Abstract Introduction Cervical cancer is the fourth largest cause of cancer deaths in women. HPV self-sampling could increase uptake of cervical screening. This rapid review aimed to determine the accuracy, concordance, uptake and acceptability of self-sampling over clinician-collected samples in high income countries. Method We followed Cochrane Rapid Reviews Methods. Top-up of 4 systematic reviews and meta-analyses was performed. Narrative data synthesis was conducted and meta-analysis where applicable. Databases searched were MEDLINE, EMBASE, CENTRAL and clinical trial registries. Risk of bias was assessed using AMSTAR 2, QUADAS, the Cochrane Risk of Bias (RoB), or the Nudelman and Otto, 2020 tool, depending on the study type. Findings The review included 39 studies for accuracy, 38 studies for concordance, 37 uptake and 48 studies for acceptability. Self-sampling has similar accuracy as clinician-collected samples when PCR-based assays are used. The overall agreement of self-sampling and clinician-collected samples was 87.1%(95%CI;85.6-88.6) with a kappa value of 0.70(95%CI;0.67-0.73). Mail-to-all strategies had higher uptake with participation differences of 11.3%(95%CI:8.4-14.2) in the intention-to-treat analysis and 7.7%(95%CI:4.7-10.8) in the per protocol analysis. Self-sampling is acceptable to non-attendees (91%(95%CI;85.3-94.6). Conclusion and Recommendation Self-sampling shows good performance on the four clinical effectiveness indicators of accuracy, concordance, uptake and acceptability.

Introduction Guidelines recommend cognitive screening post-stroke, but there is no consensus on approach. Given the dynamic nature of cognition following stroke, acute screening should both detect prevalent issues (diagnosis) and predict persisting problems (prognosis). We describe the diagnostic and prognostic utility of brief cognitive screening tools.Patients and methods Patients were screened on admission with stroke using 12 modified screening tests: 10 and 4 question Abbreviated Mental Test, Cog-4, Clock Drawing test (CDT), Cognitive Impairment Test, informal bedside assessment, General Practitioner Assessment of Cognition, Minicog, Short Form Montreal Cognitive Assessment, Six-Item Screener (SIS), Harmonised Vascular Cognitive Impairment battery and 4-A's Test. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value were calculated against a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition adjudicated reference standard of neurocognitive disorders. Test accuracy was compared using area under the receiver operator characteristic curves.Results Of 335 patients, 54 (16.1%) had pre-stroke neurocognitive disorder, 79 (23.6%) had 18-month neurocognitive disorder. Ten of 12 screening tests were more specific than sensitive. Informal bedside assessment had highest specificity (96%), but low sensitivity (9%); CDT had highest sensitivity (80%) but low specificity (33%). Negative predictive value ranged from 77% to 87%, PPV ranged from 27% to 54%. Area under the receiver operator characteristic curve ranged 0.53 (informal bedside assessment) to 0.69 (SIS).Discussion In the acute setting, where the intention of screening is often to triage those who need further assessment, the pattern of high specificity at the expense of sensitivity is the opposite of what is desired.Conclusion Brief cognitive screening tools, used in isolation, may not be suitable for assessment in acute stroke settings.

BACKGROUND:Pain arising after surgery and persisting beyond 3 months is termed 'chronic postsurgical pain' (CPSP). Prevention of CPSP is a research priority. Our objectives were to assess whether regional anaesthesia can reduce the incidence of CPSP and long-term opioid use and to determine which factors influence its effectiveness. METHODS:We conducted a Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-compliant systematic review and network meta-analysis of randomised controlled trials assessing the effectiveness of regional anaesthesia for reduction of CPSP. We searched various databases up to October 2025. We performed pairwise meta-analysis and network meta-analysis to determine whether type, timing and method (catheter or single injection) of regional anaesthesia influenced the incidence of CPSP. We investigated the effect of surgery type, baseline risk, and sex via meta-regression. We used Grading of Recommendations Assessment, Development and Evaluation (GRADE)/ Confidence In Network Meta-Analysis (CINeMA) to assess certainty of evidence. RESULTS:We included 158 randomised controlled trials involving 18 794 subjects. Overall, regional anaesthesia reduced the incidence of CPSP compared with no block (risk ratio [RR]: 0.73, 95% confidence interval [CI]: 0.67-0.80), with effects observed up to 12 months after surgery. Reductions in CPSP were also observed within specific surgery types, including mastectomy (RR: 0.69, 95% CI: 0.59-0.79), thoracotomy (RR: 0.72, 95% CI: 0.55-0.96), video-assisted thoracoscopic surgery (RR: 0.73, 95% CI: 0.56-0.96), and knee arthroplasty (RR: 0.71, 95% CI: 0.52-0.97). Opioid use was not statistically significantly different between groups (RR: 0.88, 95% CI: 0.61-1.28). CPSP evidence was low certainty; opioid use was very low certainty. Network meta-analysis suggested that neuraxial techniques reduced the incidence of CPSP more effectively than peripheral techniques after thoracotomy (neuraxial RR: 0.64 95% CI: 0.49-0.83; peripheral RR: 0.84, 95% CI 0.73-0.96) and video-assisted thoracoscopic surgery (neuraxial RR: 0.60, 95% CI: 0.45-0.80; peripheral RR: 0.77, 95% CI: 0.63-0.94), compared with no block. Differences in effectiveness based on administration time point and method of administration varied by surgery type. Network meta-analysis evidence was low to very low certainty. Meta-regression showed no significant effect of surgery type, sex or baseline risk. CONCLUSIONS:Our findings indicate that regional anaesthesia reduces the incidence of CPSP for up to 12 months after surgery. The effectiveness of regional anaesthesia was influenced by the type of regional technique used, whereas the type of surgery, sex, or baseline risk did not have a significant impact.

INTRODUCTION:The Healthcare Improvement Scotland 'Think Frailty' tool (HIS-Frailty) was developed to allow frailty triage in unscheduled care. Development was iterative, with a change around assessment of support needs to improve completion. We evaluated the psychometric properties of HIS-Frailty. METHODS:We used data from prospective, national audits of frailty screening. Consecutive adults aged ≥65 who presented as unscheduled admissions to hospital were assessed with the tool across three phases of data collection (2017-2023). Frontline healthcare workers completed HIS-Frailty and a reference standard of the Clinical Frailty Scale. We assessed concurrent validity (Pearson's correlations), discrimination (area under curve; AUC), feasibility (percentage of missing data), predictive validity for 30-day mortality and duration of hospital stay (regression), factor structure (maximum likelihood factor analysis), intra-rater reliability and inter-rater reliability (adjusted kappa). RESULTS:A total of 2447 older adults were included. HIS-Frailty scores were significantly correlated with Clinical Frailty Scale (r = 0.78, P < .001), discrimination was excellent (AUC: 0.93, 95% CI = 0.92-0.95). All domains of HIS-Frailty had <1.5% missing data. HIS-Frailty scores were associated with 30-day mortality (OR: 1.49, 95% CI = 1.32-1.69) and being in hospital at 30-days (OR: 1.73, 95% CI = 1.52-1.96). Factor analysis indicated a single underlying factor accounting for 43.4% variance. Intra-rater agreement was good (Kappa = 0.71, 95% CI: 0.53-0.88). Inter-rater agreement between specialist and non-specialist assessors was substantial (Kappa: 0.83, 95% CI: 0.68-0.97). CONCLUSION:HIS-Frailty has good psychometric properties for 'front door' frailty screening and can be used consistently and effectively by non-specialist assessors.

INTRODUCTION:A better understanding of who will develop dementia can inform patient care. Although MRI offers prognostic insights, access is limited globally, whereas CT-imaging is readily available in acute stroke. We explored the prognostic utility of acute CT-imaging for predicting dementia. PATIENTS AND METHODS:We included stroke or transient ischaemic attack (TIA) survivors from participating stroke centres in Scotland. Acute CT-scans were rated using ordinal scales for neurodegenerative and cerebrovascular changes (old infarcts, white matter lesions (WMLs), medial temporal lobe atrophy (MTA), and global atrophy (GA)) and combined together to a 'brain-frailty' score. Dementia status was established at 18-months following stroke or TIA. RESULTS:Among 195 participants, 33% had dementia after 3 years of follow-up. High brain-frailty score (⩾2/4) correlated with higher risk of dementia (HR (95% CI) 6.02 (1.89-19.21)). As individual predictor, severe MTA was most strongly associated with dementia (adjusted HR (95% CI) 2.09 (1.07-4.08)). Other predictors associated with dementia included older age, higher prestroke morbidity (mRS), WMLs, and GA. Integrated in a prediction model with clinical parameters, prestroke mRS, cardiovascular disease, GA, MTA and Abbreviated-Mental-Test were the strongest predictors of dementia (c-statistic: 0.77). DISCUSSION AND CONCLUSION:Increased brain-frailty, and its individual components (WMLs, MTA, and GA) are associated with a higher risk of dementia in participants with stroke. Combining clinical and brain-frailty parameters created a moderate dementia prediction model but added little value over clinical parameters in combination with cognitive testing. CT-based brain-frailty may provide better prognostic insights when cognitive testing isn't feasible and for identifying highest-risk individuals for dementia prevention trials to increase trial efficiency.

Tranexamic acid (TXA) is well-established as a safe intervention for reducing transfusion requirements in surgeries with high-risk for blood loss. However, its role in surgeries classified as low-risk for blood loss remains uncertain. Given the frequency of such procedures, even small clinical benefits could have substantial cumulative impact. We assessed the clinical and cost-effectiveness of TXA in surgeries with low expected blood loss A systematic review and meta-analysis of randomised controlled trials (RCTs) for adults or children undergoing low-risk surgeries, comparing peri-operative TXA (any route or dose) with placebo or standard care informed the clinical effectiveness and a decision model adapted from NICE NG24, focusing on short-term hospital costs informed the cost-effectiveness analysis. We included 82 RCTs comprising 8506 participants. TXA significantly reduced blood loss (ratio of means 0·73, 95% CI 0·68,0·79) and transfusion rates (odds ratio 0·39, 95% CI 0·25,0·61). It also reduced hospital stay by 0·4 days (MD = -0·40 days, 95% CI = -0·77, -0·02) and improved pain scores at 1 and 2 weeks postoperatively. Evidence for thrombotic events was limited and inconclusive. The cost-effectiveness analysis showed TXA was cost-saving (£156 per patient) and had a 99% probability of being cost-effective at the £20lJ000 per QALY threshold. Reduction in bleeding and improved recovery outcomes even in surgeries with low anticipated blood loss support broader use of TXA in surgical care and suggests revisiting existing guidelines to include surgeries with any bleeding risk. Further research should examine long-term safety and patient-reported outcomes. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study is funded by the NIHR [NIHR Evidence Synthesis programme (NIHR153934)]. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as [ClinicalTrials.gov][1]. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Datasets are available on reasonable request to the corresponding author. [1]: http://ClinicalTrials.gov

Background:United Kingdom blood shortages necessitate better prediction of surgical blood requirement. We sought to assess the predictive accuracy of tools designed to identify those patients requiring blood transfusion within the perioperative period. Methods:We searched the Cochrane library, EMBASE, MEDLINE, ClinicalTrials.gov and WHO trials portal, 2000-July 2023. We included studies that developed and/or validated prediction tools for blood requirement during the early perioperative period (48 hours). Risk of bias was evaluated using the Prediction model Risk Of Bias Assessment Tool. We pooled area under receiver operating curve and calibration data via random effects meta-analysis. We evaluated certainty of evidence of any estimates using the Grading of Recommendations Assessment, Development and Evaluation framework. We used meta-regression to describe associations between included variables/tool characteristics with tool accuracy. Results:We included 50 papers, describing 67 unique prediction tools. Most tools were at high risk of bias, with limited external validation. Discrimination (area under receiver operating curve) of prognostic models ranged from 0.49 to 0.96. Only two surgery-specific tools, the McClusky Index (liver transplant surgery) and Papworth Bleeding Risk Score (cardiothoracic surgery), had sufficient data to enable pooling of discrimination measures. The McClusky Index's pooled area under receiver operating curve: 0.74 (95% CI 0.61 to 0.84) and Bleeding Risk Score's area under receiver operating curve: 0.68 (95% CI 0.49 to 0.82) were both rated 'very low' certainty by Grading of Recommendations Assessment, Development and Evaluation. Pooling calibration data was not possible for any prediction tools. Meta-regression suggested that fewer included variables, longer time from surgery and independent validation studies were all associated with lower accuracy. Limitations:There were insufficient studies to assess overall tool performance via meta-analysis in other surgical subgroups beyond cardiothoracic surgery and liver transplant. Our study population is also predominantly made up of elective surgeries which may make our results less generalisable to emergency settings. Future work:Implementation and cost-effectiveness studies are needed to evaluate how promising tools could be applied to clinical practice and the economic impact such tools could have upon the service. Conclusions:Despite the availability of multiple potential tools, available data suggest none are currently suitable for predicting blood transfusion in surgical practice. Our summary of the data comes with caveats around the quality of the included papers and the limited number of tools with more than one reported external validation. Funding:This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR159933.

BACKGROUND:Treatment burden is the workload of health care for people with long-term conditions and the impact on wellbeing. A validated measure of treatment burden for use as an outcome measure in stroke trials is needed. We adapted a patient-reported measure of treatment burden in multimorbidity, Patient Experience With Treatment and Self-Management (PETS), version 2.0, to create a stroke-specific measure, PETS-stroke, and examined its psychometric properties. METHODS:We conducted an observational cohort study. Stroke and transient ischemic attack survivors were recruited between February 2022 to June 2023 from 10 hospitals in the United Kingdom and through the Scottish Health Research Register. Participants completed the PETS-stroke questionnaire along with 3 other patient-reported measures (the Stroke Southampton Self-Management Questionnaire, the Satisfaction With Stroke Care Measure, and the Shortened Stroke Impact Scale). We performed confirmatory factor analysis to test the factor structure of the PETS-stroke. We assessed Spearman rank correlations between PETS-stroke and other patient-reported measures to determine convergent validity. An intraclass correlation coefficient was performed to assess test-retest reliability. Proportions of missing data along with feedback from qualitative interviews were used to determine feasibility. T-tests were conducted to examine variations in PETS-stroke scores based on multimorbidity and socioeconomic factors. RESULTS:Three hundred eighty-one participants were included (mean age, 68.2 [SD, 11.2] years; female, 43.3%). The best fit was achieved with a 9-factor structure, and internal consistency was good (Omega values, 0.729-0.921). The factor loadings for the individual indicator items across 8 of the 9 domains were moderate to strong. All domains of PETS-stroke showed moderate to strong correlations with at least one other patient-reported measure. Test-retest reliability was good for all domains (intraclass correlation coefficient >0.7). Qualitative feedback on feasibility was positive: participants found the questionnaire to be easy and quick to complete, and missing data were within acceptable limits for 7 domains. PETS-stroke scores significantly differed based on multimorbidity in 3 domains and in 8 domains based on socioeconomic status. CONCLUSIONS:Psychometric performance suggests that PETS-stroke is a valid and feasible measure of treatment burden after stroke.

Introduction: The Modified Rankin Scale (mRS) is the most commonly used functional measure in stroke research but is limited by inter-rater reliability (IRR). Various interventions to improve mRS application have been described. We aimed to compare properties of differing approaches to mRS assessment.Patients and methods: Multidisciplinary databases (MEDLINE, EMBASE, Health and Psychosocial Instruments [OVID], CINAHL, PsycINFO [EBSCO]) were searched for adult human stroke studies describing psychometric properties of mRS. Two researchers independently screened 20% titles and abstracts, reviewed all full studies, extracted data, and conducted risk of bias (ROB) analysis. Primary outcomes for random-effects meta-analysis were IRR measured by kappa (K) and weighted kappa (KW). Validity and inter-modality reliability measures (Spearman's rho, KW) were also summarised.Results: From 897 titles, 46 studies were eligible, including twelve differing approaches to mRS, 8608 participants. There was high ROB in 14 (30.4%) studies. Overall, reliability was substantial (n = 29 studies, K = 0.65, 95% CI: 0.58-0.71) but IRR was higher for novel approaches to mRS, for example, the Rankin Focussed Assessment (n = 2 studies, K = 0.94, 95% CI: 0.90-0.98) than standard mRS (n = 13 studies, K = 0.55, 95%CI:0.46-0.64). Reliability improved following the introduction of mRS training (K = 0.56, 95% CI: 0.44-0.67; vs K = 0.69, 95% CI: 0.62-0.77). Validity ranged from poor to excellent, with an excellent overall concurrent validity of novel scales (n = 6 studies, KW = 0.86, 95% CI: 0.75-0.97). The agreement between face-to-face and telephone administration was substantial (n = 5 studies, KW = 0.80, 95% CI: 0.74-0.87).Discussion: The mRS is a valid measure of function but IRR remains an issue. The present findings are limited by a high ROB and possible publication bias.Conclusion: Interventions to improve mRS reliability (training, structured interview, adjudication) seem to be beneficial, but single interventions do not completely remove reliability concerns.

ImportanceTest accuracy studies often use small datasets to simultaneously select an optimal cutoff score that maximizes test accuracy and generate accuracy estimates.ObjectiveTo evaluate the degree to which using data-driven methods to simultaneously select an optimal Patient Health Questionnaire-9 (PHQ-9) cutoff score and estimate accuracy yields (1) optimal cutoff scores that differ from the population-level optimal cutoff score and (2) biased accuracy estimates.Design, Setting, and ParticipantsThis study used cross-sectional data from an existing individual participant data meta-analysis (IPDMA) database on PHQ-9 screening accuracy to represent a hypothetical population. Studies in the IPDMA database compared participant PHQ-9 scores with a major depression classification. From the IPDMA population, 1000 studies of 100, 200, 500, and 1000 participants each were resampled.Main Outcomes and MeasuresFor the full IPDMA population and each simulated study, an optimal cutoff score was selected by maximizing the Youden index. Accuracy estimates for optimal cutoff scores in simulated studies were compared with accuracy in the full population.ResultsThe IPDMA database included 100 primary studies with 44 503 participants (4541 [10%] cases of major depression). The population-level optimal cutoff score was 8 or higher. Optimal cutoff scores in simulated studies ranged from 2 or higher to 21 or higher in samples of 100 participants and 5 or higher to 11 or higher in samples of 1000 participants. The percentage of simulated studies that identified the true optimal cutoff score of 8 or higher was 17% for samples of 100 participants and 33% for samples of 1000 participants. Compared with estimates for a cutoff score of 8 or higher in the population, sensitivity was overestimated by 6.4 (95% CI, 5.7-7.1) percentage points in samples of 100 participants, 4.9 (95% CI, 4.3-5.5) percentage points in samples of 200 participants, 2.2 (95% CI, 1.8-2.6) percentage points in samples of 500 participants, and 1.8 (95% CI, 1.5-2.1) percentage points in samples of 1000 participants. Specificity was within 1 percentage point across sample sizes.Conclusions and RelevanceThis study of cross-sectional data found that optimal cutoff scores and accuracy estimates differed substantially from population values when data-driven methods were used to simultaneously identify an optimal cutoff score and estimate accuracy. Users of diagnostic accuracy evidence should evaluate studies of accuracy with caution and ensure that cutoff score recommendations are based on adequately powered research or well-conducted meta-analyses.

A quarter of ischaemic strokes are lacunar subtype, typically neurologically mild, usually resulting from intrinsic cerebral small vessel pathology, with risk factor profiles and outcome rates differing from other stroke subtypes. This European Stroke Organisation (ESO) guideline provides evidence-based recommendations to assist with clinical decisions about management of lacunar ischaemic stroke to prevent adverse clinical outcomes. The guideline was developed according to ESO standard operating procedures and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. We addressed acute treatment (including progressive lacunar stroke) and secondary prevention in lacunar ischaemic stroke, and prioritised the interventions of thrombolysis, antiplatelet drugs, blood pressure lowering, lipid lowering, lifestyle, and other interventions and their potential effects on the clinical outcomes recurrent stroke, dependency, major adverse cardiovascular events, death, cognitive decline, mobility, gait, or mood disorders. We systematically reviewed the literature, assessed the evidence and where feasible formulated evidence-based recommendations, and expert concensus statements. We found little direct evidence, mostly of low quality. We recommend that patients with suspected acute lacunar ischaemic stroke receive intravenous alteplase, antiplatelet drugs and avoid blood pressure lowering according to current acute ischaemic stroke guidelines. For secondary prevention, we recommend single antiplatelet treatment long-term, blood pressure control, and lipid lowering according to current guidelines. We recommend smoking cessation, regular exercise, other healthy lifestyle modifications, and avoid obesity for general health benefits. We cannot make any recommendation concerning progressive stroke or other drugs. Large randomised controlled trials with clinically important endpoints, including cognitive endpoints, are a priority for lacunar ischaemic stroke.

Introduction Treatment burden is the workload of healthcare for people with long-term conditions and the impact on wellbeing. A validated measure of treatment burden for use as an outcome measure in stroke trials is needed. We adapted a patient-reported measure (PRM) of treatment burden in multimorbidity, PETS (Patient Experience with Treatment and Self-Management version 2.0), to create a stroke-specific measure, PETS-stroke, and examined its psychometric properties. Patients and Methods We recruited stroke and transient ischaemic attack (TIA) survivors between Feb 2022-June 2023 from 10 hospitals in the UK and through the Scottish Health Research Register (SHARE). Participants completed the PETS-stroke questionnaire along with 3 other PRMs (Stroke Southampton Self-Management Questionnaire, The Satisfaction with Stroke Care Measure, The Shortened Stroke Impact Scale). We performed confirmatory factor analysis to test the factor structure of the PETS-stroke. We assessed Spearman's rank correlations between PETS-stroke and other PRMs to determine convergent validity. Intra-class coefficient was performed to assess test-retest reliability. Proportions of missing data along with feedback from qualitative interviews were used to determine feasibility. T-tests were conducted to examine variations in PETS-stroke scores based on multimorbidity and socioeconomic factors. Results Three-hundred-eighty-one participants were included. The best fit was achieved with a 9-factor structure and internal consistency was good (Omega values 0.729 to 0.921). The factor loadings for the individual indicator items across eight of the nine domains were moderate to strong. All domains of PETS-stroke showed moderate to strong correlations with at least one other PRM. Test-retest reliability was good for all domains (ICC>0.7). Qualitative feedback on feasibility was positive and missing data was within acceptable limits for 7 domains. PETS-stroke scores significantly differed based on multimorbidity in 3 domains and in 8 domains based on socioeconomic status. Discussion Psychometric performance suggests PETS-stroke is a highly promising measure of treatment burden after stroke. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial N/A ### Funding Statement The project is funded by the Chief Scientist Office (CSO) Scotland (HIPS/21/13) and the Stroke Association (TSA LECT 2017_01). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval has been provided on 16/9/20 by London and Surrey Borders NHS Research Ethics Committee (20/LO/0871). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data is available upon reasonable request from the authors.

Evidence synthesis, embedded within a systematic review of the literature, is a well-established approach for collating and combining all the relevant information on a particular research question. A robust synthesis can establish the evidence base, which underpins best practice guidance. Such endeavours are frequently used by policymakers and practitioners to inform their decision making. Traditionally, an evidence synthesis of interventions consisted of a meta-analysis of quantitative data comparing two treatment alternatives addressing a specific and focussed clinical question. However, as the methods in the field have evolved, especially in response to the increasingly complex healthcare questions, more advanced evidence synthesis techniques have been developed. These can deal with extended data structures considering more than two treatment alternatives (network meta-analysis) and complex multicomponent interventions. The array of questions capable of being answered has also increased with specific approaches being developed for different evidence types including diagnostic, prognostic and qualitative data. Furthermore, driven by a desire for increasingly up-to-date evidence summaries, living systematic reviews have emerged. All of these methods can potentially have a role in informing older adult healthcare decisions. The aim of this review is to increase awareness and uptake of the increasingly comprehensive array of newer synthesis methods available and highlight their utility for answering clinically relevant questions in the context of older adult research, giving examples of where such techniques have already been effectively applied within the field. Their strengths and limitations are discussed, and we suggest user-friendly software options to implement the methods described.

OBJECTIVES:Priority setting partnerships (PSPs) attempt to shape the research agenda to address the needs of local populations of interest. We reviewed the PSPs for older adults, with a focus on exemplar health care systems: United Kingdom (UK; publicly funded), United States (private health insurance-based), South Korea (national health insurance-based), and Africa (out-of-pocket). DESIGN:Systematic review. SETTING AND PARTICIPANTS:We searched databases and sources (January 2011-October 202l; updated in February 2023) for PSPs of older adults' health care. METHODS:Based on the British geriatric medicine curriculum, we extracted and categorized the PSP topics by areas and the research priorities by themes, and generated evidence maps depicting and comparing the research gaps across the systems. We evaluated PSP quality using the Nine Common Themes of Good Clinical Practice. RESULTS:We included 32 PSPs (United Kingdom: n = 25; United States: n = 7; South Korea and Africa: n = 0) and identified priorities regarding 27 conditions or service arrangements in the United Kingdom and 9 in the United States (predominantly in neurology/psychiatry). The UK priorities focused on treatments and interventions whereas the US on prognostic/predictive factors. There were notable research gaps within the existing PSPs, including common geriatric conditions like continence and frailty. The PSP quality evaluation revealed issues around lacking inclusion of ethnic minorities. CONCLUSIONS AND IMPLICATIONS:Research priorities for older adult health care vary internationally, but certain health care systems/countries have no available PSPs. Where PSPs are available, fundamental aspects of geriatric medicine have not been included. Future researchers should conduct prioritizations in different countries, focus on core geriatric syndromes, and ensure the inclusion of all relevant stakeholder groups.

Background Treatment burden is the workload of healthcare for people with long-term conditions and the impact on wellbeing. A validated measure of treatment burden after stroke is needed. We aim to adapt a patient-reported measure (PRM) of treatment burden in multimorbidity, PETS (Patient Experience with Treatment and Self-Management version 2.0), to create a stroke-specific measure, PETS-stroke. We aim to examine content validity, construct validity, reliability and feasibility in a stroke survivor population. Methods 1) Adaptation of 60-item PETS to PETS-stroke using a taxonomy of treatment burden. 2) Content validity testing through cognitive interviews that will explore the importance, relevance and clarity of each item. 3) Evaluation of scale psychometric properties through analysis of data from stroke survivors recruited via postal survey (n=340). Factor structure will be tested with confirmatory factor analysis and Cronbach’s alpha will be used to index internal consistency. Construct validity will be tested against: The Stroke Southampton Self-Management Questionnaire; The Satisfaction with Stroke Care Measure; and The Shortened Stroke Impact Scale. We will explore known-groups validity by exploring the association between treatment burden, socioeconomic deprivation and multimorbidity. Test-retest reliability will be examined via re-administration after 2 weeks. Acceptability and feasibility of use will be explored via missing data rates and telephone interviews with 30 participants. Conclusions We aim to create a validated PRM of treatment burden after stroke. PETS-stroke is designed for use as an outcome measure in clinical trials of stroke treatments and complex interventions to ascertain if treatments are workable for patients in the context of their everyday lives.

Background/objectivesSialorrhoea is a common non motor complication experienced by people with Parkinson's disease (PD). Despite its prevalence there is conflicting evidence on how to effectively treat it. Our aim was to establish the efficacy and safety outcomes of pharmacological interventions used to treat sialorrhoea in people with idiopathic PD. MethodsWe registered and conducted a systematic review and meta-analysis (PROSPERO: CRD42016042470). We searched seven electronic databases from inception until July 2022. Quantitative synthesis was performed where data allowed using random effects models. ResultsFrom 1374 records we included 13 studies (n = 405 participants). Studies were conducted in Europe, North America and China. There was marked heterogeneity in the interventions used, follow up times and outcome measures investigated. The main source of risk of bias identified was reporting bias. Five studies were included in the quantitative synthesis. Summary estimates showed administration of botulinum toxin significantly reduced saliva production, improved patient reported functional outcomes and was associated with an increase in adverse events. ConclusionSialorrhoea in PD is an important condition, but current data does not allow for strong recommendations on optimal pharmacological treatments. There is significant heterogeneity in outcomes measures used to evaluate the burden of sialorrhoea with lack of consensus on what constitutes clinically meaningful change. More research is required to better understand the underlying mechanism and potential treatments of sialorrhoea in idiopathic PD.

Background Treatment burden is the workload of healthcare for people with long-term conditions and the impact on wellbeing. A validated measure of treatment burden after stroke is needed. We aim to adapt a patient-reported measure (PRM) of treatment burden in multimorbidity, PETS (Patient Experience with Treatment and Self-Management version 2.0), to create a stroke-specific measure, PETS-stroke. We aim to examine content validity, construct validity, reliability and feasibility in a stroke survivor population. Methods 1) Adaptation of 60-item PETS to PETS-stroke using a taxonomy of treatment burden. 2) Content validity testing through cognitive interviews that will explore the importance, relevance and clarity of each item. 3) Evaluation of scale psychometric properties through analysis of data from stroke survivors recruited via postal survey (n=340). Factor structure will be tested with confirmatory factor analysis and Cronbach’s alpha will be used to index internal consistency. Construct validity will be tested against: The Stroke Southampton Self-Management Questionnaire; The Satisfaction with Stroke Care Measure; and The Shortened Stroke Impact Scale. We will explore known-groups validity by exploring the association between treatment burden, socioeconomic deprivation and multimorbidity. Test-retest reliability will be examined via re-administration after 2 weeks. Acceptability and feasibility of use will be explored via missing data rates and telephone interviews with 30 participants. Conclusions We aim to create a validated PRM of treatment burden after stroke. PETS-stroke is designed for use as an outcome measure in clinical trials of stroke treatments and complex interventions to ascertain if treatments are workable for patients in the context of their everyday lives.