Prolonged mechanical ventilation (MV) may lead to poor outcomes. This systematic review and meta-analysis aimed to investigate the effects of diaphragmatic stimulation on the duration of MV (DMV), the intensive care unit (ICU) length of stay (ILOS), the proportion of patients successfully weaned and maximum inspiratory pressure (MIP) in patients with prolonged MV.

Systematic review and meta-analysis.

Cochrane library, Embase, Pubmed and Web of Science up to December 2024.

Randomised controlled trials (RCTs) and cohort studies evaluating the outcomes of patients with prolonged MV after diaphragmatic stimulation were included up to December 2024.

All articles were independently assessed by two reviewers, and a third reviewer was consulted to resolve different evaluations. Newcastle-Ottawa Scale (NOS) and the Cochrane Collaboration tool in RevMan V.5.3 software (The Cochrane Collaboration, 2014) were applied to assess the quality of cohort studies or RCTs. The meta-analysis was carried out with RevMan V.5.3 software, applying a random-effects model and presenting results with 95% CIs. Heterogeneity was examined using the Higgins I² statistic, and subgroup analyses were carried out to investigate possible contributors to heterogeneity. Sensitivity analyses were further conducted in Stata 18.0 (StataCorp LP, College Station, TX, USA). Potential publication bias was assessed through funnel plots combined with Egger’s regression test. For each outcome, the certainty of evidence was appraised according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Ten studies involving 802 patients (349 received diaphragmatic stimulation) were included. The meta-analysis indicated that patients receiving diaphragmatic stimulation had shorter DMV (mean differences (MD) –5.69 d, 95% CI –10.99 to –0.39, p=0.04) and ILOS (MD –5.48 d, 95% CI –10.72 to –0.24, p=0.04). The proportion of patients successfully weaned was larger in patients with diaphragmatic stimulation (risk ratios (RR) 1.25, 95% CI 1.01 to 1.53, p=0.04). The MIP increased compared with the control group.

The promising results suggest that diaphragmatic stimulation has the potential to shorten DMV and ILOS and accelerate weaning from ventilator.

CRD42024599512.

To estimate the burden, trends, and inequalities of brain and central nervous system cancer (CNS cancer) among adults at global, regional and national level from 1992 to 2021.

Population-based study.

Adults aged 20–64 years from 21 regions and 204 countries and territories (Global Burden of Disease and Risk Factors Study 2021) from 1992 to 2021.

Our primary outcomes comprised age-standardised prevalence, incidence, mortality and disability-adjusted life-years (DALYs) for CNS cancers. The analytical framework incorporated temporal trend analysis through annual percentage change (APC) and average APC (AAPC) metrics, complemented by Bayesian age-period-cohort modelling to assess demographic influences. We employed predictive modelling with decomposition techniques to evaluate contributions from age structure shifts, population dynamics and risk factor modifications, while spatiotemporal Gaussian process regression enabled robust smoothing and trend estimation across continuous time-space dimensions. The study specifically applied frontier analysis methodologies to examine epidemiological patterns of prevalence, incidence, mortality and DALYs within the 20–64 years adult population.

From 1992 to 2021, the global age-standardised prevalence (AAPC 1.04 (95% CI 0.91 to 1.18); p

From 1992 to 2021, the global age-standardised prevalence and incidence of CNS cancer among adults aged 20–64 years increased, while age-standardised DALYs and mortality decreased. The most significant increase in prevalence and incidence was observed among those aged 20–24 years. The most significant decrease in DALYs and mortality was observed among those aged 40–44 years. The rate of increase in prevalence and incidence was lower in high SDI countries compared with low-SDI countries. DALYs and mortality began to decline in high-SDI countries, but these indicators continue to rise in low-SDI nations. Our predictive analysis found that from 2021 to 2050, the number of CNS cancer cases among people aged 20–64 years will be on the rise globally, which is expected to increase from 186 891 to 245 942, an increase of 31.6%.

Significant inequalities exist in age-standardised prevalence, incidence, DALYs and mortality of CNS cancer among countries with varying sociodemographic indices. These disparities highlight the urgent need for targeted clinical guidelines and equitable distribution of global health resources.

We aimed to understand the factors affecting psychological well-being of patients undergoing haemodialysis (HD). First, we explored how physical symptom severity, emotional distress and social support influence psychological well-being. Second, we examined the impact of different types of social support. Third, we investigated whether any variables mediate the relationship with psychological well-being.

A cross-sectional study, a type of observational design, was conducted on patients at a medical centre in Taiwan in 2020.

A total of 117 outpatients who had undergone regular HD for at least 3 months were enrolled.

The psychological well-being was assessed through self-report questionnaires.

We found that emotional distress (β=–0.25, p=0.033) had a significant negative impact on psychological well-being. However, the presence of appraisal support mitigated this effect. Specifically, appraisal support fully mediated the adverse impact of emotional distress on psychological well-being. In addition, the severity of physical symptoms was generally mild and did not influence psychological well-being.

Receiving appraisal support from family, friends and healthcare professionals not only alleviates emotional distress but also enhances psychological well-being both directly and indirectly among patients undergoing HD. Healthcare professionals should address issues of personal importance while serving as consultants, educators and evaluators to support patients in managing their chronic condition.

The management of autism spectrum disorder (ASD) involves a varied and comprehensive range of support services at various stages of an autistic individual’s life. In Thailand, parents/legal guardians of children with ASD often encounter challenges such as difficulty travelling from rural areas to access support services. The aim of the present study is to investigate the effectiveness of a computer-based intervention programme for caregivers of children with ASD called the Thai Early Intervention for Autism—Assistive Technology for Caregivers (TEI4A-ATC), designed and implemented by a multidisciplinary team.

160 children and their caregivers are being recruited. They will be randomised 1:1 into two treatment arms: access to TEI4A-ATC for the intervention group and standard care for the control group. Before enrolment, ASD diagnosis will be conducted using the Thai Diagnostic Autism Scale: children’s ASD scores will be determined using the Thai Autism Treatment Evaluation Checklist for evaluating communication, sociability and sensory/cognitive awareness and the Thai Early Developmental Assessment for Intervention for evaluating motor skills, social interaction, language development and problem-solving. Both assessment tools will be used again after 3 months of treatment. Similarly, the caregivers’ knowledge, attitude and practice (KAP) for ASD care will be assessed using a questionnaire at enrolment and again after treatment. Comparison of the children’s ASD scores and caregivers’ KAP responses between the treatment groups and before and after treatment will be performed based on the intention-to-treat principle.

This study was approved by the Human Research Ethics Committee for Mental Health and Psychiatry, Department of Mental Health, Ministry of Public Health (DMH.IRB.COA 037/2565). Written informed consent will be obtained from the participants prior to enrolment. The study’s findings may be disseminated through scientific publications and conference presentations. The results of the study will be shared with key stakeholders, including caregivers, psychiatrists, policymakers and the general public, via appropriate dissemination channels to aid in creating appropriate practice and policy guidelines.

This study was registered with the Thai Clinical Trials Registry (TCTR20240320010) on 20 March 2024.

Elder neglect by both informal and formal caregivers is common, particularly among persons with dementia, and has serious health consequences but is under-recognised and under-reported. Persons with dementia are often unable to report neglect due to memory and language impairments, increasing their vulnerability. Screening for elder mistreatment and initiation of intervention in primary care clinics may be helpful, but few evidence-based tools or strategies exist. We plan to: (1) develop a novel primary care screening tool to identify elder neglect in persons with dementia, (2) develop an innovative technology-driven intervention for caregivers and (3) pilot both for feasibility and acceptability in primary care.

We will use a multistep process to develop a screening tool, including a modified Delphi approach with experts, and multivariable analysis comparing confirmed cases of neglect in patients with dementia from the existing data registry to non-neglected controls. We will develop an evidence-based, technology-driven caregiving intervention for neglect with an expert panel and iterative beta testing. Following the development of the protocol for implementation of the tool and intervention with associated training, we will pilot test both the tool and intervention in older adult patients and caregivers. We will conduct provider focus groups and interviews with patients and caregivers to assess usability and will modify the tool and intervention. These studies are in preparation for a future randomised trial.

Initial phases of this project have been reviewed and approved by the Weill Cornell Medicine Institutional Review Board, protocol #22-06024967, with initial approval on 1 July 2022. We aim to disseminate our results in peer-reviewed journals, at national and international conferences and among interested patient groups and the public.

Unplanned pneumonia readmissions increase patient morbidity, mortality and healthcare costs. Among pneumonia patients, the middle-aged and elderly (≥45 years old) have a significantly higher risk of readmission compared with the young. Given that the 14-day readmission rate is considered a healthcare quality indicator, this study is the first to develop survival machine learning (ML) models using emergency department (ED) data to predict 14-day readmission risk following pneumonia-related admissions.

A retrospective multicentre cohort study.

This study used the Taipei Medical University Clinical Research Database, including data from patients at three affiliated hospitals.

11 989 hospital admissions for pneumonia among patients aged ≥45 years admitted from 2014 to 2021.

The dataset was randomly split into training (80%), validation (10%) and independent test (10%) sets. Input features included demographics, comorbidities, clinical events, vital signs, laboratory results and medical interventions. Four survival ML models—CoxNet, Survival Tree, Gradient Boosting Survival Analysis and Random Survival Forest—were developed and compared on the validation set. The best performance model was tested on the independent test set.

The RSF model outperformed the other models. Validation on an independent test set confirmed the model’s robustness (C-index=0.710; AUC=0.693). The most important predictive features included creatinine levels, age, haematocrit levels, Charlson Comorbidity Index scores, and haemoglobin levels, with their predictive value changing over time.

The RSF model effectively predicts 14-day readmission risk among pneumonia patients. The ED data-based model allows clinicians to estimate readmission risk before ward admission or discharge from the ED, enabling timely interventions. Accurately predicting short-term readmission risk might also further support physicians in designing the optimal healthcare programme and controlling individual medical status to prevent readmissions.

Systemic immune-inflammation index (SII) is a biomarker of inflammatory conditions; however, no scoring system has been evaluated for predicting mortality in patients with renal failure in intensive care unit (ICU). This study aimed to determine associations between SII level and mortality in patients with renal failure.

Using the Medical Information Mart for Intensive Care IV (V.2.0) database (USA), this retrospective study included 837 patients who were admitted to ICU with end-stage renal disease (ESRD), between 2008 and 2019.

Cox proportional-hazards models were used to evaluate correlations between SII and outcomes, expressing results as hazard ratios (HRs) with 95% confidence intervals (95% CIs). Regression analysis was used to determine associations between variables and SII.

In total, 837 adult patients from a total of 76 943 patients admitted to ICU were included, comprising 59.60% males with mean age 62.27±14.9 years and mean BMI 28.36±7.43 Kg/m². Using median SII (1628 X 10⁹ /L) as cut-off value, high (≥ 1628X10⁹ /L) SII was also associated with an increased risk of ICU mortality (HR 1.97 (95% CI 1.15 to 3.35), p=0.034), in-hospital mortality (HR 1.95 (95% CI 1.23 to 3.09), p=0.017) and total mortality (HR 1.30 (95% CI 1.07 to 1.58), p=0.024).

SII may predict mortality in critically ill patients admitted to ICU with ESRD. SII ≥ 1628x10⁹ /L correlates significantly with increased ICU mortality, in-hospital mortality and total mortality.

To determine the golf-related characteristics of spinal injuries among professional golfers in South Korea.

Cross-sectional survey study.

Online survey in South Korea.

A total of 439 professional active golfers (226 males and 213 females) in South Korea completed our survey.

Data collected included experiences of cervical (C)-spine and thoracic and lumbar (T/L)-spine injuries, demographics and golf-related characteristics among Korean professional golfers. Logistic regression analysis was used to explore any potential factors of golf-related spinal injuries.

A total of 33.7% (148 of 439) experienced total spine injury in professional active golfers, presenting 15.5% of C-spine injuries and 21.9% of T/L-spine injuries. Multivariate logistic regression analysis showed that left-handed (OR, 2.79; 95% CI, 1.20 to 6.47 compared with right-handed) and fingertips

Nearly 33.7% of Korean professional active golfers have experienced golf-related spinal injuries. These injuries appear to make left-handed golfers more vulnerable; however, adequate flexibility may offer protection against such injuries, suggesting the need for tailored preventative strategies based on individual biomechanical profiles.

To estimate the proportion and correlates of self-reported financial difficulty among patients with multiple myeloma (MM) or chronic lymphocytic leukaemia (CLL).

Sixty-six US community and minority oncology practices affiliated with the National Cancer Institute Community Oncology Research Programme (NCORP).

A total of 521 patients (≥18 years) with MM or CLL consented and 416 responded to a survey (completion rate=79.8%). Respondents had a MM diagnosis (74.0%), an associate degree or higher (53.4%), were White (89.2%), insured (100%) and treated with clinician-administered drugs (68.0%).

Observational, theoretical model and protocol-based patient survey administered between May 2019 and June 2020.

Financial difficulty was assessed using a single-item measure, the EORTC QLQC30: ‘Has your physical condition or medical treatment caused you financial difficulties in the past year?’ and using an ‘any-or-none’ composite measure of 22 items assessing financial difficulty, worries and the use of cost-coping strategies. Multivariable logistic regression models assessed the association of financial difficulty with diagnosis, socioeconomic and treatment characteristics.

About 16.8% reported experiencing financial difficulty using the single-item measure and 60.3% using the composite measure. Most frequently endorsed items in the composite measure were financial worry about having to pay large medical bills related to cancer and difficulty paying medical bills. Financial difficulty using the single-item measure was associated with having MM vs CLL (adjusted OR (aOR), 0.34; 95% CI, 0.13 to 0.84; p=0.02), having insurance other than Medicare (aOR, 2.53; 95% CI, 1.37 to 4.66; p=0.003), being non-White (aOR, 2.21; 95% CI, 1.04 to 4.72; p=0.04) and having a high school education or below (aOR, 0.36; 95% CI, 0.21 to 0.64; p=0.001). Financial difficulty using the composite measure was associated with having a high school education or below (aOR, 0.62; 95% CI, 0.41 to 0.94; p=0.03).

US patients with MM and CLL report financial difficulty, especially those with low socio-economic status. Interventions are needed to mitigate patients’ financial difficulty.

NCT03870633.

To evaluate the incidence and risk factors for psychiatric disorders, including depression and anxiety, and assess the risk of suicide in patients with polymyositis (PM) and dermatomyositis (DM).

Retrospective cohort study.

Data were obtained from Taiwan’s National Health Insurance Research Database (NHIRD) between 2000 and 2018.

A total of 3477 patients with PM/DM and 13 908 age- and sex-matched non-PM/DM controls were included in the study.

The primary outcome was the incidence and risk of psychiatric disorders in patients with PM/DM compared with controls. Secondary outcomes included the identification of risk factors for psychiatric disorders, mortality and suicide risk in the PM/DM cohort.

The incidence rate ratio (IRR) of psychiatric disorders was significantly higher in the PM/DM cohort than in controls (IRR 1.62, 95% CI 1.39 to 1.89), with depression being the most prevalent disorder (IRR 2.25, 95% CI 1.83 to 2.75). Key risk factors included female sex, intravenous steroid therapy, and high-dose oral steroid use. Additionally, the PM/DM cohort exhibited a higher mortality rate (IRR 3.4, 95% CI 3.15 to 3.67) and elevated suicide risk (IRR 1.99, 95% CI 0.96 to 3.86) compared with controls.

Patients with PM/DM face a significantly higher risk of psychiatric disorders, mortality and suicide. Integrating mental healthcare into the routine management of PM/DM is crucial to improving patient outcomes and reducing mortality. Future research should focus on the impact of early psychiatric interventions on survival outcomes in this population.

To examine the feasibility, safety and perceived patient response of a combined repetitive transcranial magnetic stimulation (rTMS) and quadriceps strengthening exercise intervention for knee osteoarthritis.

A two-arm, participant-blinded, therapist-blinded and assessor-blinded, randomised controlled trial with additional follow-up of pain and function at 3 months. Participants were randomised to receive active rTMS+exercise (AR+EX) or sham rTMS+exercise (SR+EX) twice weekly for 6 weeks while completing home exercises twice a week. Primary outcomes included recruitment rate, treatment attendance, dropouts, willingness to undergo therapy (11-point Numeric Rating Scale, ‘not at all willing’=0 and ‘very willing’=10), success of participant, therapist and outcome assessor blinding, adverse events and Global Perceived Effect Scale. Secondary outcomes were pain, function and measures of physiological mechanisms.

86 people were screened, 31 (36%) were randomised, 28 (90%) completed the treatments and 3 (10%) dropouts at 3-month follow-up. Both groups had high treatment attendance (98.4% and 100%). All participants scored at least 7 on the willingness to undergo therapy scale. Blinding was successful. No adverse events were reported. At the postintervention assessment, 80% in the AR+EX group and 75% in the SR+EX group reported an improvement on the Global Perceived Effect Scale. Both groups demonstrated within-group improvements in pain at the postintervention assessment but not at the 3-month follow-up. Function improved only in the AR+EX group at the postintervention assessment.

Combined rTMS and quadriceps strengthening exercise intervention for knee osteoarthritis is feasible, safe and well-received. A full-scale trial is justified to assess the clinical benefits of this novel treatment.

ACTRN12621001712897.

Stroke is a leading cause of death and disability worldwide. Stroke survivors and their caregivers often face profound social isolation and various participation restrictions, resulting in frustration and adverse health outcomes. Dyad-focused interventions, which address both survivor and caregiver needs, are essential during the transition process. However, few interventions equally prioritise the outcomes of both survivors and caregivers. This study aims to evaluate the efficacy of a newly developed dyad-focused strategy training intervention in enhancing participation among stroke survivors and their caregivers.

This study employs a single-blind, parallel-group randomised controlled trial with allocation concealment and assessor blinding. We aim to enrol 138 stroke survivor-caregiver dyads, randomly assigned in a 1:1 ratio to either the experimental intervention group or the control group. Both groups will receive their usual rehabilitation plus 45–60 min sessions of the intervention twice weekly for a total of 12 sessions. Outcome measures, including the Participation Measure-3 Domains, 4 Dimensions, General Self-Efficacy Scale and Activity Measure for Post-Acute Care, will be collected at baseline, post-intervention and at 3-month, 6-month and 12-month follow-ups. Data will be analysed using multiple linear regression and mixed-effects regression models. Qualitative indepth interviews with participants, caregivers and therapists will be conducted post intervention, transcribed and thematically analysed.

Ethics approval was obtained from the Ethics Committee of Taipei Medical University (approval number: N202203083), National Taiwan University Hospital (approval number: 202207096RINA) and Taipei Tzu Chi Hospital (approval number: 11 M-107). Findings will be disseminated through presentations at scientific conferences and publications in peer-reviewed journals.

NCT05571150; Preresults.

To explore the association between perioperative SARS-CoV-2 infection and the postoperative complications during the breakout of the Omicron epidemic wave.

Observational retrospective cohort study. Multivariable logistic regression was performed to explore the association between the duration from surgery to COVID-19 diagnosis and the likelihood of postoperative complications.

A general hospital in China.

7927 patients aged 18 years and older who underwent surgical treatment between 1 December 2022 and 28 February 2023.

The outcome was a composite of postoperative adverse events that occurred within the initial 30 postoperative days.

Of all patients, 420 (11.76%) experienced postoperative complications. Compared with No COVID-19, preoperative COVID-19 within 1 week (pre-1w) exhibited a high risk of postoperative complications (adjusted OR (aOR), 2.67; 95% CI 1.50 to 4.78), followed by patients with pre-2w (aOR, 2.14; 95% CI 1.20 to 3.80). For patients with postoperative COVID-19 within 1 week (post-1w), the aOR was 2.48 (95% CI 1.48 to 4.13), followed by patients with post-2w (aOR 1.95; 95% CI 1.10 to 3.45), and those with post-3w (aOR 2.25; 95% CI 1.27 to 3.98). The risks of postoperative complications decreased roughly with the increase of the time interval between the surgery date and SARS-CoV-2 infection. Stratification analyses suggested that perioperative COVID-19 increased the risk of postoperative complications in older patients, smokers, those with comorbidities or experiencing moderate or severe COVID-19 symptoms.

Our findings reveal a significant time-dependent relationship between perioperative COVID-19 and postoperative complications, highlighting the importance of tailored preoperative risk evaluations, enhanced postoperative surveillance, and the implementation of effective postoperative COVID-19 prevention measures.

ChiCTR2300072473.

Identifying the underlying cause of acute coma is crucial for improving outcomes in this time-sensitive medical emergency. This study aimed to explore the clinical characteristics, incidence, causes and outcomes of acute coma.

A nationwide population-based retrospective cohort study.

Among 99 217 322 emergency department (ED) visits between 2000 and 2017, 419 480 acute coma events were identified. After excluding visits with only acute coma diagnosis codes lacking detailed information, individuals without socio-demographic data or those with prior nursing home residence or disability, a total of 205 747 first-ever acute coma cases constituted the final research cohort.

The primary outcomes included the acute coma event rate, incidence rates stratified by age and underlying causes categorised into 23 clinical groups by the Agency for Healthcare Research and Quality Clinical Classification Software (CCS). Secondary outcomes assessed were reversible coma, hospitalisation rates, 30-day mortality, 1-year medical utilisation and long-term functional outcomes. Cox regression models identified factors influencing long-term mortality.

The overall event rate for acute coma was 4.23 per 1000 ED visits, and the incidence rate was 0.93 per 1000 person-years. The median age of cases was 58.27 years (SD 23.04), with a male predominance (58.90%). Infection and central nervous system (CNS)-related causes were most prevalent. Of these cases, 45.49% experienced reversible coma, 41.66% required hospitalisation and the 30-day mortality group accounted for 12.85%. CNS and drug-related causes contributed to increased 30-day mortality, while psychiatric, alcohol, women’s health and perinatal care, and seizure are causes linked to reversible coma. Patients frequently required intensive care (26.54%), life-sustaining treatments (41.09%) or experienced disability (6.57%) within one year. Generalised estimating equations revealed significantly lower odds of reversible coma for CNS (adjusted OR (aOR), 0.68; 95% CI: 0.62 to 0.74; p

Infection and CNS disorders were identified as the most common aetiologies of acute coma, with CNS and drug-related causes significantly associated with increased short-term and long-term mortality. This study demonstrates the efficacy of using CCS groups for aggregating International Classification of Diseases codes in acute coma research, providing critical insights for enhancing clinical management and outcomes.

We aimed to establish a diagnostic system using retrospective data to predict difficult wean from mechanical ventilation.

A multicentre retrospective study

Five tertiary hospitals from China.

Critically ill patients received mechanical ventilation between January 2018 and December 2022.

The primary endpoint was success weaning from mechanical ventilation (>48 hours), reintubation or death, whichever occurred first.

Among 1365 initially screened patients, 703 patients (median age: 69 years; 63.02% male) were included. From 42 factors, 22 (p≤0.10) were identified for multivariate analysis. Subsequently, the lung injury score, brain natriuretic peptide level at 24 hours, 24 hour fluid balance, use of dexmedetomidine, spontaneous breathing trial (continuous positive airway pressure vs other) and endotracheal tube reinsertion were included in the predictive model. The area under the curve value was 0.8888 (95% CI: 0.8382, 0.9394). The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, likelihood ratio (LR)+ and LR– were 0.7559, 0.875, 0.9746, 0.3608, 0.7721, 6.0743 and 0.279, respectively. We established a nomogram model based on the optimal model.

A model with six factors was established to predict difficult wean from mechanical ventilation in critically ill patients. However, the model should be verified in future well-designed studies before being extended to other populations.

ChiCTR1900021432. Registered on February 21, 2019; Post-results.

Selection of antiseizure medications (ASMs) for newly diagnosed epilepsy remains largely a trial-and-error process. We have developed a machine learning (ML) model using retrospective data collected from five international cohorts that predicts response to different ASMs as the initial treatment for individual adults with new-onset epilepsy. This study aims to prospectively evaluate this model in Australia using a randomised controlled trial design.

At least 234 adult patients with newly diagnosed epilepsy will be recruited from 14 centres in Australia. Patients will be randomised 1:1 to the ML group or usual care group. The ML group will receive the ASM recommended by the model unless it is considered contraindicated by the neurologist. The usual care group will receive the ASM selected by the neurologist alone. Both the patient and neurologists conducting the follow-up will be blinded to the group assignment. Both groups will be followed up for 52 weeks to assess treatment outcomes. Additional information on adverse events, quality of life, mood and use of healthcare services and productivity will be collected using validated questionnaires. Acceptability of the model will also be assessed.

The primary outcome will be the proportion of participants who achieve seizure-freedom (defined as no seizures during the 12-month follow-up period) while taking the initially prescribed ASM. Secondary outcomes include time to treatment failure, time to first seizure after randomisation, changes in mood assessment score and quality of life score, direct healthcare costs, and loss of productivity during the treatment period.

This trial will provide class I evidence for the effectiveness of a ML model as a decision support tool for neurologists to select the first ASM for adults with newly diagnosed epilepsy.

This study is approved by the Alfred Health Human Research Ethics Committee (Project 130/23). Findings will be presented in academic conferences and submitted to peer-reviewed journals for publication.

ACTRN12623000209695.

Substance use disorders (SUDs) are common and highly disabling, causing serious long-term harm to people’s health. Despite the existence of evidence-based interventions for treating SUDs, many individuals remain symptomatic regardless of treatment, and relapse is common. Acupuncture has been examined for the treatment of SUDs, but available evidence is mixed. This comprehensive systematic review and meta-analysis aims to provide updated evidence which will include both English and Chinese studies to investigate the effectiveness and safety of different types of acupuncture for the treatment of alcohol, tobacco and illicit drug use disorders.

This protocol is guided by the Preferred Reporting Items for Systematic Reviews and Meta Analysis Protocols. A thorough search for relevant studies in multiple electronic databases (PubMed, Embase, PsycINFO, Cochrane Library, China National Knowledge Infrastructure, VIP, Wan-fang and China Biomedical Database) and clinical trial registries will be conducted. Population-Intervention-Comparator-Outcomes-Study design criteria will be adopted for study inclusion. Only randomised controlled trials analysing the efficacy and safety of acupuncture for SUDs will be included. Two reviewers will independently conduct the study selection, data extraction and quality assessment, and disagreements will be solved by a third senior reviewer or by contacting study authors. Frequency and quantity of substance use, abstinence rate, withdrawal symptoms, treatment drop-out and relapse rates are primary outcomes. Functional status, health-related quality of life and adverse events are secondary outcomes. The risk of bias and quality of evidence will be assessed by the revised Cochrane risk-of-bias tool for randomised trials and guidelines of the Grading of Recommendations Assessment, Development and Evaluation working group, respectively. When sufficient data is available, subgroup analyses will be performed to further compare the differences in the primary and secondary outcomes based on the type of substance use, acupuncture, co-intervention status, comparison group, measurement tools, length of follow-up, risk of bias of included studies and countries of studies conducted.

No private information is used in the entire process of the systematic review. Therefore, ethical approval is not required. Findings of the proposed systematic review will be published in a peer-reviewed journal and/or disseminated through conference presentations.

The protocol has been archived in the Prospero repository (PROSPERO 2024 CRD42024566389).