Chronic wounds are a health problem that have devastating consequences for patients and contribute major costs to healthcare systems and societies. To understand the magnitude of this health issue, a systematic review was undertaken. Searches were conducted in MEDLINE, EMBASE, EBM Reviews and Cochrane library, CINAHL, EBSCO, PsycINFO, and Global Health databases for articles published between 2000 and 2015. Included publications had to target adults (≥18 years of age), state wound chronicity (≥3 weeks) and/or label the wounds as chronic, complex, hard‐to‐heal, or having led to an amputation. The review excluded studies that did not present data on generic health‐related quality of life and/or cost data, case studies, randomized controlled trials, economic modeling studies, abstracts, and editorials. Extracted data were summarized into a narrative synthesis, and for a few articles using the same health‐related quality of life instrument, average estimates with 95% confidence intervals were calculated. Thirty articles met the inclusion criteria. Findings revealed that health‐related quality of life was lowest for physical pathologies, and based on average estimates were scores most inferior in the domain physical role for both patients with chronic wounds and for those with wound‐related amputations. The cost burden was mainly attributed to amputations for patients also comorbid with diabetes, where the cost for hospitalization ranged from US$12,851 to US$16,267 (median) for this patient group. Patients with chronic wounds have poor health‐related quality of life in general and wound‐related costs are substantial. Development and implementation of wound management strategies that focus on increasing health‐related quality of life and effectively reduce costs for this patient group are urgently needed.

Chronic wounds are a major public health challenge, but little is known about the true burden with studies reporting different estimates because of disparities in study designs and measurement methods. This hampers efficient resource allocation, planning, and improvement of wound care. Our study aimed to pool prevalence estimates from a global perspective by systematically carrying out searches in MEDLINE, EMBASE, Cochrane, CINAHL, Global Health, and PsycINFO databases for articles reporting the prevalence of chronic wounds in adults, from January 2000 to June 2018. The included publications had to define wound chronicity by duration (≥3 weeks), and/or labeling the wounds as chronic, complex, or hard-to-heal. Seventeen studies met the inclusion criteria, and 11 studies analyzing chronic wounds in the general population were included in random effects meta-analyses to calculate pooled prevalence. Chronic wounds of mixed etiologies (n = 3) showed a pooled prevalence of 2.21 per 1000 population, and for chronic leg ulcers (n = 9), the prevalence was estimated at 1.51 per 1000 population. Our findings, aligned to previous studies reporting point prevalence of chronic wounds identified within the healthcare system, showed that the vast majority of chronic wounds in epidemiological studies are made up by chronic leg ulcers.

Background: Sedentary lifestyle is a major risk factor for noncommunicable diseases such as cardiovascular diseases, cancer and diabetes. It has been estimated that approximately 3.2 million deaths each year are attributable to insufficient levels of physical activity. We evaluated the available evidence from Cochrane systematic reviews (CSRs) on the effectiveness of exercise/physical activity for various health outcomes.Methods: Overview and meta-analysis. The Cochrane Library was searched from 01.01.2000 to issue 1, 2019. No language restrictions were imposed. Only CSRs of randomised controlled trials (RCTs) were included. Both healthy individuals, those at risk of a disease, and medically compromised patients of any age and gender were eligible. We evaluated any type of exercise or physical activity interventions; against any types of controls; and measuring any type of health-related outcome measures. The AMSTAR-2 tool for assessing the methodological quality of the included studies was utilised.Results: Hundred and fifty CSRs met the inclusion criteria. There were 54 different conditions. Majority of CSRs were of high methodological quality. Hundred and thirty CSRs employed meta-analytic techniques and 20 did not. Limitations for studies were the most common reasons for downgrading the quality of the evidence. Based on 10 CSRs and 187 RCTs with 27,671 participants, there was a 13% reduction in mortality rates risk ratio (RR) 0.87 [95% confidence intervals (CI) 0.78 to 0.96];I² = 26.6%, [prediction interval (PI) 0.70, 1.07], median effect size (MES) = 0.93 [interquartile range (IQR) 0.81, 1.00]. Data from 15 CSRs and 408 RCTs with 32,984 participants showed a small improvement in quality of life (QOL) standardised mean difference (SMD) 0.18 [95% CI 0.08, 0.28];I² = 74.3%; PI -0.18, 0.53], MES = 0.20 [IQR 0.07, 0.39]. Subgroup analyses by the type of condition showed that the magnitude of effect size was the largest among patients with mental health conditions.Conclusion: There is a plethora of CSRs evaluating the effectiveness of physical activity/exercise. The evidence suggests that physical activity/exercise reduces mortality rates and improves QOL with minimal or no safety concerns.Trial registration: Registered in PROSPERO (CRD42019120295) on 10th January 2019.

Chronic non-healing wounds present a substantial economic burden to healthcare system; significant reductions in quality of life for those affected, and precede often serious events such as limp amputations or even premature deaths. This burden is also likely to increase with a larger proportion of elderly and increasing prevalence of life-style diseases such as obesity and diabetes. Reviews of the evidence on the burden of illness associated with chronic wounds have not been comprehensive in scope and have not provided an assessment of the distribution of the health care costs across categories of resource use. This study is a systematic review of multiple databases for studies on adult patients with chronic wounds and with the primary objective to assess the impact on health-related quality of life by category of ulcers, and associated direct and indirect costs. Eligible studies will primary be empirical studies evaluating, describing or comparing measurement of quality of life and economic impact. Two reviewers will independently screen titles and abstracts and select studies involving adults with chronic wounds. These investigators will also independently extract data using a pre-designed data extraction form. Differences in applied methodologies and uncertainties will clearly be accounted for. Conservative valuations of costs and impact on health-related quality of life will be prioritised. Variations that may depend on age distribution, the categorisation of ulcer, healthcare system etc. will be described clearly. The proposed systematic review will yield a comprehensive assessment of the humanistic and economic burden of chronic wounds in an adult population. A better understanding of the humanistic and economic burden of chronic wounds is essential for policy and planning purposes, to monitor trends in disease burden and not at least in order to estimate the real-world cost-effectiveness of new treatments and therapies. PROSPERO CRD42016037496

Objective To assess the methodological quality of studies on prediction models developed using machine learning techniques across all medical specialties. Design Systematic review. Data sources PubMed from 1 January 2018 to 31 December 2019. Eligibility criteria Articles reporting on the development, with or without external validation, of a multivariable prediction model (diagnostic or prognostic) developed using supervised machine learning for individualised predictions. No restrictions applied for study design, data source, or predicted patient related health outcomes. Review methods Methodological quality of the studies was determined and risk of bias evaluated using the prediction risk of bias assessment tool (PROBAST). This tool contains 21 signalling questions tailored to identify potential biases in four domains. Risk of bias was measured for each domain (participants, predictors, outcome, and analysis) and each study (overall). Results 152 studies were included: 58 (38%) included a diagnostic prediction model and 94 (62%) a prognostic prediction model. PROBAST was applied to 152 developed models and 19 external validations. Of these 171 analyses, 148 (87%, 95% confidence interval 81% to 91%) were rated at high risk of bias. The analysis domain was most frequently rated at high risk of bias. Of the 152 models, 85 (56%, 48% to 64%) were developed with an inadequate number of events per candidate predictor, 62 handled missing data inadequately (41%, 33% to 49%), and 59 assessed overfitting improperly (39%, 31% to 47%). Most models used appropriate data sources to develop (73%, 66% to 79%) and externally validate the machine learning based prediction models (74%, 51% to 88%). Information about blinding of outcome and blinding of predictors was, however, absent in 60 (40%, 32% to 47%) and 79 (52%, 44% to 60%) of the developed models, respectively. Conclusion Most studies on machine learning based prediction models show poor methodological quality and are at high risk of bias. Factors contributing to risk of bias include small study size, poor handling of missing data, and failure to deal with overfitting. Efforts to improve the design, conduct, reporting, and validation of such studies are necessary to boost the application of machine learning based prediction models in clinical practice. Systematic review registration PROSPERO CRD42019161764.

Chronic wounds impose a significant and often underappreciated burden to the individual, the healthcare system and the society as a whole. Preliminary literature search suggests that there are at present no reliable estimates on the total prevalence of chronic wounds for different settings and categories of chronic wounds. Such information is essential for policy and planning purposes as the increasing number of elderly and the prevalence of lifestyle diseases point in the direction of an increased burden. Knowledge about the prevalence and incidence of chronic wounds in relation to population characteristics is important for informing healthcare planning and resource allocation. The objective is to present a transparent process for how to review the existing literature on the prevalence and incidence rates of chronic wounds and resulting implications. We will search electronic bibliographic databases (MEDLINE, EMBASE, the EBM Reviews and Cochrane, Cumulative Index to Nursing and allied Health Literature (CINAHL), PsycINFO, Global Health) and reference lists of included articles. Two investigators will independently screen titles and abstracts and select studies involving adults with chronic wounds. These investigators will also independently extract data using a pre-designed data extraction form that will cover information on demographics, diagnostics including disease prevalence, medical history, hospital and community-based management and outcomes. Subgroup analysis and sensitivity analysis will be performed to address the heterogeneity across studies. Meta-analysis will also be performed if homogeneous group of studies will be found. The collective evidence will be further stratified according to the important background variables if allowed. This study will describe the available epidemiological evidence and summarise prevalence and incidence rates of chronic wounds and related complications. A better understanding of the relationship between population profile and the prevalence of chronic wounds and related complications will be helpful in the development of guidelines for patient management. PROSPERO CRD42016037355