The role of statins in reduction of acute exacerbations in chronic obstructive pulmonary disease (COPD) remains unclear. This systematic review and meta-analysis aimed to determine the preventive effect of statins on exacerbations in COPD patients. A systematic search was conducted in PubMed, Embase, Cochrane Library, and clinicaltrials.gov, without language restrictions. Randomized controlled trials (RCTs) on treatment of COPD with statins, compared with placebo, were reviewed. Estimated effects of included studies were pooled as risk ratios (RRs) and weighted mean differences (WMDs), with 95% confidence intervals (CIs). The certainty of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework. Three RCTs (enrolling 1190 patients) met the inclusion criteria. Compared with placebo, the exacerbation related hospitalization rate (RR 0.87, 95% CI 0.77 to 0.97; GRADE = low) and severe exacerbation rate (RR 0.88, 95% CI 0.78 to 0.99; low) were significantly lower in statins groups. There was no statistically significant difference in moderate exacerbation rate (RR 0.71, 95% CI 0.48 to 1.04; very low), annualized exacerbation rate (WMD -0.21 per person-year, 95% CI -0.61 to 0.20; very low), and annualized moderate-to-severe exacerbation rate (WMD -0.21 per person-year, 95% CI -0.57 to 0.15; very low) between the two groups. In the absence of single-inhaler triple therapy (SITT), statins were associated with a reduction in severe exacerbations and hospitalization rates of COPD. Given the limitations of the evidence we found, further large-scale, high-quality studies are needed to clarify the impact of statins on prognosis and the beneficiary population. PROSPERO CRD42025644971.

Patient-Reported Outcomes (PROs) are increasingly important in oncology, providing a unique patient perspective for evaluating treatment efficacy, symptom burden, and quality of life. The psychometric properties of Patient-Reported Outcome Measures (PROMs), particularly test-retest reliability, form the cornerstone of ensuring the stability and credibility of their measurement results. However, the clinical status of cancer patients often fluctuates rapidly due to disease progression or treatment side effects, posing unique methodological challenges for assessing test-retest reliability, especially in determining appropriate retest intervals and evaluating patient stability. Currently, there is a lack of systematic reviews on methodological elements of test-retest reliability studies for PROMs in cancer populations. This study aims to systematically search, summarize, and critically appraise published studies on test-retest reliability of PROMs in cancer patients, focusing on their methodological quality and key design elements, including retest intervals, sample size, patient stability assessment, and statistical analysis methods. This protocol adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. A comprehensive literature search will be conducted across five electronic databases (PubMed, EMBASE, CINAHL, PsycINFO, Web of Science) and two supplementary sources (ClinicalTrials.gov and PROQOLID) from their inception to December 2025. All original studies reporting test-retest reliability assessments of PROMs for adult cancer patients will be included. Two reviewers will independently conduct literature screening, data extraction, and methodological quality assessment. Extracted data will include basic study information, PROMs characteristics, patient characteristics, and detailed information on test-retest reliability design. Methodological quality will be appraised using the COSMIN Risk of Bias checklist, while reporting completeness will be evaluated against the COSMIN reporting guideline (version 2.0). Due to study heterogeneity, we will perform a narrative synthesis, summarizing results in tables and figures. This study will be the first to comprehensively depict the current status of test-retest reliability assessment of PROMs in oncology, identifying strengths and weaknesses in current practices. The findings will provide evidence-based methodological recommendations for designing and reporting PROMs validation studies in cancer populations. By enhancing the rigor of PROMs validation studies, this research ultimately aims to improve the quality of patient-centered evidence in cancer clinical research and practice. PROSPERO CRD420251070381.

Lifestyle diseases are commonly described as conditions arising from long-term behavioural patterns, occupational exposures, and broader civilisational and environmental determinants. Although the term is frequently used in public health and clinical literature, its conceptual boundaries remain heterogeneous and inconsistently defined. While extensive research exists on individual non-communicable diseases and lifestyle risk factors, no comprehensive scoping review has systematically mapped how "lifestyle diseases" are defined, operationalised, and studied across behavioural, occupational, environmental, and technological domains. This protocol outlines a systematic scoping review that aims to map the scientific literature on lifestyle diseases, identify which clinical conditions are labelled as such, examine underlying determinants and contributing factors, describe reported prevention strategies, and identify research gaps in the field. The review will be conducted following the methodological framework of Arksey and O'Malley, refined by Levac et al., and reported in accordance with the PRISMA-ScR guidelines. Five electronic databases (MEDLINE/PubMed, Scopus, CINAHL, Web of Science, and APA PsycInfo) will be searched for peer-reviewed literature published from 1990 to the date of search execution. Eligibility criteria will be defined using a structured framework and will include studies that explicitly address or conceptualise lifestyle diseases. Findings will be synthesised descriptively and presented using thematic categorisation, tabular summaries, and graphical visualisations to map disease categories, determinants, preventive approaches, and geographic distribution. This review will provide a structured overview of how lifestyle diseases are defined and studied in the scientific literature. By clarifying conceptual boundaries and identifying research gaps, the review aims to support interdisciplinary research and inform future public health investigations.

Combined oral contraceptives (COCs) are widely used among premenopausal women because of their contraceptive efficacy and favourable safety profile. However, concerns remain regarding their potential association with depressive symptoms and major depressive disorder (MDD), possibly mediated through alterations in neurochemical, inflammatory, and neurotrophic biomarkers. Hence, this study aims to provide a comprehensive synthesis of the available evidence on the link between COC and selected biomarkers associated with MDD risk and to assess whether the reported outcome is associated with the generational type of COC. This systematic review protocol was prepared following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) 2015 statement. An extensive search will be conducted on Embase and MEDLINE through the Ovid and EBSCOhost interface. The Cochrane Library will be searched to augment relevant sources of information. Two reviewers will independently screen for eligible studies using a pre-defined criterion. The risk of bias and quality of included studies will be assessed via Cochrane risk of bias tools. The certainty of evidence will be assessed via Grading of Recommendations, Assessment, Development and Evaluation Assessment (GRADE) tool. The rate of depression among women of reproductive age remains alarming due to various factors related to childbearing, which may limit their economic contribution and full participation in societal development. As a result, some of these women may opt for the use of available contraceptive choices, such as COC, which are linked to the onset of MDD in high-risk individuals. More so, the change in hormonal milieu influences the secretion and physiologic role of histamine and other neurotransmitters, such as serotonin, among others, thereby contributing to an increased risk of MDD in premenopausal women. Thus, unravelling the role of COC in the secretions of these biomarkers and their contribution to the onset of MDD among premenopausal women is essential in filling the research gap that will provide insight and guidance when making informed decisions about the available contraceptive choices. The uniqueness of our review also extends to the focus on biomarker-based evidence of mood disorder risk in COC users, which may provide mechanistic insight and inform future risk-stratification research to assess the risk of MDD, both in and outside the clinical setting, among high-risk individuals. PROSPERO CRD42021284745.

Dexmedetomidine (DEX) has been consideredan effective adjunct to dental localanesthetics.Uncertaintyaboutits efficacy and safetyindental usestill remains. This study isprimarilydesignedtoevaluatethe effectiveness and safety of DEX as an adjunct to local anesthesia in dental procedures. This study followed PRISMA guidelines. The protocol was registered in PROSPERO (CRD420251035026). Outcomes were onset time, anesthesia duration, postoperative analgesia duration, post operative pain, sedation, and adverse events. Searches covered PubMed, Cochrane Library, Ovid, Embase, Web of Science, and Google Scholar. Risk of bias was assessed with Cochrane RoB 2 and ROBINS-I. RevMan 5.1 pooled mean differences and assessed heterogeneity. Sensitivity analyses and publication bias were examined in Comprehensive Meta-Analysis v3.7. Certainty of evidence was rated with GRADE. This meta-analysis encompassed sixteen controlled clinical trials comprising 658 participants. The addition of DEX decreased onset time by 48.78 s (95% CI: 64.22 to 33.35 s, p < 0.00001). This reduction is unlikely to be clinically significant in routine dental practice. DEX extended anesthesia duration by 31.10 min (95% CI: 13.77 to 48.43 min, p = 0.0004), and prolonged postoperative analgesic duration by 186.19 min (95% CI: 109.09 to 263.29 min, p < 0.00001), although both findings demonstrate substantial uncertainty due to unexplained heterogeneity (I2 = 94% and 99%, respectively). Hemodynamic evaluation revealed no clinically significant alterations in heart rate, intraoperative systolic and diastolic pressure, and oxygen saturation (p > 0.05 for all parameters). Minor variations in heart rate and blood pressure did not advance to hypotension or bradycardia. Dexmedetomidine as an adjunct to dental local anesthesia may reduce onset time, extend anesthesia duration, and postoperative analgesia with a favorable hemodynamic safety profile; however, substantial unexplained heterogeneity and modest sample size limit confidence in these estimates. Current evidence does not support routine clinical use; standardized, adequately powered trials are needed before definitive recommendations can be made.

The use of computerised clinical decision support systems (CDSSs) holds considerable potential in enhancing healthcare delivery by improving patient safety, practitioner performance, and patient outcomes. However, despite the numerous reported advantages of CDSSs, their adoption remains restricted, thereby compromising the full realisation of their potential. To enable a profound evaluation and successful implementation of these systems, it is imperative to identify the reasons for their limited uptake. The objective of this study is to provide a comprehensive overview of the barriers and facilitators to the implementation and adoption of decision support systems across healthcare settings. This study was reported in accordance with the Preferred Reporting Items for Overviews of Reviews (PRIOR) statement. A systematic search was conducted in the databases PubMed, IEEE Xplore, Scopus, and Web of Science from inception to 15 October 2024, targeting at review articles of primary studies focusing on the identification and reporting of barriers and facilitators to the implementation and adoption of CDSSs across healthcare settings. The risk of bias of the included reviews was assessed with the Risk of Bias in Systematic Reviews (ROBIS) tool, and the primary study overlap was calculated using the corrected covered area method. All data on barriers and facilitators to the implementation and adoption of CDSSs were extracted from the included reviews, synthesised through a mapping of identical factors, and ranked according to their frequency of occurrence. Of the 1640 records retrieved through database searches, 30 reviews were included in this overview, which summarised the findings of 721 unique primary studies. A total of 101 distinct factors influencing the implementation and adoption of CDSSs were identified and could be categorised into the overarching categories of human, technology-related, and contextual factors. The following six factors were reported most frequently: usability, usefulness/perceived benefits, organisational readiness, training, trust, and workflow integration. The findings of this study highlight the diversity of factors that influence a successful implementation of CDSSs and emphasise the need for their comprehensive evaluation that goes beyond the assessment of general performance aspects but takes into account human and contextual factors. PROSPERO CRD42024507614.

The term ultra-rare diseases was first introduced in 2004 by the National Institute for Health and Care Excellence during the evaluation of drugs indicated for conditions with a prevalence of fewer than 1 case per 50,000 people. This review aims to systematically examine the clinical evidence synthesis practices used worldwide to support decision-making on the incorporation of new drugs for treating ultra-rare diseases and to identify the definitions of ultra-rare diseases adopted internationally. This review follows the JBI methodology for reviews of textual evidence, including narrative reports, expert opinions, and policy documents. Eligible sources will include texts and studies addressing patients with ultra-rare diseases. The phenomenon of interest is the set of methods and practices used for synthesizing clinical evidence to inform the incorporation of health technologies for ultra-rare genetic diseases. This review focuses on the context of global health technology assessment (HTA) agencies. Searches will be conducted in the PubMed, Embase, CENTRAL, and Virtual Health Library databases, as well as on the websites of major international HTA agencies. Study selection, data extraction, and risk-of-bias assessment will be performed independently and in duplicate. Proportional meta-analyses will be conducted to summarize the frequency of study designs, outcomes, and recommendations according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach applied by HTA agencies when assessing drugs for ultra-rare diseases. The findings of this review are expected to inform the development of methodological guidelines for evidence synthesis in ultra-rare diseases-from defining ultra-rare conditions to establishing best practices for evidence generation and evaluation. In the long term, the results may guide strategies to address methodological challenges in primary studies on the efficacy and safety of health technologies for ultra-rare diseases, such as strengthening national patient registries and promoting multicenter collaborative research. PROSPERO CRD420250652106.

There are currently two opposing hypotheses regarding the risk factors for acquisition, colonisation and infection with multidrug-resistant Pseudomonas aeruginosa (MDR-PA) in the intensive care unit (ICU). Acquisition could be either endogenous or exogenous or both. It is of great interest to estimate pooled prevalence and describe individual and environmental factors associated with the colonisation and infection with MDR Pseudomonas aeruginosa in intensive care units. This systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol of this review has been registered under CRD42021233832 in the International Prospective Register of Systematic Reviews (PROSPERO) and has been published on Systematic review on November 2022All types of studies carried out in intensive care units (ICUs) were included. MEDLINE (Pubmed), EMBASE (OVID), the Cochrane Library (Wiley), Web of Science, CINAHL (EBSCOHost), LILACS (BIREME), Google Scholar and Open Grey were searched from 1983 to 2023 and the results of electronic searches were uploaded to Rayyan software. The methodological quality of the studies was assessed using the National Heart, Lung, and Blood Institute Critical Appraisal Tools.TheI2test was performed to assess the statistical heterogeneity among the included studies. The publication bias was assessed by using the funnel plot and Egger's test. Descriptive analysis and meta-analysis were performed. Fixed effect model were used to calculate the surveyed prevalence and odds ratio (OR) with their respective 95% confidence intervals (95% CI). A total of 10,791 articles were identified, of which 13 were retained for descriptive analysis and 8 for meta-analysis. The majority of these 13 studies were conducted in Western countries. Methods were heterogeneous and few studies addressed environmental factors. The pooled prevalence of MDR-PA in the ICU was 4% (95% CI: 0%-11%). Identified risk factors were: length of stay in ICU (> 8days), mechanical ventilation with OR: 3.19; 95% CI: 2.25-4.53, use of invasive devices with OR: 2.97; 95% CI: 2.40-3.68 (use of central venous catheter with OR: 3.16 95% CI: 1.87-5.33, the use of urinary catheters with OR: 2.65; 95% CI: 2.05-3.44, the use of parenteral nutrition with OR: 2.43; 95% CI: 1.15-5.16 and the use of arterial catheters with OR: 7.00; 95% CI: 2.77-17.68) and the use of antibiotics with OR: 3.69; 95% CI: 3.16-4.27 (carbapenem with OR: 4.12; 95% CI: 3.29-5.16, quinolones with OR: 3.31; 95% CI: 2.45-4.47, bectalactam with OR: 3.58; 95% CI: 2.4-5.24, and aminoglycosides with OR: 3.32; 95% CI: 2.33-4.73) and environmental factors. All this suggest that acquisition or infection by MDR-PA in ICU could be due to endogenous and exogenous transmission. Due to the few numbers of studies analysed, further investigation with more studies is needed to draw definitive conclusions. The protocol of this review has been registered under CRD42021233832 in PROSPERO and has been published on Systematic review on November 2022. Eyebe et al. (Syst Rev 11:270, 2022).

The number of older people in Germany has risen steadily in recent decades. One in four people is now aged 65 or over. As people age, their health problems tend to increase, as do their fundamental care needs. Nurses play a key role in addressing these needs through a holistic approach. To fulfil this responsibility effectively, it is necessary to examine existing nursing research on the fundamentals of care for older people and to identify gaps in the current evidence base. Therefore, we plan to conduct a mapping review with the aim of mapping the extent, range and nature of nursing research activities on the fundamentals of care, as defined in the physical, psychosocial and relational components of the Integration of Care dimension of the Fundamentals of Care Framework for older people in Germany. We will search the electronic databases PubMed/MEDLINE, CINAHL, CareLit and GeroLit, the catalogue of the German Federal Ministry of Research, Technology and Space and the German National Library for publications on nursing research based on the Integration of Care dimension of the Fundamentals of Care Framework among older people (≥ 65years). There will be no time limit. We will include studies published in English and German. Initial screening of the first ten per cent of titles and abstracts and other stages will be carried out by two independent researchers. This process will be repeated until full agreement between the researchers. Any discrepancies will be resolved with consultation of a third reviewer. Results will be reported in a narrative synthesis and complemented by tabular and numerical presentations. To the best of our knowledge, this mapping review will be the first to provide an overview of current nursing research on the fundamentals of care for older people in Germany. The inclusion of German-language texts and the absence of time limits in this review are intended to complement previous reviews. The planned mapping review will also identify the evidence gap in research in this area and contribute to the determination of future scientific research in Germany. Consequently, the findings of the mapping review could be of great interest to nurses and other health professionals for evidence-based practice, research and educational programmes. In addition, the data can be used to develop a programme for the provision of age-friendly and caring living conditions for older people in the future. The protocol was registered with Open Science Framework (osf.io/9e3uv).

Indigenous populations in high-income countries (HICs) experience disproportionately high rates of food insecurity, particularly in remote regions where high costs, poor quality, and limited variety limit access to perishable foods. Fragile perishable food supply chains (PFSCs) further compound these vulnerabilities. Although existing reviews have examined nutrition policies, socioeconomic interventions, and retail food environments, they have largely overlooked the operational and logistical challenges associated with perishable food supply chain management (PFSCM). Moreover, no review has systematically mapped the reported practices in the literature to address these challenges across interconnected supply chain levels, including procurement, transportation, distribution, and retail. To address these gaps, this systematic scoping literature review (SSLR) will employ a food access framework to synthesize the challenges and practices of PFSCM in remote Indigenous communities across 17 HICs. This SSLR will follow the Joanna Briggs Institute (JBI) methodology for scoping reviews and will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Protocols (PRISMA-P). A three-step JBI search strategy will be used to identify relevant published and unpublished evidence, including grey literature. Databases will include IEEE, MEDLINE (Ovid), ABI/Inform Global (ProQuest), CAB Abstracts, and Web of Science (Core Collection). Grey literature will be sourced from the Grey Source Index, Web of Conferences, government publications, OpenDOAR, OpenAIRE, and SSRN. Sources will be included if published in English between 1996 and 2024 and if they address PFSCM (phenomenon), perishable food access (concept), and remote Indigenous communities in HICs (context). Data will be extracted using a structured framework. Descriptive statistics will summarize study characteristics, and thematic analysis will be conducted to identify patterns in PFSCM challenges and reported practices. NVivo will support data management, and results will be reported in accordance with PRISMA-ScR guidelines. This review will provide the first systematic scoping synthesis of PFSCM challenges and reported practices in remote Indigenous communities across HICs. By integrating a food access framework with a systems-oriented supply chain perspective, the review will extend prior work that has primarily focused on retail or policy interventions and limited geographic settings. The resulting evidence map and conceptual framework will support future research, policy dialogue, and context-sensitive planning to strengthen perishable food systems and food access in remote Indigenous settings. Open science framework registration: https://osf.io/kqpvn.