Search Results (91)

The Witcher 3: Wild Hunt (2015), a role-playing game developed by CD Projekt RED, exhibits enduring appeal even ten years after its release. The game features European folkloric and Gothic aesthetics that highlight its uniqueness and gained good reception among global players. Yet, the mechanism of this transnational and transcultural appeal is still insufficiently researched. This article challenges debates about the ephemeral nature of internet trends as digital folklore, analysing how regional folk traditions converge into cultural globalisation through interactive media such as video games. The main approach of this study is literary and cultural, adopting digital folklore theory, Globalgothic theory, and Benedict Anderson’s imagined communities. This article also examines in-game quests and landscape aesthetics as part of gameplay through close reading. This study finds that the game interprets regional folk traditions into universal Gothic themes through players’ participatory performance, decontextualised narrative design, and virtual world construction. A new form of digital folklore emerges in the Witcher Universe as an imagined community forms in the virtualised reality. At the same time, longstanding folkloric and literary traditions function as an anchor for this rejuvenated digital folklore and community. Full article

Objective: To map the scientific evidence and identify knowledge gaps regarding the health of Black and Sexual and Gender Minority populations within the global context of health education. Introduction: Health education curricula should explicitly recognize, define, and address the specific needs and health disparities affecting Black and Sexual and Gender Minority populations to ensure that healthcare provision is comprehensive and inclusive in diverse settings. Eligibility criteria: Studies related to professional health training at undergraduate and graduate levels, as well as other educational modalities addressing healthcare provision for Black and Sexual and Gender Minority populations, were included. Methods: This scoping review was conducted following the JBI methodology. Studies were retrieved from Scopus, Web of Science, PubMed, Embase, MEDLINE, Virtual Health Library, CINAHL, ERIC, Cochrane Library, Brazilian Digital Library of Theses and Dissertations, ProQuest Dissertations & Theses Global, EBSCO databases, and the Networked Digital Library of Theses and Dissertations, without language or time restrictions. Two independent reviewers screened the studies and extracted data using a standardized form developed for this review. Concepts, definitions, structures, results, and applications of professional health education for the care of Black and Sexual and Gender Minority populations were systematically synthesized. The results were organized and presented in tabular and graphical formats, accompanied by a narrative summary. Results: A total of 104 studies were included. The evidence was predominantly concentrated in North America, particularly in the United States, with limited representation from other regions. Most studies were published after 2020, indicating a recent expansion of research interest. The methodological profile was characterized by a predominance of quantitative and descriptive designs, alongside qualitative and mixed-methods approaches. Thematic analysis revealed a concentration of studies addressing gender-affirming care, workforce diversity, social determinants of health, and discrimination, while intersectional approaches and long-term educational outcomes remained less explored. Conclusions: The available evidence indicates that health education has increasingly incorporated themes related to equity and diversity; however, the integration of structured and mandatory curricular approaches addressing the intersectional health needs of Black and Sexual and Gender Minority populations remains limited. The findings highlight the need for broader geographic representation, stronger methodological designs, and the development of comprehensive educational strategies capable of addressing structural inequalities within health training contexts. Full article

Background/Objectives: Mild cognitive impairment (MCI) is a clinically important state associated with an increased risk of future cognitive decline and dementia. Behaviour change interventions may support risk reduction and self-management in cognitively vulnerable adults. However, the extent to which the transtheoretical model (TTM) has been used in this population has not been clearly mapped. This scoping review examined TTM-based, TTM-informed, and TTM-congruent behaviour change interventions for adults with MCI, subjective cognitive concerns, or elevated dementia risk. Methods: This scoping review followed Joanna Briggs Institute guidance and was reported in accordance with PRISMA-ScR. The protocol was prospectively registered on the Open Science Framework. PubMed, PsycINFO, ScienceDirect, Scopus, Web of Science, CENTRAL, ProQuest Dissertations, and medRxiv were searched from inception to 30 September 2025. Eligible studies included randomised, nonrandomised, quasi-experimental, and qualitative designs. Data were charted using a piloted extraction form and were synthesised narratively. Results: Eight unique studies, represented across nine publications, were included. Only one trial explicitly operationalised the TTM in a clinically defined MCI cohort; most studies were more appropriately classified as TTM-informed or TTM-congruent. Recurrent intervention components included readiness alignment, goal setting, self-monitoring, personalised feedback, prompts and cues, problem solving, reinforcement, and relational support. Behavioural outcomes were more consistently favourable than cognitive outcomes, particularly for adherence, self-management, diet, and sustained physical activity engagement. Cognitive findings were heterogeneous: some smaller studies reported short-term improvements, whereas the largest rigorous trial found no significant cognitive benefit. Conclusions: Current evidence does not support strong claims regarding TTM-specific cognitive efficacy in MCI. Instead, it suggests that TTM-informed and TTM-congruent interventions may be useful for strengthening behavioural regulation, risk reduction, and maintenance of health-related routines in cognitively vulnerable adults. More rigorous studies are needed to test the TTM constructs prospectively and to determine whether proximal behavioural change translates into durable cognitive or functional benefit. Full article

Background/Objectives: To identify and evaluate contemporary clinical practice guidelines for the care of adult patients in their last days of life, their families and caregivers. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement (PROSPERO: CRD42021258311). PubMed, TRIP Database, Cochrane Library, ProQuest, and CINAHL were searched for CPGs published between January 2016 and December 2025 in English or Spanish, supplemented by searches of seven palliative care organisation websites. Two independent reviewers screened records; the AGREE II instrument was applied by four evaluators to assess methodological quality. Recommendations from included guidelines were categorised into 12 inductively derived decision areas encompassing recognition of the dying phase, communication and decision-making, multidisciplinary care, symptom management, and grief and bereavement. A narrative synthesis was adopted due to heterogeneity in guideline structure and recommendation grading systems. Results: Of 1118 records identified, 20 were retrieved for full-text assessment. Sixteen met CPG criteria and were appraised with AGREE II, of which eight were finally included. Included guidelines originated from five countries (UK, Spain, USA, Canada, and Europe) and were published between 2018 and 2021. Overall AGREE II scores ranged from 71% to 100%, with the lowest domain scores consistently found in Applicability. Strong recommendations were identified across most guidelines for recognition of the LDS, communication, and interdisciplinary coordination; recommendations on symptom management were mixed. Conclusions: Findings may inform professionals and health system managers in identifying key LDS care recommendations. Gaps in social, cultural, and spiritual dimensions should guide future guideline development. Key limitations include heterogeneity in guideline methods and restriction to English and Spanish publications. No external funding was received. Full article

Background: Chronic pain affects approximately 30% of older adults and is strongly associated with social isolation and loneliness, which impact an estimated 25% of the global older adult population. A substantial proportion of chronic pain in this population is classified as primary chronic pain (non-specific), characterized by persistent pain with no underlying disease or structural damage. Pharmacotherapy has limited efficacy in treating primary chronic pain and presents significant polypharmacy risks, highlighting a critical need for sustainable, non-pharmacologic interventions. Among these, Tai Chi has emerged as a promising multimodal therapy, it is a mind–body exercise that integrates gentle movement and focused breathing with social engagement, offering participants both physical relief and opportunities for meaningful human connection. Gentle movement for flexibility, balance, and strength, combined with deep breathing may also improve self-reported symptoms of chronic pain, in addition to inflammatory biomarkers such as CRP, IL-6 and TNFα. The purpose of this narrative review is to investigate the literature on Tai Chi as a method for promoting socialization and reducing self-rated chronic pain among community-dwelling, socially isolated older adults. Methods: Following librarian-assisted concept map development, we searched six electronic databases (PubMed, CINAHL, Scopus, Cochrane, ProQuest, and PsycINFO) for studies published between January 2016 and February 2026. Search strings included terms for “older adults,” “chronic pain,” “social isolation/loneliness,” and “Tai Chi.” Two reviewers independently screened results and extracted data for relevance. Results: Of the 1098 records identified, 25 studies met the inclusion criteria. Eleven studies evaluated Tai Chi or related mind–body interventions. Among these, approximately six studies reported improvements in pain-related outcomes, while five studies reported improvements in loneliness or social isolation. However, only two to three studies simultaneously evaluated both chronic pain and social isolation/loneliness outcomes within Tai Chi interventions. Overall, most studies supported Tai Chi as a safe and potentially effective intervention for older adults, with evidence suggesting benefits for both pain and social well-being. However, the limited number of studies examining combined outcomes restricts conclusions regarding the integrated effects of Tai Chi on chronic pain and social isolation. Discussion: Tai Chi is a safe, inexpensive behavioral strategy for improving social connectedness and reducing self-rated chronic pain among older adults. However, the evidence base remains fragmented, as pain and social isolation are rarely assessed together within the same trial. Future research should address this gap by considering both social isolation and chronic pain in the same study, with more standardized Tai Chi forms as the single independent variable. Full article

Background: Nurse Practitioners (NPs) are increasingly integrated into pediatric inpatient teams in response to evolving healthcare needs and workforce challenges. However, evidence describing how NP roles are operationalized, implemented, and sustained in general pediatric ward settings remain fragmented. Objective: This scoping review will synthesize international literature on NP roles in general pediatric inpatient settings, with a focus on determinants of role implementation. Guided by the Participatory, Evidence-based, Patient-focused Process for Advanced Practice Nursing (PEPPA) framework, this review will examine implementation strategies, outcomes, timelines, facilitators, barriers, and required resources to inform future integration and evaluation. Methods: This scoping review will be conducted in accordance with Joanna Briggs Institute (JBI) methodology and reported following PRISMA-ScR guidelines. A PRESS-reviewed search strategy will be applied to Scopus, MEDLINE, PsycInfo, CINAHL, Cochrane Central, ProQuest, grey literature, and reference lists for English and French language studies published from 2016 onward. Studies relating to NP roles in general pediatric wards internationally will be included. Data extraction and synthesis will be structured using the PEPPA framework’s implementation domain. Findings will be summarized descriptively and presented in tables and narrative synthesis. Conclusions: A targeted synthesis focused on determinants of NP role implementation in this context is needed. This review will clarify how NPs roles have been integrated in general pediatric wards, highlight enabling and constraining factors, and will identify gaps to guide future research, practice redesign, and policy development. Full article

Background: Suicide among emerging adults has become a significant global public health concern. Suicidal ideation is the prerequisite for suicide, and social support is recognized as a key protective factor against suicidal ideation. However, the relationship between the strength and consistency of social support and suicidal ideation among undergraduate students remains unclear. This study synthesized empirical studies to quantify the relationship between social support and suicidal ideation among undergraduate students and determine the different correlations between various sources of social support and suicidal ideation. Methods: A systematic review and meta-analysis was conducted following PRISMA 2020 guidelines. Five electronic databases (Web of Science, Scopus, PubMed, ProQuest, and ScienceDirect) were searched for studies published from 2016 to 2025. Eligible studies reported quantitative associations between social support and suicidal ideation among undergraduate students. Correlation coefficients were transformed using Fisher’s z and pooled using a random-effects model. Heterogeneity was evaluated using Cochran’s Q and I² statistics. Risk of bias assessments, moderator analysis, sensitivity analysis, subgroup analysis, and publication bias assessments were conducted. Results: Fifteen studies with sixteen independent effect sizes and more than 26,000 participants were included. The meta-analysis showed a moderate negative association between social support and suicidal ideation (pooled r = −0.33, 95% CI [−0.40, −0.25]) under a random-effects model. A high heterogeneity was observed among studies (I² = 97%, p < 0.001). There are no studies classified as having a high risk of bias. The standardized sample size demonstrated a significant moderating effect (β = 0.2568, p = 0.0022). Sensitivity analysis confirmed the stability of the pooled effect. Subgroup analysis indicated that the strength of the association between social support and suicidal ideation did not differ significantly between Asian and non-Asian studies. No significant publication bias was detected (Egger’s p = 0.19). Narrative synthesis further suggested that family support showed the most consistent protective association compared with friends’ support and support from others. Conclusions: Social support is moderately and consistently associated with reduced suicidal ideation among undergraduate students. These findings highlight social connectedness, particularly family support, as a central interpersonal protective factor and strengthen social support’s role in university suicide prevention initiatives. Full article

Background/Objectives: Increasing evidence implicates the microbiome–gut–brain axis in Autism Spectrum Disorder (ASD) pathophysiology, prompting interest in probiotics as a therapeutic strategy, although findings remain inconsistent. This systematic review aimed to evaluate the clinical efficacy of probiotic supplementation on core ASD symptoms, examine the outcome measures used, and provide insights into optimal probiotic interventions. Methods: This review was conducted in accordance with PRISMA 2020 guidelines. PubMed, Scopus, Web of Science, Ovid, ProQuest, and Wiley Online Library were searched for studies published between January 2015 and July 2025. Randomized, non-randomized, and open-label clinical studies evaluating oral probiotic supplementation in children and adolescents with ASD were included. Outcomes assessed core symptom domains using validated instruments. Study selection, data extraction, and risk-of-bias assessment (RoB 2 and ROBINS-I) were performed independently by multiple reviewers. Due to methodological heterogeneity, the findings were synthesized narratively. Results: Fourteen studies involving 924 children and adolescents with ASD across seven countries or regions were included, of which ten were randomized controlled trials. Eight studies reported significant improvement in core ASD symptoms, predominantly within the social and communication domain. The most frequently used assessment tools were the Social Responsiveness Scale (SRS), Autism Treatment Evaluation Checklist (ATEC), and Autism Diagnostic Observation Schedule (ADOS). Lactobacillus reuteri supplementation for at least three months was consistently associated with improvement in social behavior. Conclusions: L. reuteri supplementation possibly improves social and communication function in children with ASD. However, there is limited high-quality evidence on this. Evidence for other core domains remains limited and inconsistent, highlighting the need for well-designed, multicenter trials using standardized outcome measures and strain-specific hypotheses. Full article

Objectives: This scoping review synthesized the available evidence on bedside ultrasonography used to confirm short-term nasogastric tube (NGT) placement in adults. Methods: The review followed JBI Collaboration methodology. Searches were conducted in CINAHL, Embase, LILACS, PubMed, and Scopus, as well as in gray literature sources (Google Scholar and ProQuest Dissertation & Thesis Global). Primary studies and clinical guidelines addressing bedside ultrasonography for short-term NGT placement in adults (≥18 years) were eligible, with no limits on language or publication year. Data were extracted and narratively summarized with the I-AIM framework (Indication, Acquisition, Interpretation, and Decision-Making). Results: Twenty-nine studies met the inclusion criteria. Most were single-center observational studies performed in intensive care units or emergency departments. Ultrasound was primarily used for confirmation prior to enteral nutrition initiation, while gastric decompression was less frequently reported. Acquisition protocols varied, although supine positioning, convex abdominal probes, and linear cervical probes were most commonly described. The gastric antrum and esophagus were the principal anatomical landmarks, with interpretation based on direct tube visualization and dynamic fogging; color Doppler was occasionally used. Radiography remained the reference standard in most studies, and only a minority initiated feeding based solely on ultrasound findings. Reported facilitators included bedside feasibility, absence of radiation exposure, and timeliness. Barriers included operator dependency, limited visualization in patients with obesity or gas interposition, protocol heterogeneity, and the limited methodological robustness of available studies. Conclusions: Current evidence suggests that ultrasonography may represent a feasible, radiation-free bedside approach for confirmation of NGT placement. Evidence from selected studies suggests that, with structured training, healthcare professionals may achieve diagnostic accuracy in specific clinical settings, although further robust multicenter investigations are needed to confirm these findings. Full article

Although therapist responsiveness is a crucial factor in the effectiveness of psychotherapy, its role in group settings remains under-explored. This narrative review examines therapist responsiveness in group psychotherapy, exploring its theoretical basis, empirical evidence and practical implications. A narrative literature review was conducted using major academic databases, including PubMed, ProQuest, APA PsycArticles, ScienceDirect and PMC. The 11 included studies are primarily small-scale qualitative projects, including case studies, clinical vignettes, and thematic analyses. This inevitably limits the generalizability of the results. A cross-cutting thematic synthesis of these studies reveals five dimensions of group therapist responsiveness: empathy; creating a welcoming atmosphere; paying attention to subjective experience; personalizing interventions within the group context; and facilitating reflectivity and mentalization. The main limitations of the present study’s methodology are its unregistered status and the exclusion of grey literature. Future research should focus on developing validated measurement tools, conducting experimental studies, exploring cultural variations, and assessing therapist responsiveness in online group therapy settings. This narrative review emphasizes the importance of responsive therapeutic approaches in psychiatric settings and group psychotherapy, and highlights the need for further empirical research to refine theoretical models and enhance clinical applications. Full article

Background/Objectives: Missed nursing care is a recognized indicator of nursing quality and safety, while caring is a foundational concept in nursing practice. Few studies have empirically examined their relationship. This scoping review aimed to map and synthesize existing evidence on the conceptualisation, measurement approaches, and empirical relationships between caring and missed nursing care. Methods: The review was conducted using JBI methodology, reported according to PRISMA-ScR guidelines, and was registered in the Open Science Framework. Literature was searched in PubMed, CINAHL Ultimate (EBSCOhost), MEDLINE (EBSCOhost), and Web of Science, with additional grey literature searches in ProQuest Dissertations & Theses and Google Scholar. The review included studies examining caring in relation to missed nursing care across any healthcare setting. All study designs were considered. Data were extracted using an extraction tool, developed based on JBI guidelines, and piloted. Data were analyzed descriptively, tabulated, and summarized narratively. Results: Five quantitative cross-sectional studies met the inclusion criteria, conducted between 2012 and 2024 in the Philippines and Slovenia. Caring was assessed using the Caring Behaviors Inventory, Caring Ability Inventory, or CARE-Q, while missed nursing care was measured using the MISSCARE Survey or the Missed Nursing Care Scale. Most studies used Watson’s Theory of Human Caring, Duffy’s Quality Caring Model, or the Missed Nursing Care Model as theoretical frameworks. Across studies, caring behaviours and caring ability were negatively associated with missed nursing care. Conclusions: Caring can function as a moral and relational ideal and as a measurable and actionable factor related to patient outcomes. However, the evidence base remains limited, with inconsistent theoretical foundations and a lack of experimental studies. Future research should adopt theory-based, experimental approaches with diverse samples to explore causal mechanisms and evaluate strategies that strengthen caring competence and caring organizational cultures. Full article

Background/Objectives: Endocrine therapy (ET) is a common treatment for hormone-dependent breast cancer and is associated with a significant reduction in recurrence and mortality rates. However, the decision to initiate endocrine therapy is a critical and often distressing juncture for patients. The need to weigh its survival benefits against the potential burden of side effects, including mood changes, pain, muscle stiffness, and fatigue, can render this decision-making phase a source of significant distress. The present systematic review aimed to identify and synthesize the sociodemographic and psychosocial predictors of the decision-making process related to ET adherence among women with breast cancer. Methods: A systematic literature search was conducted in three electronic databases—PubMed Central, ProQuest, and Scopus—to identify studies examining the association between sociodemographic and psychosocial factors and the decision-making process regarding ET among women with breast cancer. Inclusion criteria encompassed cross-sectional studies published between 2000 and 2025. Data were extracted and analyzed to identify recurring predictors across studies. The findings were synthesized through a narrative synthesis. Results: Twelve cross-sectional studies met the inclusion criteria, comprising a total of 8510 women diagnosed with breast cancer and undergoing ET. Ten studies (83%) identified sociodemographic variables—such as age, marital status, educational level, and ethnicity—as significant predictors of decision-making. Moreover, nine studies (75%) reported psychosocial factors, including quality of life (QoL), fear of progression, infertility concerns, and social support, as influential in the decision to initiate or continue ET. Specifically, the decision to adhere to ET is generally supported by younger age, higher education, better perceived quality of life, and greater social support. Conversely, it is hindered by lower income, lower education, fertility concerns related to marital status, and diminished quality of life. Conclusions: The findings of this review indicate that both sociodemographic and psychosocial factors play key roles in shaping women’s decisions regarding adherence to ET. Understanding these predictors can facilitate decision-making and inform the development of targeted interventions aimed at improving treatment adherence and supporting patient-centered care in breast cancer treatment. The focus on decision-making processes, rather than on adherence rates, is what distinguishes this review from other systematic reviews. Full article

Background/Objectives: The aim of the present systematic review is to evaluate the performance of AI models for length of stay prediction. Methods: This SR was carried out in accordance with PRISMA 2020 and registered in PROSPERO database (CRD420251039985). Using the PICOS framework, we formulated the following research question: “Can artificial intelligence models accurately predict hospital length of stay (LOS) in patients undergoing head and neck (H&N) cancer surgery?” We searched the Cochrane Library, Embase, PubMed, and Scopus, with additional gray literature identified through Google Scholar and ProQuest. Risk of bias (RoB) was assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST), and a narrative synthesis was performed to summarize qualitative findings. Results: Of 1304 identified articles, 5 met inclusion criteria, covering 5009 patients. All studies used supervised learning to predict LOS with different variables presenting stronger associations with increased hospital LOS. Age, race, ASA score, BMI, and comorbid factors like smoking and arterial hypertension were comon variables across studies but not always the ones most strongly associated with LOS. One study also predicted discharge to non-home facilities and prolonged LOS; only one applied data balancing. Model accuracies ranged from 0.63 to 0.84, and area under the receiver operator characteristics curve (AUROC) values from 0.66 to 0.80, suggesting moderate discriminative performance. All studies had a high risk of bias, though no applicability concerns were noted. Conclusions: AI models show potential for LOS prediction after H&N cancer surgery; however, an elevated RoB and methodological shortcomings constrain the current evidence. Methodological improvements, external validation, and transparent reporting is essential to enhance reliability and generalizability, enabling integration into clinical decision-making. Full article

This study analyses how preservice mathematics teachers reflect on the incorporation of gamification in their teaching practices after participating in a training cycle focused on this active methodology. The cycle, applied to 31 students in the Secondary Mathematics Teacher Education Master’s programme in Catalonia, integrated game elements—such as narratives, quests, and badges—alongside the Didactical Suitability Criteria as a tool for developing competency in the analysis and evaluation of didactical suitability. The reasons preservice teachers provided for using gamification in mathematics teaching were analysed at two points: upon completing the training cycle and after implementing teaching proposals incorporating gamification with secondary education students in Catalonia. The results show that preservice teachers show an improvement in their reflective competency regarding gamification, as well as increased use of this active methodology. Additionally, the knowledge and competencies considered relevant by preservice teachers for working with gamification in mathematics teaching were identified. It is concluded that training in the use of gamification in mathematics teaching is necessary to apply this methodology appropriately, and that tools such as the Didactical Suitability Criteria are fundamental for reflection on, and improvement in, the use of active methodologies. Full article

Background: Kidney transplant recipients (KTRs) experience improved survival and quality of life compared to dialysis treatment, but chronic immunosuppression may increase the risk of de novo post-transplant cancer. Colorectal cancer (CRC) is increasingly recognized in this population. This systematic review aims to synthetize contemporary evidence on CRC epidemiology, outcomes, and risk determinants among KTRs. Methods: A comprehensive search for observational and registry-based studies reporting CRC in adult KTRs was conducted on PubMed, Scopus, Web of Science, and ProQuest. The studies found were subsequently subjected to screening, data extraction, and the risk-of-bias appraisal process. Due to heterogeneity, findings were synthesized narratively. Results: Twenty-six studies encompassing 863,005 KTRs met inclusion criteria: 22 retrospective cohorts, 1 prospective cohort, 2 cross-sectional, and 1 case-control. Absolute CRC occurrence varies by geography, population, and follow-up. Reported risks ranged from no excess to modestly elevated standardized incidence ratios (SIRs): ~0.76–3.60 overall, with a right-sided colon predominance. Overall, higher mortality and worse prognosis were reported in kidney transplant recipients with colorectal cancer compared to the general population, as a result of later-stage diagnosis and more aggressive histologies. Consistent risk factors included older age, time since transplantation, diabetes and metabolic comorbidities, prior dialysis duration/graft failure, and smoking; the female sex showed higher relative CRC risk in some cohorts. The remarkable role of immunosuppression profiles was consistently highlighted: cyclosporine—azathioprine maintenance and alemtuzumab induction were associated with higher CRC risk in large registries, whereas tacrolimus—mycophenolate regimens showed lower risk signals and mTOR inhibitors suggested possible protective effects. Conclusions: Contemporary evidence suggests a modest, heterogenous increase in CRC risk among KTRs, a proximal (right-sided) predominance, and a tendency toward advanced-stage presentation with reduced survival. These findings justify the need to consider risk-tailored, lifelong surveillance strategies anchored in a full colonoscopy, with earlier initiation in younger or otherwise high-risk recipients, alongside careful optimization and periodic re-evaluation of immunosuppression. Prospective multicenter studies and cost-effectiveness analyses should refine screening thresholds and therapeutic strategies. PROSPERO ID: CRD420251071658. Full article