Tinnitus, the perception of sound without an external source, affects 15% of the population, with 2.4% experiencing significant distress. In this review, we summarize the current state of knowledge about tinnitus management with a particular focus on the translation into clinical practice. In the first section, we analyze shortcomings, knowledge gaps, and challenges in the field of tinnitus research. Then, we highlight the relevance of the diagnostic process to account for tinnitus heterogeneity and to identify all relevant aspects of the tinnitus in an individual patient, such as etiological aspects, pathophysiological mechanisms, factors that contribute most to suffering, and comorbidities. In the next section, we review available treatment options, including counselling, cognitive-behavioral therapy (CBT), hearing aids and cochlear implants for patients with a relevant hearing loss, sound generators, novel auditory stimulation approaches, tinnitus retraining therapy (TRT), pharmacological treatment, neurofeedback, brain stimulation, bimodal stimulation, Internet- and app-based digital approaches, and alternative treatment approaches. The evidence for the effectiveness of the various treatment interventions varies considerably. We also discuss differences in current respective guideline recommendations and close with a discussion of how current pathophysiological knowledge, latest scientific evidence, and patient perspectives can be translated in patient-centered care.

BACKGROUND: Testing for glucose-6-phosphate dehydrogenase (G6PD) deficiency is an important consideration regarding treatment for malaria. G6PD deficiency may lead to haemolytic anaemia during malaria treatment and, therefore, determining G6PD deficiency in malaria treatment strategies is extremely important.
METHODS: This report presents the results of a scoping review and evidence and gap map for consideration by the Guideline Development Group for G6PD near patient tests to support radical cure of Plasmodium vivax. This scoping review has investigated common diagnostic tests for G6PD deficiency and important contextual and additional factors for decision-making. These factors include six of the considerations recommended by the World Health Organization (WHO) handbook for guideline development as important to determining the direction and strength of a recommendation, and included \'acceptability\', \'feasibility,\' \'equity,\' \'valuation of outcomes,\' \'gender\' and \'human rights\'. The aim of this scoping review is to inform the direction of future systematic reviews and evidence syntheses, which can then better inform the development of WHO recommendations regarding the use of G6PD deficiency testing as part of malaria treatment strategies.
RESULTS: A comprehensive search was performed, including published, peer-reviewed literature for any article, of any study design and methodology that investigated G6PD diagnostic tests and the factors of \'acceptability\', \'feasibility,\' \'equity,\' \'valuation of outcomes,\' \'gender\' and \'human rights\'. There were 1152 studies identified from the search, of which 14 were determined to be eligible for inclusion into this review. The studies contained data from over 21 unique countries that had considered G6PD diagnostic testing as part of a malaria treatment strategy. The relationship between contextual and additional factors, diagnostic tests for G6PD deficiency and study methodology is presented in an overall evidence and gap, which showed that majority of the evidence was for the contextual factors for diagnostic tests, and the \'Standard G6PD (SD Biosensor)\' test.
CONCLUSIONS: This scoping review has produced a dynamic evidence and gap map that is reactive to emerging evidence within the field of G6PD diagnostic testing. The evidence and gap map has provided a comprehensive depiction of all the available literature that address the contextual and additional factors important for decision-making, regarding specific G6PD diagnostic tests. The majority of data available investigating the contextual factors of interest relates to quantitative G6PD diagnostic tests. While a formal qualitative synthesis of this data as part of a systematic review is possible, the data may be too heterogenous for this to be appropriate. These results can now be used to inform future direction of WHO Guideline Development Groups for G6PD near patient tests to support radical cure of P. vivax malaria.

Background: People with intellectual disabilities (ID) experience many health and social inequalities. Increasing physical activity is a proven intervention to address such inequalities, yet the physical activity rates of this population are substantially lower than the general population. Aim: Research has been growing to understand why this is and how to intervene to increase the physical activity levels of people with ID. Method: Using a behavioural epidemiological framework, the research in this area from barriers and facilitators of physical activity to translational research testing interventions within natural settings is reviewed. Findings from a total of 14 reviews and eight empirical studies and protocols were included. Results: Whilst there are multiple investigations into what promotes or enhances physical activity for people with ID, findings from intervention studies show few successful outcomes. Gaps within the existing research are identified and recommendations about how intervention efficacy might be improved are provided to inform future research and practice. Conclusion: Findings from previous research on barriers and facilitators can be further capitalised on and intervention studies should be underpinned by better links to theory and more systemic approaches.

Best, is to be \'of the highest quality, or being the most suitable, pleasing, or effective type of thing or person\'. Within medical education, \'best-ness\' is evident within best practice guides and recommendations, and within research, where best evidence influences design and conduct. Yet, much of the evidence of best-ness fails to consider best for who and where, what, and when. Thinking needs reframing, given that \"best-ness\" and medical education are such good bedfellows, but it is critical that we recognise the impact and influence of context - that practice can be good, but cannot be universally and unflinchingly best.

UNASSIGNED: Arts and health practice and research has expanded rapidly since the turn of the millennium. A World Health Organization scoping review of a large body of evidence claims positive health benefits from arts participation and makes recommendations for policy and implementation of arts for health initiatives. A more recent scoping review (CultureForHealth) also claims that current evidence is sufficient to form recommendations for policy and practice. However, scoping reviews of arts and health research-without critical appraisal of included studies-do not provide a sound basis for recommendations on the wider implantation of healthcare interventions.
UNASSIGNED: We performed a detailed assessment of 18 Randomised Controlled Trials (RCTs) on arts-based interventions included in Section 1 of the CultureForHealth report using the Joanna Briggs Institute Critical Appraisal Tool for RCTs (2023).
UNASSIGNED: The 18 RCTs included demonstrated considerable risks of bias regarding internal and statistical conclusion validity. Moreover, the trials are substantially heterogeneous with respect to settings, health-issues, interventions, and outcomes, which limits their external validity, reliability, and generalisability.
UNASSIGNED: The absence of a critical appraisal of studies included in the CultureForHealth report leads to an overinterpretation and overstatement of the health outcomes of arts-based interventions. As such, the CultureForHealth review is not a suitable foundation for policy recommendations, nor for formulating guidance on implementation of arts-based interventions for health.

BACKGROUND: In 2015, the results of the \'Small bites versus large bites for closure of abdominal midline incisions (STITCH) Trial\' were published in The Lancet. This demonstrated the superiority of small bite laparotomy closure over mass closure for the reduction of incisional hernias; despite this most surgeons have not changed their practice. Previous research has shown the time taken for the implementation of evidenced based practise within medicine takes an average of 17 years. This study aims to understand the reasons why surgeons have and have not changed their practice with regards to closure of midline laparotomy.
METHODS: Semi-structured interviews were completed with surgical consultants and registrars at a single institution in South West England. The interview topic guide was informed by a review of the published literature, which identified barriers to adopting evidence into surgical practice. Interview transcripts underwent thematic analysis with themes identified following discussions within the research team, exploring views on published data and clinical practise.
RESULTS: Nine interviews with general surgical and urological consultants as well as registrars in training were performed. Three themes were identified; \'Trusting the Evidence & Critical Appraisal\', \'Surgical Attitude to Risk\' and \'Adopting Evidence in Practise\', that reflected barriers to the introduction of evidenced based practise to clinical work.
CONCLUSIONS: Identification of the themes highlights possible areas for intervention to decrease the adoption time for evidence, for example from randomised controlled trials. The continued updating of clinical practise allows clinicians to provide best evidenced based care for patients and improve their outcomes.

OBJECTIVE: Post-stroke dysphagia is a common swallowing disorder that occurs after a stroke, leading to an increased risk of aspiration pneumonia and malnutrition. There is a pressing need for effective and safe interventions for its rehabilitation. This review aims to answer two key scientific questions: (1) What is the efficacy of repetitive transcranial magnetic stimulation in the rehabilitation of post-stroke dysphagia? (2) Is repetitive transcranial magnetic stimulation a safe intervention for post-stroke dysphagia?
METHODS: A comprehensive search was conducted across four electronic databases: PubMed, Cochrane Library, Web of Science, and Embase. The search aimed to identify relevant studies concerning our topic of interest and was completed on 28 May 2024.
METHODS: In accordance with the PRISMA checklist, a comprehensive search of four databases was conducted, which identified 13 relevant systematic reviews. The inclusion criteria were systematic reviews that evaluated the efficacy and safety of repetitive transcranial magnetic stimulation for post-stroke dysphagia. Exclusion criteria were reviews that did not focus on post-stroke dysphagia or did not evaluate repetitive transcranial magnetic stimulation as a therapeutic intervention. The quality, bias, reporting, and overall evidence quality of these reviews were assessed using validated tools, including the AMSTAR 2 tool for assessing the methodological quality of systematic reviews, the ROBIS tool for assessing the risk of bias, and the GRADE approach for evaluating the overall quality of evidence. This rigorous approach ensures that our review provides a comprehensive and reliable overview of the current state of knowledge on the use of repetitive transcranial magnetic stimulation for post-stroke dysphagia.
RESULTS: The sample sizes for the individual studies included in the systematic reviews/meta-analyses ranged from 66 to 555. The total number of participants across all studies included in the overall analyses was 752. The evidence was limited by the methodological flaws and heterogeneity of the systematic reviews. The quality of the evidence varied from high to low, with most outcomes having moderate quality. Future research should adopt more rigorous, standardized, and comprehensive designs to confirm the efficacy and safety of repetitive transcranial magnetic stimulation for post-stroke dysphagia. The main reason for downgrading the evidence quality was the small sample size and high heterogeneity of the primary studies.
CONCLUSIONS: This overview synthesized research on repetitive transcranial magnetic stimulation for dysphagia, aiming to inform clinical and policy decisions. However, the current evidence does not conclusively establish the safety and efficacy of repetitive transcranial magnetic stimulation for post-stroke dysphagia rehabilitation. The studies reviewed varied in quality, and many were of poor quality. Therefore, while some studies suggest potential benefits of repetitive transcranial magnetic stimulation, these findings should be interpreted with caution. There is a pressing need for more rigorous, high-quality research to validate the use of repetitive transcranial magnetic stimulation for post-stroke dysphagia rehabilitation. The implications of these findings for clinical practice and policy will be clearer once we have more robust, evidence-based recommendations.

OBJECTIVE: To quantify the strength of statistical evidence of randomised controlled trials (RCTs) for novel cancer drugs approved by the Food and Drug Administration (FDA) in the last two decades.
METHODS: We used data on overall survival (OS), progression-free survival (PFS), and tumour response (TR) for novel cancer drugs approved for the first time by the FDA between January 2000 and December 2020. We assessed strength of statistical evidence by calculating Bayes Factors (BFs) for all available endpoints, and we pooled evidence using Bayesian fixed-effect meta-analysis for indications approved based on two RCTs. Strength of statistical evidence was compared between endpoints, approval pathways, lines of treatment, and types of cancer.
RESULTS: We analysed the available data from 82 RCTs corresponding to 68 indications supported by a single RCT and seven indications supported by two RCTs. Median strength of statistical evidence was ambiguous for OS (BF = 1.9; IQR 0.5-14.5), and strong for PFS (BF = 24,767.8; IQR 109.0-7.3*106) and TR (BF = 113.9; IQR 3.0-547,100). Overall, 44 indications (58.7%) were approved without clear statistical evidence for OS improvements and seven indications (9.3%) were approved without statistical evidence for improvements on any endpoint. Strength of statistical evidence was lower for accelerated approval compared to non-accelerated approval across all three endpoints. No meaningful differences were observed for line of treatment and cancer type.
CONCLUSIONS: This analysis is limited to statistical evidence. We did not consider non-statistical factors (e.g., risk of bias, quality of the evidence).
CONCLUSIONS: BFs offer novel insights into the strength of statistical evidence underlying cancer drug approvals. Most novel cancer drugs lack strong statistical evidence that they improve OS, and a few lack statistical evidence for efficacy altogether. These cases require a transparent and clear explanation. When evidence is ambiguous, additional post-marketing trials could reduce uncertainty.

OBJECTIVE: Variations in US commercial health plan coverage policies affect how patients access medications. Plans may vary in treatment access criteria, line of therapy, and prescriber requirements. In this study, we examined coverage of esketamine hydrochloride (Spravato) for major depressive disorder (MDD) and treatment-resistant depression (TRD) to answer the following question: how do US commercial health plans cover esketamine, and how do they guide prompt patient access to the drug?
METHODS: We used information from the Tufts Medical Center Specialty Drug Evidence and Coverage database, which includes coverage policies issued by 18 large commercial health plans in the United States. Esketamine coverage policies for MDD and TRD active in December 2022 were collated and analyzed. We compared coverage policies according to step therapy protocols, patient subgroup restrictions, and prescriber requirement criteria, evaluating patient access using the number of restrictions and proportion of plans including each criterion.
RESULTS: Plans more often imposed step therapy requirements for access to esketamine for TRD than for MDD, with line of treatment of ≤9 steps for MDD compared with 1 to 5 steps for TRD. Plans also varied with respect to the therapies they required patients to first try and experience treatment failure before granting access to esketamine for both indications. Clinical coverage requirements varied in thresholds and rating scales used to assess severity of depressive symptoms.
CONCLUSIONS: Plans vary in terms of line of therapy and clinical coverage requirements for access to esketamine. Variation in health plan coverage policies may result in inequitable access and added complexity for patients and clinicians navigating care, which may delay access to urgent treatment.
RESULTS:
UNASSIGNED: Not applicable.

This rapid review delves into the realm of social prescribing as a novel approach to suicide prevention by addressing the social determinants of health. Through an exploration of various databases including MEDLINE, PsychInfo, WILEY, and Sage, a total of 3,063 articles were initially identified as potentially relevant to the research. Following a meticulous screening process, 13 articles were included in the final review, shedding light on the potential effectiveness and impact of social prescribing interventions on suicide prevention. Key findings indicate the need for additional monitoring and support for individuals at risk of suicide, emphasising warm referrals and sustained connections after referral to enhance the efficacy of social prescribing models. The review also highlights the importance of social capital and trust among vulnerable populations, underscoring the significance of community-based referrals in suicide prevention initiatives. Overall, this review identifies the potential of social prescribing as a valuable tool in mitigating suicide risk factors and promoting mental health and wellbeing in diverse populations.