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BackgroundSystematic review guidance recommends the use of programme theory to inform considerations of if and how healthcare interventions may work differently across socio-economic status (SES) groups. This study aimed to address the lack of detail on how reviewers operationalise this in practice.MethodsA methodological systematic review was undertaken to assess if, how and the extent to which systematic reviewers operationalise the guidance on the use of programme theory in considerations of socio-economic inequalities in health. Multiple databases were searched from January 2013 to May 2016. Studies were included if they were systematic reviews assessing the effectiveness of an intervention and included data on SES. Two reviewers independently screened all studies, undertook quality assessment and extracted data. A narrative approach to synthesis was adopted.ResultsA total of 37 systematic reviews were included, 10 of which were explicit in the use of terminology for ‘programme theory’. Twenty-nine studies used programme theory to inform both their a priori assumptions and explain their review findings. Of these, 22 incorporated considerations of both what and how interventions do/do not work in SES groups to both predict and explain their review findings. Thirteen studies acknowledged 24 unique theoretical references to support their assumptions of what or how interventions may have different effects in SES groups. Most reviewers used supplementary evidence to support their considerations of differential effectiveness. The majority of authors outlined a programme theory in the “Introduction” and “Discussion” sections of the review to inform their assumptions or provide explanations of what or how interventions may result in differential effects within or across SES groups. About a third of reviews used programme theory to inform the review analysis and/or synthesis. Few authors used programme theory to inform their inclusion criteria, data extraction or quality assessment. Twenty-one studies tested their a priori programme theory.ConclusionsThe use of programme theory to inform considerations of if, what and how interventions lead to differential effects on health in different SES groups in the systematic review process is not yet widely adopted, is used implicitly, is often fragmented and is not implemented in a systematic way.Electronic supplementary materialThe online version of this article (10.1186/s13643-017-0638-9) contains supplementary material, which is available to authorized users.

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Importance: Previous studies report both coexistence and mutual exclusivity of atopic eczema (AE) and psoriasis, but these have not been appraised systematically. Knowledge of such disease association throws light on disease mechanisms and may influence therapeutic choices. Objective: To summarise evidence for AE and psoriasis occurring in the same person at the same point in time. Planned primary outcome was the incidence, prevalence or risk of psoriasis or eczema. Methods: Ovid MEDLINE and Ovid Embase were searched from inception to 1st February 2020. The search strategy was built around the key terms 'atopic eczema', 'psoriasis' and 'co-existence'. Observational studies (cohort, case-control, cross-sectional and case-series) with a minimum of 10 consecutive patients were included. There were no restrictions on participants, geography or language. Studies were selected, data extracted and critically appraised by two independent reviewers. Data were extracted on the method of diagnosis: health professional (dermatologist, criteria, other), self-reported, not specified. Study quality was assessed using validated Joanna Brigg's Institute critical appraisal tools. A random-effects model was used to combine studies. The effect of study quality on the pooled estimate was investigated using stratification. Heterogeneity was explored by subgroup analysis. Results: This review included 31 studies and 20 523 individuals with psoriasis and 1 405 911 with AE. Eight studies reported the prevalence of AE in those with psoriasis and values ranged from 0.17% to 20%: the pooled prevalence was 2% (95% confidence interval [CI]: 1, 3). Seven studies reported the prevalence of psoriasis in those with AE and values ranged from 0.3% to 12.6%; the pooled prevalence was 2% (95% CI: 1, 3). Ten studies were assessed as low risk of bias. Geographical area, method of diagnosis, setting and whether the assessment of diagnosis was blinded, partly contributed to the heterogeneity. Conclusions: This review provides some evidence for the coexistence of AE and psoriasis. Clinicians should be aware of coexistence at diagnosis, when selecting therapies and when reviewing poor response to treatment.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Crush Injuries of Chest-Bargh et al.]BRITISH of paradox and reduction in residual deformity. It reduces pain and allows humane sedation without fear of respiratory depression. If a trained medical and nursing staff and proper facilities-that is, a respiratory unit-are available, and they Should be, the hazards of I.P.P.V. are negligible.Though blood-gas analysis is not used as the main indication for I.P.P.V., it has been found to be of great value in the management of a patient on a ventilator. This is particularly so in the " difficult " patient-that is, one with chronic lung disease or a low compliance from any other cause. Here frequent adjustments of inspiratory flow rates and inflation pressures may be necessary to achieve adequate ventilation, and the results of blood analysis are then invaluable. It is also very useful in the interpretation of certain clinical signs. For example, if varying levels of consciousness are occurring, are these due to a concurrent head injury or to hypoxia and acidosis ? Or, if the patient's blood pressure is falling, is this due to excessive ventilation or hypovolaemia ? In the patient with renal failure is the restlessness respiratory or renal in origin ? In these situations blood-gas studies may be the only means of deciding.As the management of the respiatory problems improves the mortality rate will depend more and more on the severity of the associated injuries. For this reason patients in this series have been classified according to the sites of injury-that is, thoracic only or thoracic together with other major injuries. Furthermore, as patients die from dysfunctions rather than injuries, we have attempted to quantitate these dysfunctions.Ten patients died. In four of these (Cases 27, 31, 71, and 128) death resulted from dysfunctions which could not be influenced by I.P.P.V. Three deaths (Cases 125, 193, and 199) were due to failure of respiration with which I.P.P.V. with pure oxygen failed to cope. The remaining three deaths (Cases 57, 66, and 122) were due to multiple factors, of which respiratory dysfunction contributed its share.It is impossible to compare the results in this series with the results of current authors (Reid and Baird, 1965 ;Lloyd et al., 1965; Campbell, 1966). The indications for I.P.P.V. are different, and, furthermore, the mortality rate will, in part, depend on the presence of other serious injuries-for example, head or abdominal visceral injuries. However, if the results of this series are compared with those recorded by Griffiths in 1960 a marked improvement in the mortality rate is obvious. This is largely due to the efficient management of the respiratory problem. SummarySixty-four patients with severe crush injuries of the chest are reviewed. They have been classified according to the anatomical site of injury. The great majority of patients received I.P.P.V., the indications for this being on clinical rather than biochemical features-particularly the persistence of dyspnoea and paradoxical respiration after the correction of airway obst...

An 8-year-old boy presented with multiple episodes of erythematous painful necrotic eruptions since the age of 18 months. The lesions had initially developed on the patient's heels and toes (Fig. 1), and over time had also started to involve his ears, inner thighs and hips. During each episode, the lesions began as small purple macules, which increased in size during a few hours. The lesions were extremely painful and could persist for several months. They occurred more frequently and were more severe during the winter months. The child was otherwise healthy, and no relevant family history was reported.Extensive laboratory investigations (Table S1) for vasculitis and vasculopathy were performed. Vasculitis screens were negative. Fibrinogen, plasma viscosity, antithrombin, Protein S and Protein C levels were normal.Genetic testing found no evidence of prothrombin G20201A mutation. A heterozygous Factor V Leiden mutation was detected; however, as this confers only a slightly increased risk of thrombosis, it was felt that this mutation was insufficient to explain the full clinical presentation. 1 Cryoglobulinaemia, cryofibrinogenaemia and congenital thrombotic thrombocytopenic purpura were excluded. Screening tests for anticardiolipin and anti-b2-glycoprotein I antibodies were negative. Lupus anticoagulant (LA) was negative by three independent methods [dilute Russell viper venom time (dRVVT), kaolin clotting time and

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