Michelle Doering

Despite well‐documented harms of prenatal alcohol exposure, evidence‐based treatment guidelines for alcohol use disorder (AUD) during pregnancy remain limited. We systematically reviewed international clinical practice guidelines to examine how they address the full cascade of AUD care during pregnancy, including diagnosis, engagement, treatment initiation, and retention. We searched over 40 clinical practice guideline databases (including PubMed and Guidelines International Network) and gray literature sources globally, identifying 1045 records. Using the Population, Interventions, Comparators, Attributes, Recommendation Characteristics (PICAR) framework, we evaluated guidelines from medical organizations in English‐speaking nations addressing alcohol use and AUD management in pregnancy. Our final analysis included 18 guidelines from the United States, Canada, the United Kingdom, Australia/New Zealand, and the World Health Organization published from 2014 to the present. Two reviewers independently assessed each guideline using the Appraisal of Guidelines Research and Evaluation‐Recommendations Excellence (AGREE‐REX) framework to evaluate quality and risk of bias. We used narrative synthesis to summarize findings across key concepts and care cascade stages. Nearly all guidelines (94%) described risks of alcohol exposure and recommended counseling on cessation (89%), yet few extended beyond these early cascade stages. Only 44% mentioned medications for AUD (MAUD), and merely 17% discussed specific psychosocial treatments. Among guidelines addressing MAUD, only one cautiously supported use, while three explicitly recommended against it. Most guidelines (61%) ended treatment recommendations at referral to specialty care, with half limiting guidance to acute alcohol withdrawal management. Taken together, our findings reveal a stark misalignment between screening emphasis and treatment guidance. While guidelines consistently recommend universal screening and brief intervention, they provide minimal actionable frameworks for managing AUD throughout pregnancy. This gap leaves clinicians without evidence‐based pathways for comprehensive AUD treatment during the prenatal period, highlighting an urgent need to strengthen both the evidence base and clinical guidance for AUD management in pregnancy.

Introduction: Obesity and related cardiometabolic comorbidities, including hypertension, dyslipidemia, diabetes, metabolic dysfunction-associated steatotic liver disease (MASLD), and atherosclerotic cardiovascular disease (ASCVD), are increasingly prevalent among individuals with inflammatory bowel disease (IBD). These conditions influence disease activity, therapeutic response, surgical outcomes, and overall quality of life, yet evidence remains fragmented. The M odulate O besity and relate D metabolic compl I cations F or Y ielding improvements in IBD outcomes (MODIFY-IBD) initiative aims to synthesize evidence and generate consensus recommendations to guide practice and future research in this area. Methods and analysis: We will conduct a structured evidence review organized into three domains: (1) the impact of obesity on IBD outcomes (2) burden of cardiometabolic complications in IBD, and (3) management of obesity and cardiometabolic comorbidities in IBD. Draft clinical statements will be generated and evidence summaries prepared using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) framework, with certainty of evidence rated where applicable. In the assessment of those statements where GRADE is not feasible, a multidisciplinary international panel of gastroenterologists, surgeons, endocrinologists, hepatologists, cardiologists, and dietitians will assess each statement using the RAND/UCLA Appropriateness Method. Panelists will rate the appropriateness of each statement (only those that fall into their area of expertise) on a 1-9 scale (1-3 = inappropriate, 4-6 = uncertain, 7-9 = appropriate), with medians rounded up (e.g., 6.5 = appropriate). Agreement will be assessed using the RAND Disagreement Index (DI <1.0 = agreement). Ethics and dissemination: This study will not involve direct patient participation, as it is based on evidence synthesis and expert consensus; therefore, formal Research Ethics Committee approval will not be required. Patient representatives will contribute to the consensus process to provide contextual perspectives, but no identifiable data will be collected. Findings will be disseminated through publication in peer-reviewed journals, presentation at major gastroenterology and IBD conferences, and communication with professional societies. A lay summary and patient-friendly infographic will also be developed to facilitate translation of recommendations into clinical practice. PROSPERO registration number: CRD420251178843: A systematic review of the impact of obesity on inflammatory bowel disease outcomes CRD420251178799: A Systematic Review of Cardiometabolic Complications in Inflammatory Bowel Disease CRD420251174653: Management of Overweight, Obesity, and Cardiometabolic Comorbidities in Inflammatory Bowel Disease: A Systematic Review Strengths and limitations: Integrates systematic evidence synthesis with both GRADE and RAND/UCLA methods, an approach not previously applied to obesity and cardiometabolic comorbidities in IBD. International, multidisciplinary panel (gastroenterology, surgery, endocrinology, cardiology, dietetics, radiology) ensures broad expertise. Anonymous scoring and iterative re-rating reduce bias while enabling structured discussion. Patient and public involvement will inform priorities and dissemination, although RAND scoring remains expert-only. Evidence is largely observational and rapidly evolving (e.g., Glucagon-Like Peptide-1 Receptor Agonists [GLP-1Ras], endobariatric therapies), necessitating future updates.

Ablation of atrial fibrillation can restore normal heart rhythm, but its effect on clinical outcomes is uncertain. To determine the effect of ablation on ischemic stroke at more than 30 days (primary outcome). Search of 9 databases without language restrictions from 1 January 1987 to 13 September 2024, and bridge search of 2 databases to 1 May 2025. Randomized controlled trials of catheter or surgical ablation versus no ablation that had at least 1 month of follow-up and reported stroke and/or mortality. Dual independent data extraction and risk-of-bias assessment. Compared with medical therapy, catheter ablation reduced risks for ischemic stroke after 30 days (relative risk [RR], 0.63 [95% CI, 0.43 to 0.92]), mortality (RR, 0.73 [CI, 0.60 to 0.88]), and heart failure (HF) hospitalization (RR, 0.68 [CI, 0.55 to 0.85]). However, catheter ablation increased the RR for ischemic stroke at or before 30 days (6.81 [CI, 1.56 to 29.8]) such that the RRs were 0.77 (CI, 0.55 to 1.09) for any ischemic stroke and 0.77 (CI, 0.57 to 1.05) for all strokes. Surgical ablation reduced the RRs for ischemic stroke (0.54 [CI, 0.34 to 0.86]) and stroke from any cause (0.54 [CI, 0.35 to 0.82]) but had uncertain benefit for other outcomes; RRs were 0.63 (CI, 0.37 to 1.06) for ischemic stroke after 30 days, 0.90 (CI, 0.70 to 1.15) for mortality, and 0.90 (CI, 0.60 to 1.35) for HF hospitalization. Clinical heterogeneity of trials, lack of participant-level data, and inclusion of unblinded trials. Catheter ablation reduced the risks for ischemic stroke at more than 30 days, mortality, and HF hospitalization. Surgical ablation had uncertain benefit, except for stroke. National Center for Advancing Translational Sciences of the National Institutes of Health (Awards TL1TR002344 and UL1TR002345). (PROSPERO: CRD42023409751).

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: As digital interventions gain prominence in mental health care, they present opportunities to improve access and scalability. Despite their potential, the overall impact of digital behavioral activation (BA) interventions across different formats and populations is not yet fully understood. Objective: This systematic review examines the characteristics and functions of digital BA interventions and evaluates their effectiveness for mental health and other patient-related outcomes. Methods: A comprehensive search of databases (PubMed, Embase, Web of Science, APA PsycInfo, and ClinicalTrials.gov) was performed in November 2023 to identify randomized controlled trials (RCTs) assessing the effectiveness of digital BA interventions for depression and anxiety. A total of 2 reviewers screened the studies for inclusion. Meta-analysis using a random-effects model assessed intervention impact on outcomes including depression, anxiety, quality of life (QoL), BA scores, functioning and disability, and stress. Statistical heterogeneity was evaluated with the I² statistic and statistical significance was evaluated with P values. Studies that did not meet the meta-analysis criteria underwent narrative synthesis. Results: A total of 18 articles reporting 17 RCTs were included across three intervention types: (1) internet-based BA (n=12, 71%), delivering digital therapies to foster new behavioral activities for depression management; (2) electronic messaging–based BA (n=2, 12%), involving prompts to support behavior change; and (3) telehealth-based BA (n=3, 17%), providing remote health care services. We identified single-component and multicomponent interventions that combined BA with elements such as problem-solving therapy or cognitive behavioral therapy. A total of 12 RCTs were included in the meta-analysis, while the remaining studies were narratively synthesized. Risk of bias (RoB) was assessed in all included studies. Digital BA interventions significantly reduced depressive symptoms at 2 months (P<.001, I²=0%), 3 months (P=.001, I²=51%), and 6 months (P=.009, I²=29%) post treatment, but not at 12 months (P=.82, I²=89%). Significant improvements in BA scores at 6 months were observed (P<.001, I²=0%). QoL improved significantly at 3 months (P=.002, I²=22%) and 6 months (P=.009, I²=0%). Stress levels were also significantly reduced at 3 months (P<.001, I²=25%). However, no significant changes were identified in anxiety and functioning and disability outcomes at either 3 months (anxiety: P=.08, I²=68%) or 6 months (anxiety: P=.24, I²=44%; functioning and disability: P=.88, I²=90%). Across included studies, RoB was generally low, particularly for random sequence generation and allocation concealment. Conclusions: Digital BA interventions are effective in reducing depressive symptoms and improving QoL in the short- to midterm. However, these effects tend to diminish over time with no sustained benefits observed at 12 months. Future research should focus on developing and testing interventions with greater long-term efficacy, clarifying the role of BA within multicomponent digital approaches, and identifying the optimal intervention “dose” needed to maintain lasting effects. Trial Registration:

Introduction Perianal fistulising Crohn’s disease (pfCD) is a distinct and debilitating phenotype seen in around one-third of patients with CD. Clinical trials in pfCD are increasingly using magnetic resonance imaging (MRI) criteria as a primary endpoint, but there is heterogeneity in the radiological definition of a healed perianal fistula that currently limits our ability to perform meaningful meta-analyses of studies. Our aim is to standardise outcomes through the generation of an international consensus definition of a radiologically healed fistula. Methods and analysis This international Delphi consensus study employs a two-part strategy. The first is a systematic review to identify a longlist of variables used to define radiological healing in pfCD. MRI-based indices used to score fistula severity and healing will be assessed for their methodological quality using Consensus-based Standards for the selection of health Measurement Instruments (COSMIN). The systematic review protocol will be conducted using COSMIN methodology and reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The second part will be an online Delphi consensus, guided by the results of the systematic review. Radiologists, gastroenterologists and colorectal surgeons with expertise in the management of pfCD will be invited to take part in two to three rounds of online surveys. Once an a priori threshold of >80% agreement is reached on individual radiological components used to define ‘healing’ and ‘healed’, a final meeting of key stakeholders will be organised to generate a consensus definition of a healed fistula. Ethics and dissemination The study has been deemed exempt from a formal Research Ethics Committee review as no patients will participate directly in the consensus process, given the technical nature of the research question. The study is registered with the local R&D department (Reference RD24/007). Publication of this study will help standardise radiological endpoint measurement in clinical trials of pfCD and improve the synthesis and meta-analysis of comparative studies. PROSPERO registration number CRD42024504334.

BACKGROUND As digital interventions gain prominence in mental health care, they present opportunities to improve access and scalability. Despite their potential, the overall impact of digital behavioral activation (BA) interventions across different formats and populations is not yet fully understood. OBJECTIVE This systematic review examines the characteristics and functions of digital BA interventions and evaluates their effectiveness for mental health and other patient-related outcomes. METHODS A comprehensive search of databases (PubMed, Embase, Web of Science, APA PsycInfo, and ClinicalTrials.gov) was performed in November 2023 to identify randomized controlled trials (RCTs) assessing the effectiveness of digital BA interventions for depression and anxiety. A total of 2 reviewers screened the studies for inclusion. Meta-analysis using a random-effects model assessed intervention impact on outcomes including depression, anxiety, quality of life (QoL), BA scores, functioning and disability, and stress. Statistical heterogeneity was evaluated with the I² statistic and statistical significance was evaluated with P values. Studies that did not meet the meta-analysis criteria underwent narrative synthesis. RESULTS A total of 18 articles reporting 17 RCTs were included across three intervention types: (1) internet-based BA (n=12, 71%), delivering digital therapies to foster new behavioral activities for depression management; (2) electronic messaging–based BA (n=2, 12%), involving prompts to support behavior change; and (3) telehealth-based BA (n=3, 17%), providing remote health care services. We identified single-component and multicomponent interventions that combined BA with elements such as problem-solving therapy or cognitive behavioral therapy. A total of 12 RCTs were included in the meta-analysis, while the remaining studies were narratively synthesized. Risk of bias (RoB) was assessed in all included studies. Digital BA interventions significantly reduced depressive symptoms at 2 months (P<.001, I²=0%), 3 months (P=.001, I²=51%), and 6 months (P=.009, I²=29%) post treatment, but not at 12 months (P=.82, I²=89%). Significant improvements in BA scores at 6 months were observed (P<.001, I²=0%). QoL improved significantly at 3 months (P=.002, I²=22%) and 6 months (P=.009, I²=0%). Stress levels were also significantly reduced at 3 months (P<.001, I²=25%). However, no significant changes were identified in anxiety and functioning and disability outcomes at either 3 months (anxiety: P=.08, I²=68%) or 6 months (anxiety: P=.24, I²=44%; functioning and disability: P=.88, I²=90%). Across included studies, RoB was generally low, particularly for random sequence generation and allocation concealment. CONCLUSIONS Digital BA interventions are effective in reducing depressive symptoms and improving QoL in the short- to midterm. However, these effects tend to diminish over time with no sustained benefits observed at 12 months. Future research should focus on developing and testing interventions with greater long-term efficacy, clarifying the role of BA within multicomponent digital approaches, and identifying the optimal intervention “dose” needed to maintain lasting effects. CLINICALTRIAL

The purpose of this scoping review was to characterize the nature and scope of existing literature on the role of built environments in the community participation of adults aging with physical disabilities (AAwPD). A scoping review was selected to identify the volume and types of evidence available, pinpoint knowledge gaps, and clarify key concepts. Twenty-one articles were included for review, all of which were published within the last 20 years and identified components of the built environment for intervention. Results demonstrated the need for investigators to identify common indicators, use a shared lexicon, and improve dissemination of results across disciplines.

Introduction: Postpartum depression has costly consequences for the mother, baby, and society. Numerous pharmacological and non-pharmacological interventions are available for the prevention and treatment of postpartum depression. To date, no attempt has been made to synthesize the evidence from comparisons of interventions both within and across these categories. Methods: We will perform a systematic review of the literature and perform network meta-analysis of interventions to (a) prevent and (b) treat postpartum depression. This review will include studies of primiparous or multiparous women during pregnancy or within 12 months of delivery of their baby that assess either interventions initiated during pregnancy or within 1 year of childbirth. Comparators will be other eligible interventions or control conditions. The outcome of interests will be related to the antidepressant efficacy of the interventions as well as their acceptability. The published literature will be searched in Ovid MEDLINE 1946-, Embase.com 1947-, Scopus 1823-, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. The search will use a combination of standardized terms and keywords for postpartum depression, a sensitive search filter to limit for randomized controlled trials, and a librarian-created “humans” filter. The search results will be uploaded to the Covidence online systematic review platform (Veritas Health Information Ltd., Victoria, Australia) where two review team members will independently screen articles. We will extract data to include year of publication, language, country, participants (number, demographic data, eligibility criteria, psychiatric symptoms, and co-morbidities), characteristics of the intervention and control conditions, and reported outcomes. Risk of bias for each study will be assessed independently by two review authors using the RoB 2: A revised Cochrane risk of bias tool for randomized trials. Network meta-analysis will be performed using a Bayesian hierarchical model supplemented with a Markov chain Monte Carlo approach. Discussion: Postpartum depression is a devastating disease with long-lasting consequences. Given the numerous available interventions to both prevent and treat postpartum depression and the great number of studies comparing them, it is imperative that clinicians and patients are provided with an assessment of their comparative efficacy and acceptability. Systematic review registration: Prospero registration (CRD42022303247).

Many analgesics inadequately address the psychiatric comorbidities of chronic and persistent pain, but there is no standard preclinical model of pain-altered behavior to support the development of new therapies. To explore this conflicting and inconclusive literature, we conducted a focused systematic review and meta-analysis on the effect of complete Freund adjuvant–induced (CFA) rodent hind paw inflammation on multiple classical indicators of exploratory behavior, stress coping, and naturalistic behavior. Our primary objective was to define CFA's effect on assays including, but not limited to, the elevated plus maze and forced swim test. Our secondary objective was to discover how variables such as species and strain may influence outcomes in such assays. We searched Ovid MEDLINE, Embase, Scopus, and Web of Science in April and October 2020 for studies with adult rodents injected with CFA into the hind paw and subsequently tested for aspects of “anxiety-like” or “depressive-like” behaviors. Forty-four studies evaluated performance in the elevated plus or zero maze, open field test, light–dark box, place escape and avoidance paradigm, forced swim test, tail suspension test, sucrose preference test, wheel running, and burrowing assay. Complete Freund adjuvant modestly but significantly decreased exploratory behavior, significantly increased passive stress coping in the tail suspension test but not the forced swim test, and significantly decreased preference for sucrose and naturally rewarding activity. Subgroup analyses revealed significant differences between species and animal sourcing. Based on the evidence provided here, we conclude future studies should focus on CFA's effect on natural rewards and naturalistic behaviors.