Diagnosis-related groups (DRGs) are among the most widely adopted case-mix-based hospital payment systems, introduced to improve efficiency, enhance cost transparency and contain rising healthcare expenditure. Although a substantial body of literature evaluates the economic and system-level effects of DRGs, comparatively less attention has been paid to the perspectives of healthcare providers who work within these reimbursement structures and directly experience their consequences in daily clinical practice. This systematic review synthesises evidence on physicians' and hospital administrators' perspectives of DRG-based payment systems in high-income countries, with particular attention to perceived effects on clinical decision-making, quality of care, administrative workload and professional autonomy. Nursing and allied health perspectives are identified as warranting a separate dedicated review and are not the focus of the present work. The review was conducted in accordance with PRISMA 2020 guidelines and registered with PROSPERO (CRD42024575025). Six electronic databases (PubMed, Scopus, Web of Science, CINAHL, Embase and ProQuest) were searched for English-language studies published between 1994 and 2024. Qualitative, quantitative and mixed-methods studies reporting provider or hospital-level perspectives on DRG implementation were included. Methodological quality was assessed using the Joanna Briggs Institute (JBI) appraisal tools and risk of bias was assessed using the ROBINS-I tool. The Mixed Methods Appraisal Tool (MMAT) was available for mixed-methods studies, though none were ultimately included. Findings were synthesised narratively using thematic aggregation. Twelve studies from approximately 25 high-income countries met the inclusion criteria. Healthcare providers acknowledged several benefits of DRG systems, including improved cost transparency, more standardised care pathways and incentives for efficiency. However, concerns were consistently raised regarding increased administrative workload, reduced clinical autonomy, financial pressure to shorten length of stay and potential risks to care quality, particularly for complex or severely ill patients. Provider acceptance of DRGs varied substantially across settings and was strongly influenced by local system design, training, coding infrastructure and alignment with professional values. From the perspective of physicians and hospital administrators, DRG-based payment systems represent a trade-off between economic rationalisation and clinical discretion. Although DRGs can support efficiency and accountability, their success depends critically on thoughtful system design, adequate training, robust data infrastructure and ongoing engagement with providers to safeguard care quality and professional autonomy. Nursing and allied health perspectives, which the available evidence base did not allow this review to address adequately, represent an important and underexplored dimension of provider experience with DRG systems and warrant focused future research.
Within allied-health programs, gross anatomy is widely regarded as a foundational and content-dense course challenging instructors and students alike to manage an overwhelming volume of information within an increasingly constrained curriculum. In the late 1960's, the Duke University medical curriculum was redesigned to produce 'scientists-doctors' intensifying the instructional challenges of gross anatomy. In the wake of a series of unsuccessful experiments, comparative anatomists Matt Cartmill and James Shafland were recruited to develop and teach a medical gross anatomy course at Duke. Drawing on comparative anatomy, embryology, and evolutionary theory, Cartmill and colleagues developed a distinctive pedagogical framework organized around an idealized vertebrate metameric Bauplan-the Typical Body Segment (TBS)-with an accompanying textbook: Human Structure. Rather than trying to memorize details about sprawling sets of isolated structures, the TBS approach transforms learning gross anatomy into a series of stories about how evolution and development regionally pattern and differentiate Typical Body Segments into functionally specialized, interconnected modules. This article discusses the circumstances leading to the emergence of Cartmill's course-directorship and the TBS approach to teaching gross anatomy at Duke. We argue that the consistent use of a central homological schema as a starting point for narratives about the complex human form offers many pedagogical advantages, including reduced cognitive load, improved organization of anatomical knowledge, as well as a better grasp on patterns of interaction and variation among parts. Drawing on qualitative data from student course evaluations at High Point University, we further illustrate how this approach appears to shift students' orientation from rote memorization toward a conceptual understanding of anatomy. Finally, we document the diffusion and transformation of the TBS paradigm through faculty lineages, postdoctoral training, and allied health programs, highlighting its enduring influence on contemporary anatomy education. Together, this history and analysis underscore the value of centering evolutionary and developmental narratives in the teaching of human anatomy and documents the major contributions from Cartmill and other gross anatomists who taught with the TBS approach at Duke University.
To review and evaluate the literature for upstream, structural interventions that seek to improve maternal mortality rates among Black birthing people in the United States. Searches were conducted in PubMed, Embase, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Of the 883 articles returned, 623 abstracts were screened, and 7 articles met the criteria for inclusion. Articles were eligible for inclusion if they assessed the impact of structural interventions on maternal mortality, including among Black birthing people. Data were extracted on study designs, intervention type, outcomes, and health equity implications using a standardized template. Findings were synthesized thematically according to intervention type and included Access to reproductive health care and Social investment as effective maternal health policy. The findings revealed that maternal mortality is largely preventable and responsive to structural interventions. Interventions that addressed upstream determinants such as racism and social conditions demonstrated the greatest impact in reducing maternal mortality and improving equity. Targeted policy and programmatic interventions that address social and structural determinants of maternal health are essential to mitigating the maternal mortality crisis. Efforts that extend health care access, invest in public health infrastructure, and promote reproductive justice are particularly effective in improving outcomes for Black birthing people.
Radical cystectomy with urinary diversion can substantially affect sexual function, body image, and intimate relationships. Structured sexual rehabilitation guidance that is specific to cystectomy and usable within nursing and rehabilitation pathways remains limited, especially for women and for patients living with urinary diversion. To develop a practice-oriented, evidence-informed and consensus-based framework for sexual rehabilitation across the cystectomy care pathway. We conducted a targeted narrative review of literature published between January 2000 and June 2025 in the Medical Literature Analysis and Retrieval System Online via PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library, supplemented by cancer survivorship, ostomy, pelvic rehabilitation and sexual medicine guidance. Two reviewers screened records and mapped evidence by recovery phase, sex-related anatomy, diversion type, presenting problem and delivery setting. Recommendations were refined through two rounds of multidisciplinary author-panel consensus. The work was aligned with the Scale for the Assessment of Narrative Review Articles, intervention reporting principles from the Template for Intervention Description and Replication checklist, selected Appraisal of Guidelines for Research and Evaluation principles, and sex- and gender-sensitive reporting guidance. The revised framework is organised into prehabilitation, early postoperative care and late rehabilitation. It distinguishes nurse-led, shared interdisciplinary and specialist-only actions; specifies transition criteria between phases; integrates diversion-specific intimacy planning; and provides safety precautions for pelvic floor, manual therapy, pharmacological and psychosexual interventions. Outcome monitoring uses the International Index of Erectile Function, 5-item version; the Female Sexual Function Index, 19-item version; and the Body Image Scale, supplemented by goal-based and process indicators. The framework offers a cautious, adaptable route for integrating sexual health assessment, education, pelvic rehabilitation, stoma-related support, psychosexual communication and referral into routine cystectomy survivorship care. It should be implemented with local scope-of-practice governance and evaluated prospectively, including patient-partner co-design and long-term outcomes beyond 12 months.
To explore the experiences and factors associated with exclusive breastfeeding among women with postpartum depression (PPD). Following Arksey and O'Malley's methodological framework for scoping studies, searches were conducted in the CINAHL (Cumulative Index to Nursing and Allied Health Literature), PubMed, ScienceDirect, Scopus, EBSCO, Virtual Health Library, and Taylor & Francis databases. Full-text articles published in English, Spanish, and Portuguese between 2015 and 2024 on breastfeeding experiences among women up to 6 months postpartum with PPD. In total, 14 articles met the inclusion criteria. Data were charted using a spreadsheet matrix, which included the following information: authors, year of publication, country, study population, objectives, methods, and main findings. Extracted data were collated and analyzed using thematic synthesis to group recurring patterns into conceptual themes. Consequently, a variety of experiences with exclusive breastfeeding were identified among women with PPD and classified into three main categories: (a) rewarding, characterized by emotional bonding and a sense of accomplishment; (b) frustrating, often involving latching difficulties, low supply, or feelings of inadequacy; or (c) supportive, highlighting the critical role of health care provider encouragement and perseverance. These experiences were influenced by sociocultural, physical, psycho-emotional, and health care-related factors. The experiences of women with PPD who exclusively breastfeed are shaped by multiple interrelated factors that affect the breastfeeding process. Health care systems and public policies must integrate emotional and physical support strategies to strengthen breastfeeding, especially among women experiencing PPD.
The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke from distal- and medium-vessel occlusion (DMVO) for endovascular thrombectomy (EVT). The intended audiences are prehospital care providers, physicians, and allied health professionals. The Society of Vascular and Interventional Neurology Guidelines and Practice Standards committee formed a writing group to conduct a structured literature review on EVT for DMVO-related acute ischemic stroke and to draft practice recommendations in accordance with the Society of Vascular and Interventional Neurology Guidelines and Practice Algorithm. A structured literature search was conducted across PubMed, MEDLINE, and the Cochrane Library from January 2015 through February 2026, supplemented by manual review of reference lists from key studies and conferences. Recommendations were developed with consensus from an expert panel and the Guidelines and Practice Standards committee, with final approval by the Society of Vascular and Interventional Neurology Board of Directors. Data from all randomized controlled trials, prior meta-analyses, and subgroup analyses were extracted to evaluate the latest evidence on the safety and efficacy of EVT in patients presenting with DMVO acute ischemic stroke. The guideline outlines practical considerations for patient selection, procedural technique, and systems of care. These guidelines provide focused practical recommendations based on recent evidence regarding patient selection and decision-making for EVT in patients presenting with acute DMVO. Routine EVT for DMVO is not supported by current evidence; however, performing EVT in patients with disabling acute dominant M2 occlusion remains reasonable.
To explore Practice Development interventions and associated contextual factors to understand their impact on patient and staff outcomes and experiences in healthcare settings. Systematic review. Preferred Reporting Items for Systematic Reviews and Meta-analysis informed design, conduct and management. A systematic approach was taken, utilising multiple reviewers and consensus methods. Mixed Methods Appraisal Tool informed quality appraisal. Qualitative findings were analysed using Reflexive Thematic Analysis. Quantitative results are presented as a narrative summary. CINAHL; MEDLINE; PubMed; Scopus; ScienceDirect; Nursing and Allied Health; Cochrane Library; Internurse.com; The Kings Fund; GOV.UK and Trip Database were searched between 1st January 1980 to 5th January 2026. Twenty-nine studies were included. Eighteen studies met all quality assessment criteria. Limited quantitative data was available, and inconsistent outcome measures constrained quantitative analysis. Qualitative analysis generated three themes: (1) Shaping Practice: the interplay of organisational context, culture, and structure, (2) Enablers and constraints in Practice Development, (3) Collective empowerment. Across diverse study designs, the majority of studies indicate that PD contributes positively to staff working environments and the contexts in which patient care is delivered. However, current findings do not demonstrate consistent improvements in clinical outcomes or quality of life. Practice Development may contribute to improvements in care environments for patients and staff, respectively. This review highlights knowledge gaps in the generalisability and transferability of Practice Development that would benefit from further exploration. Practice Development may enhance healthcare environments, but further research is needed to determine if these benefits impact upon clinical outcomes. Preferred Reporting Items for Systematic reviews and Meta-Analyses. No patient or public contribution. PROSPERO registration number: CRD42024557949.
To map existing scientific evidence on the relationship between clinical supervision and burnout and burnout-related outcomes among nurses in clinical practice. Scoping review. The review followed the Joanna Briggs Institute methodology for scoping reviews. A total of 1396 records were identified and imported into Rayyan for screening. Data were synthesised descriptively using absolute and relative frequencies and presented in narrative and tabular form. Searches were conducted in February 2025 in CINAHL Complete, Nursing & Allied Health Collection: Comprehensive, MedicLatina, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PubMed, and Web of Science Core Collection. Grey literature was searched in OpenGrey and the Portuguese Open Access Scientific Repository (RCAAP). No time or language restrictions were applied. Twenty studies were included. The evidence base was heterogeneous and predominantly cross-sectional. Clinical supervision in Nursing (CSN) was mainly delivered face-to-face and most frequently in group formats, with considerable variability in frequency, duration and theoretical grounding. Burnout was primarily assessed using validated instruments, particularly the Maslach Burnout Inventory. Nine studies reported inverse statistical associations between CSN and burnout or burnout-related outcomes. Clinical supervision is frequently associated with burnout and burnout-related indicators among nurses. Clearer intervention reporting, stronger theoretical grounding, and research designs capable of exploring temporal and contextual dynamics are needed to advance the field. Clinical supervision may represent a context-sensitive organisational support strategy within broader workforce well-being frameworks, particularly when structurally defined and supported by leadership. This review clarifies how clinical supervision has been conceptualised and evaluated, identifying reporting gaps and priorities for future research. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review. No stakeholder consultation was undertaken. Future research should consider involving practising nurses and supervisors to define core CSN components. The protocol was registered in the Open Science Framework.
The Imposter Phenomenon (IP)-doubting one's abilities despite clear achievements-is well-documented among healthcare professionals but has never been studied among practicing chiropractors, who face unique challenges including professional isolation and ambiguous healthcare identity. This study aimed to determine IP prevalence among South African chiropractors and investigate associations with age, gender, years of experience, and province. A cross-sectional survey using the validated Clance Imposter Phenomenon Scale (CIPS) was distributed via email to all 960 chiropractors registered with the Allied Health Professions Council of South Africa. Data were collected online from 25 March to 17 May 2024. Descriptive statistics, independent-samples t-tests, and one-way ANOVA were used; results are interpreted through effect sizes (Cohen's d) and 95% confidence intervals, with exact p-values reported as continuous evidence measures. Cronbach's alpha assessed reliability. The study followed STROBE and CHERRIES guidelines. Of 159 chiropractors (16.6% response rate), mean age was 37.8 years (SD = 10.8); 61.6% were female. Mean CIPS score was 50.78 (SD = 16.82), indicating moderate IP. Severity distribution: 33.3% few, 39.0% moderate, 22.6% frequent, 5.0% intense IP (66.6% at or above moderate threshold). Females scored higher than males (55.66 vs. 42.93; t(147.69)= - 5.25, p < 0.001; d = 0.85). Chiropractors  ≤ 35 years scored higher than those  > 35 years (53.52 vs. 47.95; t(152) = 2.05, p = 0.042; d = 0.33). Chiropractors with ≤ 10 years of experience showed a non-significant trend toward higher IP scores than those with  > 10 years (52.90 vs. 47.94; two-tailed p = 0.066; d = 0.30). No provincial differences were found (F(3,155) = 0.62, p = 0.601). Cronbach's α was 0.94. Moderate to intense IP affects two-thirds of chiropractors in this South African sample, particularly females and early-career practitioners. These findings highlight the need for targeted mental health interventions, mentorship, and peer support. This first study of IP among practicing chiropractors provides evidence for practitioner well-being initiatives with implications for chiropractic education, professional development, and retention.
Health, immigration status, race, and gender are intersecting concepts that reveal higher rates of acute and chronic mental health concerns among women. This qualitative systematic review aimed to identify, critically appraise, and synthesize qualitative evidence on how women living with diverse immigration statuses experience mental health interventions in Canada. Literature was searched using Medline (Ovid) and then translated into each of the following databases: Cumulative Index for Nursing and Allied Health Literature (CINAHL Ebsco), PsycINFO (Ebsco), Web of Science, CINAHL, Medline and PsycINFO; and Web of Science. Using Joanna Briggs Institute (JBI) methods and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, studies published between 2003 and 2025 were identified and screened within Covidence for quality using the standard JBI critical appraisal checklist for qualitative research. A total of 107 findings consisting of participants' verbatim quotes were extracted from 18 studies and aggregated into the following synthesized findings: (1) Women's socio-emotional well-being, (2) Culturally misaligned mental health care among racialized women, (3) Women's cultural preferences and access conditions, and (4) Women's recommendations for improving mental health care and support. Implications of the review findings address gaps in equity-informed mental health services tailored to women living at the intersections of racism and diverse immigration status in Canada.
In this study, we sought to conduct a systematic review and meta-analysis of mental health outcomes in survivors of neurocritical illness. Literature databases [PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycInfo] were searched for terms relating to critical illness, intensive care, and outcomes from January 1970 to June 2024. English-language studies of adults with critically illness with a primary neurological diagnosis were included if they reported on mental health outcomes [specifically, depression, anxiety, post-traumatic stress (PTS), or general mental health]. Data extraction was performed, in duplicate, for prespecified variables related to study outcomes. Random effects meta-analyses were conducted to estimate pooled prevalence and symptom severity. Of more than 33,000 abstracts screened, 24 publications reported on mental health outcomes: 19 reported on depression outcomes, 11 on anxiety, 7 on PTS, and 8 on general mental health. The median [interquartile range (IQR)] time to first depression, anxiety, and/or PTS assessment was 3 (1.75, 12), 4.5 (1.1, 7.5), and 3 (0, 3) months, respectively. The most common assessment tools were the Hospital Anxiety and Depression Scale, Depression Subscale (HADS-D; n = 8) and the Hospital Anxiety and Depression Scale, Anxiety Subscale HADS-A (n = 8), and Post-traumatic Stress Disorder Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5)/Post-traumatic Stress Disorder Checklist, Civilian Version (PCL-C) for PTS (n = 4). General mental health outcomes were studied using seven unique tools at a median (IQR) follow-up time of 3 (0.5, 6) months. Pooled depression prevalence [95% confidence interval (CI)] was 24% (20-29%) among publications using HADS-D and 26% (16-38%) in publications using any assessment tool. Pooled anxiety prevalence was 37% (21-56%) using HADS-A and was 32% (18-51%) using any assessment tool. PTS prevalence was 14% (8-21%). Heterogeneity of assessment tools precluded a pooled analysis of general mental health. These findings highlight the burden of mental health symptoms following neurocritical care illness, with prevalences higher than the general population. These findings were impacted by substantial between-study heterogeneity-particularly in assessment tools and timing of evaluations-limiting precise prevalence estimation.
This cross-sectional study investigates healthcare practitioners' perceptions of the implementation of artificial intelligence (AI) to enhance patient safety culture in Riyadh, Saudi Arabia, conducted from March to June 2025. The focus is on understanding how AI is perceived in the context of improving patient safety culture and aligning with Saudi Vision 2030 goals. The study employed a cross-sectional design and administered self-administered online surveys via convenience sampling among healthcare practitioners across multiple healthcare settings in Riyadh. The study targeted a population including doctors, nurses, and allied health professionals. A structured questionnaire was developed to assess perceptions of AI, including key variables such as perceived AI benefits, concerns about data privacy, and the necessity of training. Descriptive statistics were computed to characterize the sample, including age, gender, and profession. Findings revealed that most participants perceived AI as supportive of patient safety through improved diagnostic accuracy, reduced medical errors, and streamlined workflows, which participants believed may contribute to a stronger patient safety culture. Descriptive analyses suggested variation in perceptions across professional groups. The study found that healthcare practitioners in Riyadh generally perceived AI as a potentially valuable tool for supporting patient safety culture, particularly through improving diagnostic accuracy and reducing errors; however, concerns about data privacy and insufficient training remain significant barriers that must be addressed to ensure effective and safe AI integration. This study highlighted healthcare practitioners' positive perception of AI's role in enhancing patient safety culture in Riyadh. While AI is seen as beneficial in improving accuracy and reducing errors, challenges such as data privacy concerns and a lack of training were identified as barriers to its implementation. Not applicable.
Polyendocrine metabolic ovarian syndrome (PMOS) is a common endocrine disorder affecting 1.55 million women of reproductive age worldwide. While its physical and reproductive impacts are well-documented, the cognitive effects of PMOS remain under-researched and poorly understood. This systematic review aims to investigate existing literature on cognitive function in women with PMOS. The objective of this review is to identify specific cognitive differences between women with PMOS and those without, highlight gaps in current research and clinical care, and inform the development of more comprehensive care frameworks for individuals with PMOS. A systematic search was conducted using Ovid MEDLINE, Ovid EMBASE, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) for studies published up to June 23, 2025. Eligible studies underwent data extraction and risk of bias assessment in accordance with standard systematic review protocols. Out of 2887 articles screened, 22 studies met the inclusion criteria. Twenty-two studies involving 136,008 women with PMOS and 333,895 without PMOS were included. Across cognitive domains, pooled correlations generally indicated small, non-significant negative associations, including executive function (r = -0.12, 95% confidence interval [CI] -0.26 to 0.02), attention (r = -0.13, 95% CI -0.38 to 0.14), and working memory (r = -0.14, 95% CI -0.31 to 0.05). Substantial heterogeneity was observed in several domains, often driven by individual outlying studies. Risk of bias was generally low, and funnel plots with Egger's regression provided no evidence of publication bias. This review underscores the need for further research into the cognitive aspects of PMOS. Addressing this gap is essential for developing a more comprehensive approach to PMOS treatment and support beyond its traditional focus on physical and reproductive health.
Historically, daily hours of wearing a cranial remolding orthosis (CRO) was not objectively assessed, and the compliance to the treatment plan was evaluated subjectively through questionnaires in previous studies. To assess objective monitoring of the postoperative CRO in infants with single suture craniosynostosis. Prospective comparative study. Data collection regarding the number of hours that the CRO was worn was obtained from data recorded from the Orthotimer sensor and data recorded from the participants' parents. A total of 21 individuals (11 boys and 10 girls) participated in the study. Among these 21 participants, 9 had scaphocephaly (sagittal craniosynostosis), 9 had trigonocephaly (metopic craniosynostosis), and 3 had unilateral coronal deformity (coronal craniosynostosis). A significant difference was observed in adherence to the CRO treatment between the objective and subjective methods (p<0.05). Accordingly, the compliance based on parental reports (subjective method) was significantly higher than the data recorded objectively (p<0.05). It was found that parents tend to report higher estimates regarding the use and compliance of the CRO. Therefore, for a more accurate assessment of the hours spent wearing the CRO, the objective method is the preferred choice.
暂无摘要（点击查看详情）
To examine the efficacy of conservative (non-surgical) treatments, usual care, and no treatment for chronic radicular and non-specific back pain. Time course network meta-analysis. Six electronic databases (Medline, SPORTDiscus, CINAHL, PsycINFO, Embase, and CENTRAL), searched from inception to 24 July 2020, and 302 previous systematic reviews. Full peer reviewed publications in English or German of randomised controlled trials, randomised clinical trials, randomised controlled cluster trials, or randomised crossover trials in adults (aged ≥18 years) receiving common conservative treatments for non-specific and radicular chronic low back pain. Treatments examined were acupuncture, education or advice, electrotherapy (including heat and ice electrotherapeutic modalities applied non-invasively), exercise training, manual treatments or manipulation, massage, the McKenzie method, pharmacotherapy, psychological treatments, traction, physical therapy (otherwise not falling into specific treatment combinations), placebo, multidisciplinary pain management, usual care (eg, management by a doctor), and no treatment (true control). Back pain intensity, leg pain intensity, disability, and mental health outcomes were reported immediately (<1 day), and at short term (≥1 day and ≤3 months), intermediate term (>3 and <12 months), and long term (≥12 months) time points. 581 reports of 551 studies (71 126 patients) were included. 510 trials included people with non-specific chronic low back pain and 41 trials included those with radicular chronic low back pain. For back pain (0-100 scale), acupuncture (mean difference -20.91, 95% credible interval -24.00 to -11.95), electrotherapy (-18.98, -21.84 to-10.95), exercise (-15.59, -17.51 to -10.05), manual treatment (-19.48, -22.17 to -11.74), massage (-25.61, -30.42 to -10.91), and multidisciplinary pain management (-18.96, -22.26 to -9.58) exceeded the minimal clinically important difference (set at 0.5 standard deviation) in the short term. For disability (0-100 scale), acupuncture (mean difference -10.52, 95% credible intervals -11.84 to -6.59), massage (-9.95, -11.45 to -5.50), and multidisciplinary pain management (-12.56, -13.91 to -8.55) were clinically effective in the short term. In the immediate and intermediate term only, the McKenzie method and massage, respectively, exceeded the minimal clinically important difference. In the long term, although two of the 14 treatments for back pain and nine of 14 treatments for disability had statistically significant benefits compared with no treatment, the effects were not clinically significant. The certainty of the evidence based on the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) framework was low (1.4%) to very low (98.6%) across interventions and time points. Findings for massage and the McKenzie method were not stable in the sensitivity analyses. Treatment effects for radicular chronic low back pain did not seem to differ from those for non-specific chronic low back pain. Some treatments were effective for pain and function in non-specific chronic low back pain, but improvements did not persist long term. Most of the evidence was for non-specific chronic low back pain; the evidence base for radicular chronic low back pain was limited. Although sensitivity analyses did not provide evidence for a different response in radicular chronic low back pain, an evidence gap remains for this subpopulation. Future work should explore strategies to establish the long term efficacy of modifications to lifestyle and behaviour. PROSPERO CRD42020182039.
In addition to a gap detection threshold, an auditory gap detection task also provides information on response time. This study investigated the association of response time from an adaptive gap detection task with two validated measures of cognitive processing speed as well as scores from a cognitive screener, while accounting for the effects of age, peripheral hearing ability, and HIV status. Participants (age 17-45 years) were from a prospective cohort study in Dar es Salaam, Tanzania with normal hearing ability and no reported neurological diseases. The final sample included 283 unique subjects (158 living with HIV, 125 without HIV) matched on age and sex. Multiple linear regression models were employed to assess the relationship between gap response time and cognitive processing speed scores from the Tests of Variables of Attention, Cogstate test battery, and Montreal Cognitive Assessment. Regression analysis showed significant relationships between gap response time and all processing speed scores, except one. Age showed varying degrees of association with different processing speed measures, but peripheral hearing ability did not show any significant relationship with speed measures. This study identifies a link between cognitive processing speed and gap detection response times. With further validation, gap detection response times could emerge as a straightforward yet informative measure of cognitive processing speed and would expand the clinical usefulness of the gap test. In the audiology clinic, this measure may hold promise as a tool for detecting and monitoring cognitive decline.
Developmental dyslexia refers to a common neurodevelopmental disorder, which impairs the accuracy and fluency of reading, and early identification is vital for initiating timely intervention. Nonetheless, the traditional methods of formal assessment are time- and resource-intensive, which limits their scalability. Machine-learning approaches and eye-tracking technologies provide objective, data-driven solutions for dyslexia screening. This research integrates current evidence on eye-movement-based and emerging multimodal computational methods for dyslexia screening, risk identification, and algorithmic classification during reading tasks. PubMed, Scopus, Web of Science, and CINAHL were searched systematically to identify studies published between January 2015 and March 2026. Eligible studies included analysis of eye-movement obtained via eye tracking or electrooculography (EOG), with or without predictive modeling. Methodological quality was assessed using JBI, PROBAST, ROBINS-I, and COSMIN tools. Twenty-three articles were included out of 50 full-text articles screened comprising eye-movement biomarker/observational studies (n = 5), machine-learning prediction-model studies (n = 14), intervention response studies (n = 2), and reliability/feasibility studies (n = 2). The sample sizes ranged from small experimental cohorts (<20 participants) to larger datasets (>300 participants). In the literature, dyslexic readers were consistently found to exhibit longer fixation durations, increased regression behavior and reduced saccadic efficiency. Machine-learning algorithms using fixation, saccade, scan path, and signal-based features demonstrated classification accuracies ranging from approximately 80 to 95% with some studies reporting values approaching 99% under specific experimental conditions. Nevertheless, there was a significant heterogeneity in datasets, feature extraction methods, outcome definitions and validation schemes. Notably, numerous studies used proxy diagnostic labels, small or internally derived datasets, and internal cross-validation, which introduces the risk of overfitting and performance inflation. Explicit multimodal or multi-source modeling was identified in three of 23 studies involving combinations of gaze data with demographic, cognitive, linguistic, VR-bed, text-derived, saliency-map, or CNN-based features. Two additional studies used EOG as an alternative eye-movement signal modality rather than true multi-source fusion. Therefore, the evidence base remains dominated by eye-movement and gaze-derived approaches, while multimodal evidence should be interpreted as emerging and exploratory. Altogether, eye-movement based computational systems are a promising, non-invasive method for scalable dyslexia screening. PROSPERO, identifier (RD42061332527).
Tick-borne diseases (TBDs) are significant causes of febrile illnesses in humans. Healthcare workers' (HCWs) knowledge, attitudes, and practices (KAP) regarding ticks and TBDs may influence prognosis. This study is aimed at assessing the KAP and associated factors among HCWs regarding TBD to provide evidence to improve preventive strategies, diagnosis, and enhance patient outcomes. The electronic questionnaires were used to collect data on respondents' demographics and KAP on TBD. Of 401 HCWs, the median age was 29 (interquartile range (IR): 26-39). More than half of all HCWs (58.4%) were aged ≤ 30 years, and 51.1% were male. Only 12.2% received training outside Tanzania, 45.4% were medical doctors. Among all HCWs, 47.1% had TBD knowledge above the median. Regarding attitude of HCWs toward TBD, 208 (97.7%) out of 214 who had some awareness of TBD recognized the knowledge gap and a need for further training on TBD. After adjusting for other factors, being male (adjusted odds ratio (AOR) = 1.57, 95% CI: 1.01-2.46), having a postgraduate education (AOR = 3.05, 95% CI: 1.45-6.39), and having received TBD training (AOR = 2.08, 95% CI: 1.28-3.40), remained significantly associated with TBD knowledge above median. Similarly, after adjusting for other factors, being male (AOR = 0.57, 95%CI = 0.37-0.89), having postgraduate education (including physicians; AOR = 0.28, 95%CI = 0.13-0.61), and having awareness on TBD were significantly associated with practice above median toward TBD prevention. The knowledge gap on TBD among HCWs was substantial as more than half of the HCWs had knowledge score below median about TBD. On attitude, almost all HCWs who had some awareness of TBD were in need of training on TBD. More than half of HCWs practiced TBD preventative actions below median. Targeted training to improve and expand HCWs' knowledge, attitudes, and practices regarding TBD are expected to enhance early detection, improve patient outcomes, reduce transmission rates, and strengthen public health response efforts.
ContextPhysical inactivity is a major contributor to chronic disease, disability, and premature mortality in the United States and is associated with substantial healthcare expenditures. Although regular physical activity improves health outcomes, individuals with chronic conditions often require structured supervision to exercise safely and effectively. Building upon this context, the objective of this review is to synthesize evidence on the clinical, psychosocial, and economic impacts of supervised exercise interventions (SEIs) and to examine policy and implementation factors influencing their adoption. To achieve this objective, a structured literature review was conducted, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework.Eligibility CriteriaStudies published in English between 2010 and 2024 that involved adults aged 18 years or older and evaluated supervised exercise interventions with reported clinical, psychosocial, economic, or policy-related outcomes were included.Study SelectionPubMed, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched using predefined keywords. Reference lists of relevant studies were also reviewed to identify additional eligible articles.Main Outcome MeasuresClinical outcomes (eg, mortality, aerobic capacity, HbA1c), psychosocial outcomes (eg, adherence, depression, quality of life), and economic and policy outcomes (eg, cost-effectiveness, reimbursement).ResultsTwenty studies met the inclusion criteria. Across cardiovascular, metabolic, oncologic, pulmonary, and geriatric populations, SEIs were associated with improved clinical outcomes, including reduced rehospitalization and mortality, enhanced aerobic capacity, improved glycemic control, and reductions in fatigue and depressive symptoms. SEIs were cost-effective across disease categories, with several studies reporting healthcare cost savings within 1 year. However, disparities in referral and participation persisted among racial and ethnic minorities, rural populations, and individuals with lower socioeconomic status.ConclusionSEIs are effective and scalable strategies for managing chronic diseases and preventing secondary complications. Evidence indicates that supervised exercise improves clinical, psychosocial, and economic outcomes across diverse populations. Expanding reimbursement and strengthening integration within health systems will be critical to improving equitable access to SEIs.