activities of daily living, stroke severity, medication use and polypharmacy, polymorphism, pain, apathy, limb heaviness, neuroticism, mobility, and thyroid-stimulating hormone. Guidelines either did not report on PSF or, when reported, their recommendations were supported by little or low level of evidence. Conclusion: Although we identified a number of recent studies which have added to our current knowledge on PSF, none are robust enough to change current clinical practice.

Introduction: Emotional difficulties among young people are debilitating and increasing in prevalence. Parent focused interventions delivered online offer a convenient and potentially effective way to increase young people’s access to support. A systematic review offers the opportunity to assess their effectiveness and to identify characteristic of interventions which are particularly effective. Objective: To assess the existing online interventions for parents of young people that are designed to improve young people’s mental health and wellbeing. Methods: We will conduct a systematic review of randomised controlled trials identified through searching CENTRAL, Embase, MEDLINE, PsycINFO, and PubMed. We will follow Cochrane Handbook and involve at least two people in screening and data extraction. Risk of bias will be assessed using Cochrane risk of bias tool. We will use EndNote, Excel, and Review Manager for managing the studies and data. We will also apply TIDieR checklist to extract and summarise the specific characteristics of interventions. Protocol registration: PROSPERO CRD42018114921; registered on 31 October 2018.