The PRISMA 2020 statement: An updated guideline for reporting systematic reviews

Efficacy and safety of ureterorenoscopy in the elderly: A systematic review axnd meta-analysis

OBJECTIVE

Ureterorenoscopy (URS) is a common procedure performed for renal or upper ureteric stones. Nevertheless, the efficacy and safety of URS in the elderly is unclear. We conducted the first meta-analysis of literature comparing outcomes of URS between elderly and non-elderly patients.

METHODS

Embase, PubMed, Web of Science, and Scopus databases were searched for studies relevant to the review. The last date was 2nd September 2024. The elderly were defined as ≥ 65 or 60 years of age. Outcomes compared were stone-free rates (SFR), complications, and length of hospital stay (LOS).

RESULTS

Nine studies met the inclusion criteria. Pooled analysis showed that there was no difference in SFR between elderly and non-elderly groups after URS (OR: 0.96 95% CI: 0.81, 1.14 I2 = 3%). Meta-analysis failed to show any statistical significant in all complication rates (OR: 1.04 95% CI: 0.77, 1.40 I2 = 51%) as well as infectious (OR: 1.27 95% CI: 0.84, 1.92 I2 = 0%), medical (OR: 2.01 95% CI: 0.23, 17.57 I2 = 93%), surgical (OR: 1.18 95% CI: 0.68, 2.03 I2 = 0%) or Clavein Dindo grade ≥2 (OR: 1.02 95% CI: 0.60, 1.75 I2 = 0%) complications between elderly and non-elderly groups. Meta-analysis showed that the elderly had significantly longer LOS as compared to non-elderly patients (MD: 0.75 95% CI: 0.05, 1.45 I2 = 90%).

CONCLUSIONS

URS seems to efficacious and safe in the elderly. Patients ≥60 or 65 years of age have similar SFR and complication rates as younger patients. However, LOS may be increased in the elderly. More robust studies taking into account baseline characteristics and importantly presenting rates are needed to validate the current results.

Effects of immune checkpoint inhibitors on the quality of life of patients with metastatic or recurrent head and neck cancer: a systematic review protocol

OBJECTIVE

The objective of this review is to evaluate the effect of immune checkpoint inhibitors compared to radiation and other systemic therapies, such as chemotherapy and targeted therapies, on the quality of life of patients with metastatic or recurrent head and neck cancer.

INTRODUCTION

Recurrent and metastatic head and neck cancers are associated with high morbidity and mortality. The treatment modalities including radiation and chemotherapy have considerable negative effects on quality of life. Immunotherapy, in particular immune checkpoint inhibitors, is a promising treatment option, offering effective disease control with improved patient-reported outcomes.

INCLUSION CRITERIA

The review will include experimental or observational studies that compare the effect of immune checkpoint inhibitors with either radiation therapy or systemic therapies (eg, chemotherapy, targeted molecular agents) on the quality of life of patients (aged >18 years) with head and neck cancer.

METHODS

The databases to be searched include MEDLINE (Ovid), Embase, Scopus, Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials (CENTRAL). Sources of unpublished studies and gray literature to be searched will include ClinicalTrials.gov and ProQuest Dissertations and Theses. Titles and abstracts will be screened, and full texts of articles that meet the inclusion criteria will be retrieved for further assessment. Two independent reviewers will appraise eligible studies using the JBI tools for experimental and observational research, and will extract data. Where appropriate, meta-analysis will be conducted. The certainty of the findings will be evaluated following the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

REVIEW REGISTRATION

PROSPERO CRD42024567283.

Systematic Review: Practices and Programs in Inflammatory Bowel Disease Transition Care

BACKGROUND

Adolescents with inflammatory bowel disease (IBD) transitioning to adult care is often deemed a challenging period for patients, their carers, and practitioners. The use of structured transition programs is increasingly incorporated into standards of care, yet the optimal format remains unknown. The aim of this study is to carry out a systematic review of structured transition programs and their components to assess the impact on disease-specific and transition-related outcomes.

METHODS

A systematic review (PROSPERO ID: CRD42023380846) was performed across 4 databases (PubMed, CINAHL, CENTRAL, and EMBASE) and relevant publications up to March 2023 were reviewed. Studies evaluating either a structured transition program or targeted intervention which also measured a transition- and/or disease-related outcomes were included for evaluation in accordance with the PRISMA statement.

RESULTS

Three thousand four hundred and thirty-two articles were identified and 29 included in the final review. A structured transition program was reported in 21 studies and 8 investigated discrete transition-related interventions. The key transition-related outcomes included knowledge, self-efficacy, adherence, clinic attendance, and transition readiness which overall improved with the use of structured transition programs. Similarly, interventions consistently improved relapse/admission rates and corticosteroid use across most studies, although the benefit in hospitalization and surgical rates was less evident. Methodological limitations alongside heterogeneity in study design and outcome measures impacted on the quality of the evidence as assessed by the GRADE rating.

CONCLUSIONS

Transition- and medical-related outcomes for adolescents with IBD have been shown to benefit from structured transition programs but practices vary greatly between centers. There is no current standardized transition model for patients with IBD prompting further research to guide future development of guidelines and models of care.

Pro-inflammatory cytokines in myasthenia gravis: a systematic review and meta-analysis

BACKGROUND

Myasthenia gravis (MG) is an autoimmune neuromuscular disorder impacting muscle endplate components. Pro-inflammatory cytokines, particularly, might play pivotal roles in MG pathogenesis, influencing regulatory T cells and contributing to chronic inflammation. We did this systematic review and meta-analysis to address the conflicting results about pro-inflammatory cytokine profiles in MG.

METHODS

A thorough search was conducted in PubMed, Scopus, and Embase to find studies measuring interleukin (IL)-1 family (IL-1β, IL-18, IL-33, IL-36, IL-37), IL-6, and tumor necrosis factor-alpha (TNF-α) levels in MG patients' serum and controls. Selection criteria encompassed various MG types, including ocular and generalized, with and without thymoma, and acetylcholine receptor (AChR) antibody-positive and negative.

RESULTS

Of the 1843 identified studies, 16 met the inclusion criteria. The meta-analysis revealed a significant increase in serum TNF-α, IL-1β, and IL-33 level in MG patients compared to controls. The included studies also implied elevated levels of IL-18 in people with MG compared to controls and elevated levels of IL-18 and IL-33 in generalized MG compared to ocular MG.

CONCLUSION

Our study highlights the altered profiles of pro-inflammatory cytokines in MG.

Incidence of Myocardial Injury in Patients Submitted to Abdominal Aortic Aneurysm Repair: A Systematic Review and Meta-Analysis

BACKGROUND

Repair of abdominal aortic aneurysms (AAAs) is a major vascular surgery that carries risk of myocardial injury following noncardiac surgery (MINS). MINS occurs in approximately 20% of patients and affects patient outcomes, but its incidence remains unclear in this subset of patients. This systematic review aims to determine the incidence of MINS in patients undergoing AAA repair.

METHODS

MEDLINE, Web of Science, and Scopus were searched for studies assessing MINS after AAA repair. The incidence of MINS in endovascular aortic repair (EVAR) and open aortic repair (OAR) was pooled by random-effects meta-analysis, with sources of heterogeneity being explored. Assessment of studies' quality was performed using National Heart, Lung, and Blood Institute Study Quality Assessment and RoB 2 Tool.

RESULTS

Sixteen studies were included, with a total of 25,649 participants. Two were randomized controlled trials, while the remaining were cohorts. Age ranged from 65.8-75.5 and percentage of male participants between 78% and 96.6%. The pooled incidence of MINS ranged from 0.4% to 18.7% for EVAR and 1.8-46.8% for OAR. Meta-analytical incidence of MINS after EVAR was 12.5% (95% confidence interval [CI] 6.2-18.7%) in cohort studies and 0.9% (95% CI 0.4-1.4%) in multicenter database studies, both with severe heterogeneity (I2 = 91.0% and 79.1%). For OAR, the incidence was 30.6% (95% CI 19.5-41.7%) in cohort studies, 3.2% (95% CI 1.8-4.6%) in multicenter database studies, and 32.4% (95% CI 18.1-46.8%) in randomized controlled trials, all with high heterogeneity (I2 = 96.8%, 86.6%, and 71.3%).

CONCLUSION

MINS incidence was significant, and results indicate a possible difference between EVAR and OAR, but the significant heterogeneity found indicates a need for additional research with consistent methodology and definitions. Registered at PROSPERO (reference: CRD42024507346).

Association between antiretroviral therapy and dental caries in children and adolescents with HIV: a systematic review and meta-analysis

OBJECTIVE

To evaluate the evidence regarding the association between antiretroviral therapy and dental caries in children and adolescents with HIV.

METHODS

Searches were conducted in five international databases (PubMed, Scopus, EMBASE, CENTRAL, and LILACS) from the inception of records up to October 2024, including studies that examine the impact of antiretroviral therapy on caries in individuals under 18 years of age. The risk of bias was assessed using the Newcastle-Ottawa Scale. Quantitative synthesis was performed using the inverse variance method or Mantel-Haenszel method, depending on the type of outcome analyzed. Measures of association included odds ratios and mean differences, employing a random-effects model with a 95% confidence interval.

RESULTS

A total of 585 studies were identified, of which 17 were selected for qualitative review and 15 were included in the meta-analysis. The meta-analysis revealed a significantly higher risk of dental caries in children and adolescents with HIV undergoing antiretroviral therapy compared to those without the virus (odds ratio of 2.11; 95% CI: 1.41-3.17). Subgroup analysis showed a stronger association in case-control studies and for the DMFT index. The certainty of the evidence according to GRADE was rated as very low.

CONCLUSION

Despite limited certainty, the results suggest that HIV under antiretroviral therapy is associated with a higher risk of dental caries. It is prudent to interpret these results with caution, considering the methodological limitations of the studies. However, given the possible relevance of this association for public health, it is recommended to consider specific dental care protocols for children and adolescents with HIV, as well as the need for preventive strategies integrated into HIV management.

Effects of low anterior resection syndrome after colorectal cancer resections on health-related quality of life: a systematic review and meta-analysis

BACKGROUND

Low anterior resection syndrome (LARS) is a term that encompasses multidimensional bowel dysfunction that typically occurs following resections of rectum and distal parts of the colon. We aimed to systematically assess the available literature on the effects of bowel dysfunction after colorectal cancer (CRC) surgeries on health-related quality of life (HRQOL) and conduct a meta-analysis.

METHODS

Studies were included if they assessed patients who had undergone sphincter-preservation surgeries for CRC. Studies were eligible if they assessed bowel dysfunction using the LARS score and HRQOL using the European Organization for Research and Treatment Core Quality-of-Life Questionnaire (EORTC QLQ-C30).

RESULTS

Of 1410 reports, 28 studies were included. According to the analyses, patients with major LARS had lower global health status [weighted mean differences (WMD) = - 10.98; 95% confidence interval (CI) - 13.18, - 8.79], physical functioning (WMD = - 5.96; 95% CI - 7.40, - 4.52), role functioning (WMD = - 10.59; 95% CI - 12.54, - 8.63), emotional functioning (WMD = - 11.09; 95% CI - 14.34, 7.84), cognitive functioning (WMD = - 9.27; 95% CI - 12.22, - 6.32), and social functioning (WMD = - 15.73; 95% CI - 18.82, - 12.63) and higher scores of symptoms compared to patients with minor/no LARS.

CONCLUSIONS

The study findings suggest that patients with major LARS experience worse HRQOL compared to those with minor/no LARS.

REGISTRATION

PROSPERO, CRD42023479657.

The effect of resistant dextrin on glucose regulation markers in patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVES

The increasing prevalence of type 2 diabetes (T2D) necessitates greater efforts to find effective therapeutic agents for this complex condition. This study conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effects of resistant dextrin (RD) supplementation on markers of glucose regulation in patients with T2D.

METHODS

The databases PubMed, Web of Science, Scopus, and the Cochrane Library were searched from inception to March 20, 2025 aiming to identify RCTs evaluating the effect of RD supplementation on fasting blood sugar (FBS), fasting insulin levels, and glycosylated hemoglobin (HbA1c) in patients with T2D. The meta-analysis was conducted using a random-effects model to calculate weighted mean differences (WMDs) and corresponding 95% confidence intervals (95% CI). The quality of the included RCTs was assessed using the Cochrane risk of bias tool. The outcome data was pooled using Stata software, version 11.2.

RESULTS

Four RCTs (260 participants) were included in the systematic review and meta-analysis. Meta-analyses indicated that RD supplementation was associated with a significant reduction in HbA1c levels (WMD: -0.30%; 95% CI: -0.56 to -0.03; P = 0.02; I2=0.0%). However, the effect of RD on FBS (WMD: -5.45 mg/dl, 95% CI: -12.38 to 1.93; P = 0.14; I2=55.3%) and fasting insulin levels (Hedges' g: -0.26; 95% CI: -0.74 to 0.21; P = 0.28; I2=70.4%) was not statistically significant.

CONCLUSION

This systematic review and meta-analysis demonstrated that RD supplementation may effectively lower HbA1c levels in patients with T2D. However, it is crucial to conduct more clinical studies with adequate sample sizes and rigorous methodologies to develop evidence-based treatment guidelines.

Variable Return-to-Sport Rates with Improved Pain and Patient-Reported Outcomes Following Osteochondral Allograft Transplantation: A Systematic Review

Osteochondral allograft transplantation (OCA) of the knee is a reliable surgical technique for managing symptomatic full-thickness chondral lesions ≥2 cm2 in young and active patients. There is a need for comprehensive analysis of recent studies among a growing body of literature to better understand the outcomes of OCA among athletic patients, particularly in terms of return to sports participation and graft longevity. To systematically review existing literature reporting the return-to-sport (RTS) outcomes and patient-reported outcome measures (PROMs) following OCA of the knee among athletic patients. A systematic review was performed in PubMed, Web of Science, and Embase from database inception through December 22, 2024. Studies that reported RTS outcomes after knee OCA were included. Data were analyzed descriptively, and methodological quality was assessed using the Methodological Index for Non-Randomized Studies. Inclusion criteria were met by 13 studies involving 699 patients. The mean patient age was 31.8 years (range 15.2-52.6), with a mean follow-up of 59.9 months (range 24-87.5). Reported RTS rates ranged from 59.4 to 90.9%. The mean time to RTS ranged from 9.0 to 14.6 months; one study documented a median RTS time of 16 months. Between 27.3 and 79.1% of athletes made RTS at the same level, 13.5 to 63.6% at higher levels, and 9.1 to 31.6% at lower levels. Significant (p < 0.05) improvements were noted in Tegner (delta -1.8 to 1.4), Visual Analog Scale-Pain (delta -5.7 to -3.7), and International Knee Documentation Committee scores (delta 25 to 33.0). The most common complications were deep vein thrombosis/pulmonary embolism (1.3%), symptomatic hardware (0.72%), and infections (0.72%). Graft failure ranged from 0 to 10.8%, and reoperation from 0 to 50%. OCA of the knee demonstrates variable RTS rates, with improved postoperative pain and outcomes scores. Graft failure occurred in 0 to 10.8% of patients. IV, Systematic Review of Level III and IV studies.

Prevalence of low birth weight and associated factors in Ethiopia: An umbrella review of systematic review and meta-analyses

Low birth weight (LBW) is one of the major causes of neonatal mortality and morbidity in low and middle-income countries (LMICs). Despite the goal of reducing newborn morbidity and mortality by 2030, low-income countries, including Ethiopia, still confront major challenges. Although various systematic reviews and meta-analyses (SRMA) have been conducted on LBW in Ethiopia, there is notable variation among their findings. This umbrella review aimed to consolidate inconsistent findings into a single summary estimate, providing a robust synthesis of evidence from systematic reviews and meta-analyses to bolster health policy development and planning in Ethiopia.Articles were retrieved on PubMed/Medline, Science Direct, Web of Science, HINARI, and Google Scholar. Assessments of Multiple Systematic Reviews checklist scores were used to assess the quality of the included SRMA studies. A random-effects model was used to estimate the overall effect size.A total of eleven SRMA studies (5 prevalence and 6 predictors) involving 190,492 neonates with an outcome of interest were included in the analysis. The summary estimate for the prevalence of LBW was 16% (95% CI: 13, 18%). Being prematurity [POR: 7.86; 95% CI: 5.79, 10.67], not attending antenatal care (ANC) [POR: 2.4, 95% CI: 1.49, 3.88], having pregnancy-induced hypertension (PIH) [POR: 4.2; 95% CI: 2.78, 6.36], being a rural resident [POR: 2.14, 95% CI: 1.56, 2.94], having a pregnancy interval < 24 months [POR: 2.96; 95% CI: 1.79, 4.9], not having iron-folic acid supplementation (IFAS) [POR: 0.38; 95% CI: 0.29, 0.5], and being a maternal age < 20 [POR: 2.02, 95% CI: 1.41, 2.9] were significantly associated with LBW. This umbrella review revealed more than three out of twenty neonates experienced LBW in Ethiopia. Being premature, not attending antenatal care, having pregnancy-induced hypertension, being a rural resident, having a pregnancy interval < 24 months, not having iron-folic acid supplementation and being a maternal age < 20 were significant predictors of LBW. Therefore, timely diagnosis, proper treatment, and follow-up of women at risk might combat the incidence of LBW in Ethiopia.

MicroRNAs in patients with pemphigus: A systematic review

BACKGROUND

Pemphigus is a group of rare and severe autoimmune blistering diseases (AIBDs). MicroRNA's role in the pathogenesis of pemphigus disease has been previously studied, but MicroRNAmicroRNAs research in dermatology is still at its beginning.

METHODS

This review was carried out using a systematic search on PubMed, Scopus Embase, and Web of Science from 1990 to February 2025 to explore the role of microRNA in the diagnosis and severity evaluation of pemphigus disease.

RESULTS

A total of 8 studies were identified in the systematic review that indicated the expression level of 18 types of microRNA was significantly different from that of healthy people.

CONCLUSIONS

The collective data presented in this review indicate that MicroRNAmicroRNAs may help diagnose and predict the course of pemphigus, while the clinical application of these findings has yet to be verified.

Electroencephalogram activity related to psychopathological and neuropsychological symptoms in institutionalised minors: a systematic review

OBJECTIVE

This systematic review aims to update the current evidence on the effects of institutionalisation in minors living in residential care homes, specifically focusing on alterations in neuronal systems and their association with psychopathological and neuropsychological outcomes.

METHODS

Searches were conducted in the Web of Science, Scopus, PubMed, and Google Scholar databases, following PRISMA methodology for peer-reviewed empirical articles. The final selection comprised 10 studies that met the inclusion criteria: (1) published articles with quantitative data, (2) aimed at observing the relationship between psychological and neuropsychological symptoms and the electroencephalogram (EEG) activity in institutionalised children, (3) published between 2016 and 2023, and (4) examining institutionalised minors in residential care homes.

RESULTS

The articles show that these children exhibit general immaturity in EEG patterns, with a predominance of slow waves (primarily in the theta band). They also demonstrate poorer performance in executive functions (e.g. working memory, inhibition, and processing speed) and cognitive processes, along with a higher risk of externalising problems. However, current evidence does not allow definitive conclusions on whether early EEG abnormalities predict long-term neuropsychological deficits, despite data showing associations between EEG changes and certain cognitive dysfunctions at the time of evaluation.

CONCLUSION

The reviewed evidence suggests that EEG alterations in institutionalised minors are linked to executive dysfunction and increased psychopathological risk. These findings highlight the value of EEG in identifying at-risk children and inform the design of preventive interventions. Longitudinal studies are needed to clarify causal relationships.

Global consequences of dam-induced river fragmentation on diadromous migrants: a systematic review and meta-analysis

The global proliferation of dams has altered flow and sediment regimes in rivers, presenting a major threat to freshwater biodiversity. Diadromous species, such as fishes, decapod crustaceans and gastropods, are particularly susceptible to fragmentation because dams obstruct their breeding migrations between coastal waters and rivers. Although dams have contributed to significant declines in abundance of some commercially important diadromous fishes (salmonids and anguillids) and Macrobrachium shrimps, understanding of the impacts of fragmentation on the majority of diadromous animals is limited. Moreover, the number of species known to have diadromous life cycles has risen substantially during the last four decades, from ~250 to more than 800. This synthesis aims to consolidate the global impacts of fragmentation on diadromous animals and highlight potential knowledge gaps. We identified 338 publications documenting the impacts of dams on diadromous fishes and decapods, but this was reduced to 65 publications after application of our strict selection criteria. Specifically, we only included studies that compared unfragmented (e.g. undammed) or restored (e.g. dams with fish passes) with fragmented (e.g. site above dams) rivers. To assess statistical significance, the results of studies that were replicated sufficiently to enable calculation of standardised effect sizes were also subject to meta-analysis focusing on three topics: impacts of dam-induced fragmentation; efficacy of fish passes; and the mitigative potential of dam removal. Study outcomes were evaluated from five key variables: abundance; species richness; assemblage composition; population genetic diversity; and population genetic structure. We found that fragmentation led to net negative effects across all key variables for diadromous fishes. Fishes with limited jumping or climbing ability and obligate diadromous migrants that cannot persist as landlocked populations were more threatened by fragmentation. However, fishes that were capable climbers or jumpers and facultatively diadromous were nonetheless susceptible to impacts, particularly in their abundance and gene flow between fragmented populations. Installation of fish passes did not lead to positive outcomes, whereas dam removal was effective in restoring connectivity for fishes, suggesting that it is a more effective, albeit potentially contentious, approach (e.g. the dam may serve an important societal need), for restoring habitat connectivity. A smaller number of publications investigated diadromous decapods (seven versus 61 on fishes), and our synthesis of their findings suggests that decapods were vulnerable to habitat alteration by dams, but were less sensitive to their barrier effects because they were better climbers than fishes. Gastropods were the least studied diadromous taxon, and none met our criteria for systematic review or meta-analysis. The imbalance in information about diadromous taxa was compounded by a scarcity of studies from the tropics, particularly in South America, Africa, South Asia, Southeast Asia, and East Asia. These regions support diverse aquatic assemblages so the impacts of dams may be underestimated given existing knowledge gaps. The conservation of diadromous migrants would be best served by avoiding the construction of dams while improving mitigation strategies, such as fish passage design, to limit the most damaging effects of river fragmentation.

Suicide Notes: A Scoping Review of Qualitative Studies to Highlight Methodological Opportunities for Prevention

Suicide is a public health concern, and prevention programs are fundamental to decreasing its rates. Suicide notes might be crucial to understanding motives associated with suicidal behaviours. In this way, it is necessary to understand the qualitative methods that are most frequently used to analyze this data. Investigating these factors is crucial for developing targeted and preventive interventions. This scoping review aimed to answer the question "What is the state of art about qualitative methods adopted to analyze suicide notes?" by systematically mapping the literature on this topic. This review adopted the JBI guidelines for Scoping Reviews and followed the PRISMA-ScR guidelines. A comprehensive search strategy has been implemented across PubMed, Web of Science, and Scopus databases. Grey literature was not included in this review. Eligible studies encompassed qualitative studies on suicide notes published in English. Two independent researchers screened titles and abstracts and subsequently conducted full-text assessments based on predefined inclusion criteria. Relevant data have been systematically extracted and tabulated. The findings were thematically organized and qualitatively summarized, with potential visual aids such as graphs and tables. The studies highlighted the most used qualitative methods to analyze suicide notes, such as LIWC, Leenar's, Grounded Theory, Thematic Analysis and others. This study summarizes the current knowledge about qualitative methods to analyze suicide notes. Further research is necessary for the development of prevention programs destined for this population.

What works, how and in which contexts when using digital health to support parents/carers to implement intensive speech and language therapy at home for children with speech sound disorder? A realist review

PURPOSE

Digital health solutions to support parent-implemented interventions alongside direct speech and language therapist (SLT) input could help increase intervention intensity for children with speech sound disorder (SSD) to meet evidence-based recommendations. This realist review explores the factors which could make intensive parent-implemented digital interventions for children with SSD effective, and how this complex intervention might work in different contexts.

METHODS

Realist review methodology was adopted to explore what works, why, how, for which parents/carers, and in what circumstances. Realist methods aimed to understand the active ingredients, contexts, and associated outcomes of this complex intervention. Preliminary theories were developed to describe how and why digital parent-implemented interventions work for children with SSD. Data was extracted from 43 papers to test and refine preliminary theories. Behaviour change theories were used to explain how the intervention works in practice.

RESULTS

A set of 20 explanatory theories were developed to depict how and why digital parent-implemented interventions work in different contexts. Theories covered five areas: child-participation; the child-parent-SLT dynamic; parent-training; partnership and collaboration; intervention intensity. The theories describe mechanisms of the intervention and how these are responded to in different situations. Findings highlight the importance of intensive intervention for children with SSD.

CONCLUSIONS

This realist review adds new in-depth insight into how digital parent-implemented interventions work, for whom, and why. This new understanding has potential to support future successful digital parent-implemented interventions and increase intervention intensity for children with SSD globally. Implications for services and the potential of emerging digital health approaches to promote parent-implemented interventions are discussed.

Effects of Different Training Methods on Open-Skill and Closed-Skill Agility in Basketball Players: A Systematic Review and Meta-Analysis

BACKGROUND

Open-skill and closed-skill agility attributes are pivotal for achieving success in basketball. However, systematic synthesis of evidence regarding the effectiveness of different basketball-specific training methods on agility performance is lacking among basketball players in the literature. Consequently, this systematic review with meta-analysis aimed to evaluate the effectiveness of prominent training methods in improving open-skill and closed-skill agility in basketball players.

METHODS

Using keywords related to 'basketball', 'agility', and 'training', we searched for experimental studies in PubMed, Web of Science, and EBSCOhost databases that were published in the last decade (between January 2013 and September 2023). The included training methods were categorized into five groups, including reaction training (RT), speed training (SpT), strength and balance training (SBT), plyometric training (PT), and stretching training (StrT). The effects of training methods were summarized using standardized mean differences (SMD) with 95% confidence intervals in R software.

RESULTS

A total of 29 studies met the inclusion criteria, comprising 42 separate effects. Studies only assessed the effects of different training methods on closed-skill agility performance, with no open-skill agility assessments used. Improvements in closed-skill agility were apparent between pre-and post-training intervention with most training methods including a large effect for RT [SMD = 0.86, 95% CI (0.53, 1.19)], medium effects for PT [SMD = 0.62, 95%CI (0.38, 0.86)] and SBT [SMD = 0.59, 95%CI (0.13, 1.05)], and a small effect for SpT [SMD = 0.43, 95%CI (0.13, 0.74)]. While no effect for StrT [SMD = 0, 95%CI (-0.98, 0.98)] was apparent, only one study examined this training method.

CONCLUSIONS

RT appears to be the most effective method for developing closed-skill agility among basketball players, particularly when implemented in small-sided games. SBT and PT also appear impactful in developing closed-skill agility to similar extents. SpT appears to benefit closed-skill agility to a minor extent with limited research examining the effectiveness of StrT on agility among basketball players. Surprisingly, no studies have incorporated open-skill agility tests when assessing the effectiveness of training methods, which is essential to address in future research. Outcomes from this review provide guidance to basketball coaches and performance staff for selecting training methods that optimize closed-skill agility performance in their players.

Computer Vision Technologies in Movement Disorders: A Systematic Review

BACKGROUND

Evaluation of movement disorders primarily relies on phenomenology. Despite refinements in diagnostic criteria, the accuracy remains suboptimal. Such a gap may be bridged by machine learning and video technology, which permit objective, quantitative, non-invasive motor analysis. Markerless automated video-analysis, namely Computer Vision, emerged as best suited for ecologically-valid assessment.

OBJECTIVES

To systematically review the application of Computer Vision for assessment, diagnosis, and monitoring of movement disorders.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched Cochrane, Embase, PubMed, and Scopus databases for articles published between 1984 and September 2024. We used the following search strategy: ("video analysis" OR "computer vision") AND ("Parkinson's disease" OR "PD" OR "tremor" OR "dystonia" OR "parkinsonism" OR "progressive supranuclear palsy" OR "PSP" OR "multiple system atrophy" OR "MSA" OR "corticobasal syndrome" OR "CBS" OR "chorea" OR "ballism" OR "myoclonus" OR "Tourette's syndrome").

RESULTS

Out of 1099 identified studies, 61 met inclusion criteria, and 10 additional studies were included based on authors' judgment. Parkinson's disease was the most investigated movement disorder, with gait as the prevalent motor task. OpenPose was the most used pose estimation software. Automated video-analysis consistently achieved diagnostic accuracies exceeding 80% across most movement disorders. For tremor, dystonia severity and tic detection, Computer Vision strongly aligned with accelerometery and clinical assessments.

CONCLUSIONS

Computer Vision holds potential to provide non-invasive quantification of presence and severity of movement disorders. Heterogeneity in video settings, software usage, and definition of standardized guidelines for videorecording are challenges to be addressed for real-word applications.

(Third-wave) cognitive behavioral therapy for generalized anxiety disorder in adults: A systematic review and Bayesian network meta-analysis

Generalized anxiety disorder (GAD) imposes a substantial burden on the patient and society. To manage GAD, cognitive behavioral therapy (CBT) is a widely recognized psychotherapeutic approach. Moreover, the third-wave CBTs expand the treatment options and have the potential to positively impact patient outcomes and preferences. However, which CBT protocols or third-wave CBTs are the most effective and appropriate for use in primary care settings remains uncertain. This study explored the short-and long-term relative efficacy of various CBT protocols and third-wave CBTs in reducing GAD symptom severity via a Bayesian network meta-analysis. The meta-analysis comprised 56 studies involving 4388 participants. Combining the initial analysis and sensitivity analysis, the results indicated that among the CBT protocols, Dugas's CBT protocol-which incorporates self-monitoring, education on uncertainty intolerance, assessment of worry beliefs, improvement of problem orientation, and dealing with core fears-demonstrated superior short- and long-term efficacy in reducing GAD symptom severity. Within the third-wave CBTs, the short- and long-term efficacy of acceptance-based therapy for GAD treatment is also notable. The Bayesian meta-regression analysis results showed that whether the therapies or protocols were guided by a clinician significantly moderated the effect size compared with the control group. These findings provide valuable insights for future GAD therapists in selecting appropriate therapies and protocols and a reference for updating GAD treatment guidelines.

Psychological therapies for post-traumatic stress disorder in children and adolescents

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects (i.e. benefits and harms) of psychological therapies for post-traumatic stress disorder and complex post-traumatic stress disorder in children and adolescents.

The Outcomes of Arthroscopic Surgery for Patients with Shoulder Impingement Syndrome: A Systematic Review

Objectives

To evaluate the outcomes of arthroscopic surgery for patients with shoulder impingement syndrome (SIS).

Methods

A systematic search was conducted in PubMed, Web of Science, SCOPUS, and Science Direct for studies on the outcomes of arthroscopic surgery for SIS. Screening, data extraction, and quality appraisal were performed independently.

Results

Eleven studies with a total of 782 patients were included. Arthroscopic subacromial decompression (ASAD) showed reduced pain and improved function regardless of age or chronicity, with high satisfaction rates and a low complication rate of 0-19.4%. Arthroscopic acromioplasty provided good short-term outcomes for refractory SIS and superior long-term outcomes compared to open surgery.

Conclusion

ASAD is more effective than open or conservative treatment for recalcitrant SIS, though similar results can be attained with well-structured exercise therapy. Low complication rates associated with arthroscopy underscore its safety.

A Meta-Analytic Review of the Relationship Between Alcohol and Bystander Intervention for Sexual Assault

Sexual assault (SA) remains a significant public health issue, and there is growing interest in SA prevention approaches. Bystander intervention (BI) programs aimed at increasing individuals' willingness to intervene when they witness problematic situations show promise. However, social contexts that are high-risk for SA often involve alcohol, which may impact bystanders' abilities to intervene. Indeed, theoretical and empirical work has suggested that alcohol may impact BI. However, research has yet to quantitatively and systematically review extant literature to quantify whether and how much alcohol might impair BI. The current meta-analysis estimated associations between bystander alcohol use and BI in real, imagined, or hypothetical SA scenarios within both experimental and correlational/naturalistic studies, disaggregating the latter into BI behaviors, intentions, and attitudes. Database searches and author requests yielded 27 eligible articles (n = 11,139) for meta-analysis. Results suggested that naturalistic alcohol use (i.e., alcohol use as it occurs across daily life) may be negatively correlated with bystander intentions only (k = 15, r = -.08, p < .001). Experimentally administered alcohol may also be negatively associated with BI (k = 5, g = -0.16, p = .002), but this association was less robust and appeared specific to attitudes. Moderation analyses suggested that such patterns might shift as a function of college status but not gender. Samples with outlying effect sizes and the relatively low number of experimental studies identified indicate the need for more research in this area. These findings thus inform the next steps for research in this area and for refinement of bystander-based interventions to be optimally effective in reducing SA risk.

Effects of dietary supplements on patients with osteoarthritis: a systematic review and network meta-analysis

BACKGROUND

A growing body of research is exploring the role of antioxidant and anti-inflammatory dietary supplements in the treatment of osteoarthritis, highlighting an increasing emphasis on non-pharmacological interventions. Although more patients are turning to supplements to manage osteoarthritis, their actual effectiveness remains uncertain.

OBJECTIVE

This study aims to provide a comprehensive evaluation of the available evidence concerning the efficacy of various dietary supplements in osteoarthritis treatment.

SEARCH STRATEGY

We searched PubMed, Embase, Cochrane Library and Web of Science for studies on the use of various dietary supplements in the treatment of osteoarthritis from the creation of each database until Jan 20, 2025.

INCLUSION CRITERIA

(1) Research object: osteoarthritis. (2) Intervention measures: patients in the treatment group received dietary supplements, while the control group received placebos. (3) Research type: randomized controlled trials (RCTs).

DATA EXTRACTION AND ANALYSIS

Two researchers independently examined the literature and retrieved data based on predefined criteria. The information gathered included the first author, year of publication, sample size, participant demographics, length of the follow-up period, intervention and control measures, and inclusion indications. RCTs comparing dietary supplements to placebo with the pain and function subscales of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) among patients with osteoarthritis were included. The optimal dietary supplement was identified based on the total ranking by summing the surface under the cumulative ranking curve (SUCRA) of these two scores. Furthermore, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to confirm the quality of the evidence.

RESULTS

Overall, 23 studies covering 21 dietary supplements and involving 2455 participants met the inclusion criteria. In the WOMAC pain score, the SUCRA of passion fruit peel extract was 91% (mean difference [MD]: -9.2; 95% confidence interval [CI]: [-16.0, -2.3]), followed by methylsulfonylmethane (89%), undenatured type II collagen (87%), collagen (84%), and Lanconone (82%). The SUCRA (99%) of passion fruit peel extract (MD: -41.0; 95% CI: [-66.0, -16.0]) ranked first in terms of the WOMAC function score, followed by Lanconone (95%), collagen (86%), ParActin (84%), and Lactobacillus casei strain Shirota (83%). The top three total rankings are passion fruit peel extract (95.0%), Lanconone (88.5%), and collagen (85.0%). However, the GRADE revealed low evidence quality.

CONCLUSION

Passion fruit peel extract was the best supplement for improving WOMAC pain and function scores in patients with osteoarthritis, followed by Lanconone and collagen. However, further large-scale, well designed RCTs are required to substantiate these promising findings. Please cite this article as: Chen CS, Wen L, Yang F, Deng YC, Ji JH, Chen RJ, Chen Z, Chen G, Gu JY. Effects of dietary supplements on patients with osteoarthritis: A systematic review and network meta-analysis. J Integr Med. 2025; Epub ahead of print.

Out-of-hospital births and the experiences of emergency ambulance clinicians and birthing parents: a scoping review of the literature

OBJECTIVE

Emergency ambulance services attend a wide array of medical and trauma patients. Infrequently, this includes imminent or out-of-hospital births (OOHBs). This scoping review explores emergency ambulance clinician involvement with OOHBs, and patient and clinician experiences with birthing in the out-of-hospital setting.

DESIGN

Scoping review using the Joanna Briggs Institute framework and 'participant, concept, context' criteria.

DATA SOURCES

CINAHL, Embase, Medline, Web of Science and Wiley Online were searched until 20 February 2024.

ELIGIBILITY CRITERIA FOR SELECTING ARTICLES

Articles discussing an unplanned OOHB, or a planned home birth with complications where an emergency ambulance was required, were included.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently determined inclusion using Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews guidelines. A data extraction tool summarised findings for descriptive synthesis.

RESULTS

63 articles were included. 36 articles involved retrospective research. 38 articles were published since 2015, with USA (n=17) and Australia (n=13) the highest contributors. Risk factors for OOHBs were varied, with maternal age or being multigravida/multiparous often cited. 99 complications were described, ranging from relatively minor ailments (ie, nausea and vomiting) to life-threatening situations such as maternal or neonatal cardiac arrest. Common management/interventions reported were assisting with birth, maternal intravenous cannulation and medication administration.Birth parents, partners and clinicians all describe OOHBs as anxiety-provoking but joyous when a healthy neonate is born. The OOHB experience is enhanced for patients when clinicians communicate well, while those who appeared inexperienced increased patient anxiety.OOHBs experience many challenges to optimal care, categorised as 'emergency ambulance clinicians desiring additional education and training', 'communication and collaboration difficulties', 'environmental issues', 'technology and aids' and 'other' limitations.

CONCLUSIONS

OOHBs are rare events requiring expert assistance to optimise patient outcomes. There remain significant challenges to unplanned OOHBs; ongoing training and skill competency is required to improve patient safety and clinician confidence. Further research investigating patient outcomes and experiences is recommended.

Assessing the robustness of vascular surgery meta-analyses using the Fragility Index: a cross-sectional study

OBJECTIVES

To systematically assess the robustness of meta-analyses based on randomised controlled trials (RCTs) in vascular surgery using the Fragility Index (FI).

DESIGN

Cross-sectional study.

SETTING

Meta-analyses published in English from January 2019 to April 2025, identified from EMBASE, PubMed and Web of Science.

PARTICIPANTS

67 articles, with 291 meta-analyses involving RCTs evaluating vascular surgical interventions, covering venous, aortic, peripheral arterial, vascular access and other relevant fields.

MAIN OUTCOME MEASURES

FI, defined as the minimum number of event changes required to alter the statistical significance of meta-analysis results, and its association with sample size and total number of events, analysed using frequency distribution histograms and restricted cubic spline models.

RESULTS

The median FI was 7, with considerable variation across different fields. Aortic meta-analyses demonstrated higher robustness compared with venous and vascular access meta-analyses. FI showed a non-linear relationship with sample size and total number of events, indicating robustness improved only up to specific thresholds, beyond which robustness declined or plateaued.

CONCLUSION

Overall robustness of meta-analyses in vascular surgery was moderate, with notable variability among research areas. FI provides valuable insight into the stability of synthesised evidence, suggesting the need for improved methodological quality and advocating broader adoption of FI in meta-analytical research.

Efficacy and safety of Shenfu injection on bradyarrhythmia: A systematic review and meta-analysis

BACKGROUND

Bradyarrhythmia is a form of arrhythmia commonly seen in clinical settings. This study aims to investigate the efficacy and safety of the Shenfu injection (SFI) in the treatment of bradyarrhythmia.

METHODS

A comprehensive search was conducted in seven databases for randomized controlled trials (RCTs) related to SFI and the treatment of bradyarrhythmia. Primary outcome in this meta-analysis included the overall response rate in clinical symptom improvement. The risk of bias was evaluated utilizing the Cochrane Collaboration's tool.

RESULTS

A total of 28 studies, involving 2143 patients with bradyarrhythmia, were included. The meta-analysis results suggest that SFI treatment is superior to conventional medication alone. Further sensitivity analysis demonstrated that the total response rate in the SFI group was significantly higher than that in the conventional medication group (RR = 1.29; 95% CI: 1.22-1.37; P < .00001). Moreover, the improvement in heart rate in the SFI group was significantly better than that in the conventional medication group (MD = 5.17; 95% CI: 3.77-6.58; P < .00001). In terms of safety, the incidence of adverse events was lower in the SFI treatment group (5.25%, 19/362) compared to the conventional medication alone group (34.04%, 113/332) (RR = 0.20; 95% CI: 0.08-0.51; P < .001).

CONCLUSION

SFI demonstrates significant improvement in the overall response rate and safety for patients with bradyarrhythmia compared to conventional basic therapy. However, due to the presence of potential bias in the included studies, well-designed RCT trials are needed to confirm the efficacy and safety of adjuvant SFI therapy for the treatment of bradyarrhythmia.

The impact of extra-pancreatic infections on outcomes of acute pancreatitis: A systematic review and meta-analysis

BACKGROUND

The impact of extrapancreatic infections (EPI) on outcomes of acute pancreatitis has received limited attention in the literature. We compiled data from published studies to present high-quality evidence on the prognostic role of EPI on acute pancreatitis.

METHODS

This PRISMA-compliant and PROSPERO registered review (CRD42024516872) searched Embase, Scopus, Web of Science, and PubMed for comparative studies between EPI and no-EPI. Outcomes assessed were mortality, intensive care unit (ICU) admission, necrosis, organ failure, persistent organ failure, and length of hospital stay (LOS).

RESULTS

Seven studies were included in the review. The meta-analysis found that patients with EPI had a significantly higher risk of mortality as compared to the no-EPI group (OR: 3.85 95% CI: 2.79, 5.31). The risk of ICU admission (OR: 12.24 95% CI: 3.56, 42.10), necrosis (OR: 3.50 95% CI: 1.37, 8.89) organ failure (OR: 6.03 95% CI: 3.75, 9.70) and persistent organ failure (OR: 6.72 95% CI: 3.58, 12.62) was significantly increased in the EPI group compared to the non-EPI group. The meta-analysis also found significantly longer LOS in the EPI group (MD: 11.92 95% CI: 4.75, 19.08).

CONCLUSION

EPI is associated with a worse prognosis in acute pancreatitis. EPI was associated with an increased risk of mortality, ICU admission, organ failure, and prolonged LOS. Limited number of studies and baseline confounding are drawbacks of current evidence which need to be rectified by future studies.

Teaching to Teach: A Scoping Review of Teaching Skill-Development Programs across Medical Education

OBJECTIVES

Teaching is an integral part of the day-to-day responsibilities of physicians and physicians-in-training. We provide an overview across the medical education continuum of who is being trained how to teach, the methods of delivery used, and the effectiveness of the program in improving teacher confidence and teaching skills to improve the execution of teaching training programs.

METHODS

In October 2020, the authors conducted a scoping review, systematically searching six databases (PubMed, Embase, MEDLINE, Cochrane, Cumulative Index to Nursing and Allied Health Literature, and Web of Science) for literature dating back to 2010 describing interventions aimed at teaching physicians or physicians-in-training how to teach effectively. Four authors screened the articles for inclusion based on title and key words. Four authors reviewed all of the articles selected to identify key features, including manuscript citation, study design, study institution, demographic information, course description, and efficacy, and entered the data into a Qualtrics survey. Two authors then analyzed the data extracted.

RESULTS

Of 23,409 potentially eligible studies, 163 were included. The populations studied included medical students (17%), residents (55%), fellows (13%), faculty/attendings (23%), and other (4%). The length of the training interventions ranged from half a day or less to longer than 1 year. Multiple instructional methods were used including lecture (71), observed teaching in action (71), case-based learning (34), learner feedback (24), modules (25), objective structured teaching exercises (19), essays/writing assignments (11), portfolio and/or personal teaching philosophy development (5), and tests/examinations (4). Evaluation methods varied, and efficacy was measured by an improvement in confidence in teaching abilities (61), in self-reported teaching abilities (59), objective structured teaching exercises scores (3), and an increased interest in academic medicine (33).

CONCLUSIONS

Current programs designed to teach medical students, residents, and physicians how to teach vary widely. We propose that future research is needed to advance the instruction of physicians and physicians-in-training on how to be effective clinical educators.

A Current Perspective on Left Atrial Appendage Closure Device Infections: A Systematic Review

PURPOSE

Left atrial appendage (LAA) closure has become the standard of care for patients with atrial fibrillation (AF) at high risk of thromboembolism who are intolerant or unwilling to take anticoagulants. LAA occlusion device infection is a challenging complication, and there is a paucity of data on the management and outcomes of LAA occlusion device infection. We aimed to summarize the existing literature and highlight the knowledge gap in this area.

METHODS

A detailed search was conducted through the databases PubMed/MEDLINE, EMBASE, Web of Science, CINAHL, and Cochrane Central using the relevant keywords. All cases with presented data regarding diagnosis, treatment, and outcome were included from the reports.

RESULTS

The analysis included 12 case reports encompassing a total of 12 patients. The mean age was 73.6 ± 11.0 years, and 50% of the cases were male. The most commonly implanted device was the Watchman (in eight of the 12 cases). The median time between LAA closure and infection was 6.6 (0.2-36) months. Transesophageal echocardiography was diagnostic in all cases, and positron emission tomography/computed tomography (PET/CT) was useful in diagnosis in three cases. The most common pathogen was Staphylococcus aureus (n = 7). The LAAC device was removed in seven cases; one patient refused surgery, and in the other three cases, removal of the device was not considered appropriate due to the patient's poor condition. Data on whether the device was removed could not be retrieved for one patient. Mortality occurred in three cases (25%), and all deaths occurred during hospitalization.

CONCLUSION

LAA closure device infections are rare but carry a high risk of complications and mortality. Treatment should include device removal in appropriate cases, and antibiotherapy alone should be considered only in selected cases. Further studies are needed to clarify diagnostic and treatment strategies based on the causative pathogens and patient status.

School-Based Victimization Prevention Education Programs for Children and Youth With Intellectual and Developmental Disabilities: A Scoping Review

Youth with intellectual and developmental disabilities (IDD) are at significantly higher risk of experiencing multiple types of interpersonal victimization across their lifespan compared to their peers without IDD. Despite the extensive literature on efficacy of prevention education programs for children without IDD, very little is known about comparable programs for children with IDD. In this scoping review, we synthesized the literature on existing programs for children with IDD. We identified thirteen programs which we critically assessed against established best practice criteria for prevention and special education and evaluation. The current literature on prevention education programs for children with IDD exhibits significant limitations, such as weak research designs and poor measurement of outcomes.

Pediatric and Juvenile Lunatomalacia: To Treat Surgically or Not? A Systematic Review and Personal Experience

Background

Pediatric or juvenile lunatomalacia is still a less understood disease of childhood or young adolescence with spontaneous lunate osseous alterations and sometimes incomplete reconstitution of the lunate shape and bony structure. The treatment regimen to be used is still unclear. Given the young age of the patients, the question arises whether surgery is beneficial.

Methods

We performed a systematic literature review and analysis. We included studies from the last 5 decades addressing this issue and included additional publications identified through manual screening of references. Data were collected from public bibliographic databases.

Results

We included a total of 37 studies in this article. No studies of higher levels of evidence were available. Almost all were case reports or case series, but the quality was overall rated good in most cases. Adding our case to the available studies with a focus on the treatment results, the survey and statistical analysis revealed that a conservative approach most likely results in the best outcomes until the age of 15 years.

Conclusions

Our systematic review of this topic demonstrated a lack of high-quality studies. Only reports and smaller case series were found to provide answers. The total number of patients with this entity is also low, but this work is the most comprehensive review of reported cases in the literature. Considering all these reports and our case, we recommend a conservative approach until the age of 15 years.

Comparative Efficacy and Safety of Mirabegron and Vibegron in Female Patients With Overactive Bladder: A Systematic Review and Meta-analysis of Randomized Controlled Trials

OBJECTIVE

To compare the efficacy and safety of mirabegron and vibegron in female patients with overactive bladder (OAB).

METHODS

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A meta-analysis of randomized controlled trials (RCTs) referred to the use of mirabegron and vibegron in female patients with OAB from PubMed, EMBASE, Cochrane Library, and Web of Science databases was performed.

RESULTS

Three RCTs involving 371 patients were included. We found that vibegron was more effective in relieving urgency urinary incontinence in females with OAB compared to mirabegron [mean difference (MD)=0.25, 95% confidence interval (CI) 0.04 to 0.47, p=0.02]. And vibegron was similar to mirabegron in OAB symptom score (OABSS) [MD=0.22, 95% CI -0.32 to 0.76, p=0.42], urgency (MD=0.15, 95% CI -0.08 to 0.38, p=0.20), quality of life (QOL) (MD=-0.18, 95% CI -0.49 to 0.13, p=0.26), mean volume voided per micturition (MD=-6.16, 95% CI -21.50 to -9.17, p=0.43). In terms of the safety outcomes, there were no significant differences between mirabegron and control groups in terms of the total adverse events (TAEs) [odds ratio (OR)=0.75; 95% CI: 0.44 to 1.26; p=0.28], dry mouth (OR=1.01; 95% CI: 0.36 to 2.81; p=0.99), constipation (OR=0.69; 95% CI: 0.33 to 1.44; p=0.32), elevated post-void residual (PVR) (OR=0.35; 95% CI: 0.05 to 2.23; p=0.26), and dizziness (OR=1.02; 95% CI: 0.14 to 7.31; p=0.98).

CONCLUSION

In female OAB patients, the efficacy and safety of mirabegron and vibegron were similar. Vibegron may be more effective than mirabegron in relieving urgency urinary incontinence.

Efficacy of Acellular Dermal Matrix in Improving Clinical Outcomes in Pediatric Burns: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

This latest systematic review and meta-analysis aim to examine the efficacy of acellular dermal matrix (ADM) in pediatric burns.

METHODS

Relevant articles were retrieved from Pubmed, Embase, Cochrane, Web of science, China National Knowledge Infrastructureris, VIP Database for Chinese Technical Periodicals and Wanfang database. The primary outcome was the healing time, and secondary outcomes were the skin graft survival rate, reoperation, complications, numbers of dressing change, incidence of scarring, scar areas and scar scores. Data were pooled and expressed as relative risk (RR), mean difference (MD) and standardized mean difference (SMD) with a 95 % confidence interval (CI).

RESULTS

12 studies with 884 patients were included in this systematic review and meta-analysis. The pooled data from all included studies demonstrated that the patients who have applied ADM treatment had significantly reduced healing time (MD = -3.13; 95 % CI: -4.99 to -1.26; p < 0.001, I2 = 94.0 %), complications (RR = 0.40; 95 % CI: 0.20-0.79, p = 0.008, I2 = 25 %), numbers of dressing change (MD = -4.41; 95 % CI: -7.46 to -1.37, p = 0.005, I2 = 97 %) and incidence of scarring (RR = 0.38; 95 % CI: 0.18-0.78, p = 0.009, I2 = 77 %) compared to those who have not applied ADM treatment. There were no significant differences in skin graft survival rate, reoperation, scar areas and scar scores between the two groups.

CONCLUSION

ADM may accelerate wound healing, reduce complications and dressing changes, and inhibit scarring in pediatric burns, however, due to the high level of heterogeneity and methodological differences among the included studies, these results should be interpreted with caution. Further research with standardized protocols and larger, more diverse patient populations is needed to confirm these findings.

The impact of different radiology report formats on patient information processing: a systematic review

BACKGROUND

Since radiology reports are primarily written for health professionals, patients may experience difficulties understanding jargon and terminology used, leading to anxiety and confusion.

OBJECTIVES

This review evaluates the impact of different radiology report formats on outcomes related to patient information processing, including perception, decision (behavioral intention), action (actual health behavior), and memory (recall of information).

METHODS

PubMed, Web of Science, EMBASE, and PsycInfo were searched for relevant qualitative and quantitative articles describing or comparing ways of presenting diagnostic radiology reports to patients. Two reviewers independently screened for relevant articles and extracted data from those included. The quality of articles was assessed using the Mixed Methods Appraisal Tool.

RESULTS

Eighteen studies, two qualitative and sixteen quantitative, were included. Sixteen studies compared multiple presentation formats, most frequently traditional unmodified reports (n = 15), or reports with anatomic illustrations (n = 8), lay summaries (n = 6) or glossaries (n = 6). Glossaries, illustrations, lay summaries, lay reports or lay conclusions all significantly improved participants' cognitive perception and perception of communication of radiology reports, compared to traditional reports. Furthermore, these formats increased affective perception (e.g., reduced anxiety and worry), although only significant for lay reports and conclusions.

CONCLUSION

Modifying traditional radiology reports with glossaries, illustrations or lay language enhances patient information processing.

KEY POINTS

Question Identifying the impact of different radiology report formats on outcomes related to patient information processing to enhance patient engagement through online access to radiology reports. Findings Lay language summaries, glossaries with patient-oriented definitions, and anatomic illustrations increase patients' satisfaction with and understanding of their radiology reports. Clinical relevance To increase patients' satisfaction, perceived usefulness and understanding with radiology reports, the use of lay language summaries, glossaries with patient-oriented definitions, and anatomic illustrations is recommended. These modifications decrease patients' unnecessary insecurity, confusion, anxiety and physician consultations after viewing reports.

[How to: correctly read scientific articles : Research design and methodology]

Criteria for assessment of the significance of scientific articles are presented. The focus is on research design and methodology, illustrated by the classical study on prehospital volume treatment of severely injured individuals with penetrating torso injuries by Bickell et al. (1994). A well-thought out research design is crucial for the success of a scientific study and is documented in a study protocol beforehand. A hypothesis is a provisional explanation or prediction and must be testable, falsifiable, precise, and relevant. There are various types of randomization methods, with the randomized controlled trial being the gold standard for clinical interventional studies. When reading a scientific article it is important to verify whether the research design and setting align with the research question and whether potential sources of error have been considered and controlled. Critical scrutiny should also be applied to references, the funding and expertise of the researchers.

Identifying the most effective acute stress induction methods for producing SAM- and HPA-related physiological responses: a meta-analysis

BACKGROUND AND OBJECTIVES

Laboratory-based stress inductions are commonly used to elicit acute stress but vary widely in their procedures and effectiveness. We compared the effects of stress induction techniques on measures of two major biological stress systems: the early sympathetic-adrenal-medullary (SAM) and the delayed hypothalamic-pituitary-adrenal (HPA) axis response.

DESIGN

A review and meta-analysis to examine the relationship between stress induction techniques on cardiorespiratory and salivary measures of SAM and HPA system activity.

METHODS

A systematic literature search identified 245 reports and 700 effects.

RESULTS

The overall effect of stress induction techniques on the stress response was moderate (Fisher's zr = 0.44), inducing stronger SAM-related (zr = 0.48) versus HPA-related (zr = 0.37) responses. Three factors moderated these associations: the stress system examined (SAM vs HPA), the specific stress induction technique employed (e.g., Cold Pressor), the physiological sampling time relative to the stress induction, and participant sex. Loud music elicited the most robust SAM-related effects, whereas combined stress inductions elicited the most robust HPA-related effects. Men showed stronger stress responses than women.

CONCLUSIONS

Stress induction techniques variably elicit SAM - and HPA-related responses. Results recommend specific induction techniques for targeting stress systems, highlighting the importance of carefully selecting methodologies in laboratory contexts.

A Systematic Review and Meta-analysis of Attitudes of Iranian Nurses and Related Factors Towards End-Of-Life Care

This meta-analysis aimed to summarize the evidence regarding attitudes of Iranian nurses and related factors towards end-of-life (EOL) care. PubMed, Web of Science, Scopus, Magiran, Iranmedex, Scientific Information Database, and Google Scholar search engine were searched using Persian and English appropriate keywords from the earliest records up to September 11, 2020. A total of 849 nurses were included in six studies. After a meta-analysis of the mean score of nurses' attitudes, the pooled mean was 80.07 out of 120 (Q(5)=4.32, I-squared=0.00%; 95%CI: 73.53-86.60; p < 0.001). Marital status, ward type, education level, a history of participating in EOL care workshops, personal study of EOL care, experience of caring for a dying family member or close people, natural and approach acceptance, fear of death, and professional autonomy had a significant positive relationship with nurses' attitudes towards EOL care. Therefore, further large-scale studies considering potential confounding variables are needed to confirm our findings.

Optimal Duration of Antibiotic Therapy for Primary Osteomyelitis Discitis: A Systematic Review and Network Meta-Analysis

STUDY DESIGN

Systematic review and network meta-analysis.

OBJECTIVE

This study aimed to systematically review the literature on the management of primary osteomyelitis discitis and perform a network meta-analysis comparing the efficacy of different antibiotic treatment durations.

BACKGROUND

Primary osteomyelitis discitis is a challenging condition with varying management strategies.

MATERIALS AND METHODS

A comprehensive literature search was conducted. Studies reporting outcomes for the treatment of primary osteomyelitis discitis were included. A random-effect network meta-analysis was performed comparing antibiotic treatment durations of <4 weeks, 4 to 8 weeks, 8 to 12 weeks, and 12 to 16 weeks. The surface under the cumulative ranking curve (SUCRA) was used to rank treatment effectiveness.

RESULTS

Sixty-three articles with 4233 patients were included. Staphylococcus aureus was the most common causative agent (57.6%). The 4 to 8-week antibiotic duration ranked highest across fixed-effect and random-effect models (SUCRA: 0.8207 and 0.8343). The 12 to 16-week duration ranked highest in the fixed-effect model (SUCRA: 0.8460) but dropped substantially in the random-effect model (SUCRA: 0.3067). The <4-week duration showed mixed results. The 8 to 12-week duration consistently ranked lowest. No statistically significant differences were found between durations for symptomatic relief.

CONCLUSION

Antibiotic therapy for 4 to 8 weeks may provide the optimal balance of efficacy and treatment duration for most patients with primary osteomyelitis discitis. However, treatment should be individualized based on clinical response. Further prospective studies are needed to clarify optimal management strategies for this complex condition.

Association between arterial carbon dioxide tension and poor outcomes after cardiac arrest: A meta-analysis

BACKGROUND

Abnormal arterial carbon dioxide tension (PaCO2) is a common finding after cardiac arrest (CA). Inconsistent results regarding the association between abnormal PaCO2 and poor outcomes have been reported previously. We performed a meta-analysis to evaluate whether hypocapnia or hypercapnia is associated with an increased risk of hospital mortality and poor neurological outcomes in adult patients with CA.

METHODS

PubMed, Embase, and the Cochrane Library databases were searched through October 2024 to determine studies investigating the association between PaCO2 and the risk of hospital mortality and/or poor neurological outcomes in adult patients with CA. A random-effects model was used to calculate the pooled odds ratio (OR) with 95% confidence intervals (CIs) for cohort studies and relative risks (RRs) with 95% CIs for randomized controlled trials (RCTs).

RESULTS

A total of 14 cohort studies and 3 RCTs comprising 72344 patients were included. Pooled analysis indicated that hypocapnia was associated with an increased risk of hospital mortality (nine cohort studies, OR 1.37; 95% CI, 1.18-1.59; P < 0.0001) and poor neurological outcomes (five cohort studies, OR, 1.75; 95% CI, 1.04-2.96; P = 0.035). Within cohort studies, hypercapnia was associated with increased risk of hospital mortality (10 trials, OR 1.40; 95% CI, 1.13-1.73; P = 0.002), but not associated with poor neurological outcomes (six cohort studies, OR, 1.57; 95% CI, 0.87-2.83; P = 0.130). Within RCTs, mild hypercapnia was not associated with an increased risk of poor neurological outcomes after CA.

CONCLUSIONS

Current evidence indicated that hypocapnia was associated with an increased risk of hospital mortality and poor neurological outcomes after CA; however, hypercapnia was associated with an increased risk of hospital mortality but did not appear to be associated with increased poor neurological outcomes after CA.

SYSTEMATIC REVIEW PROTOCOL

INPLASY 2024100120. Registered 28 October 2024.

31P-MRS-Measured Phosphocreatine Recovery Kinetics in Human Muscles in Health and Disease-A Systematic Review and Meta-Analysis

The noninvasive, in vivo measurement of postexercise phosphocreatine (PCr) recovery kinetics using 31-phosphorus magnetic resonance spectroscopy (31P-MRS) is a highly prevalent method for assessing skeletal muscle energetics. However, 31P-MRS methodology is notoriously laboratory-specific, leading to uncertainty about the normal range of PCr recovery kinetics among healthy individuals, as well as relationships with disease and demographic factors. This systematic review and meta-analysis characterized the normal range of PCr recovery kinetics from 31P-MRS in human skeletal muscles across the lifespan, differences between healthy and those with muscle-related diseases, and relationships between intermuscular PCr recovery measurements and demographic factors. PubMed, Web of Science, Cochrane, and Google Scholar databases were searched for PCr recovery studies, which resulted in a final set of 128 studies eligible for meta-analysis. Studies were categorized into three muscle groups (forearm, upper leg, and lower leg) and further subdivided into three groups: diseased, control (the comparator group in studies of disease), and healthy (those recruited into studies that lacked a disease group). Only English-language studies were included. All statistical analysis was performed using Stata 17 software. Forest plots showed significant heterogeneity across PCr recovery time estimates and outlier study removal significantly reduced this heterogeneity. Greater age was associated with longer PCr recovery in upper leg muscles among both healthy (ρ = 0.387, p < 0.05) and diseased (ρ = 0.733, p < 0.05) individuals. Additionally, longer PCr recovery time was correlated with more acidic end-of-exercise pH in all three muscle groups among healthy individuals. In conclusion, skeletal muscle energetics as indexed by 31P-MRS-based PCr recovery time is similar across three different skeletal muscle groups among healthy people. Common diseases significantly prolong PCr recovery times. Methodological heterogeneity has a significant impact on PCr recovery time measurements in this literature. Greater age and more acidic pH increase PCr recovery time among healthy people.

Identifying Potential Chemicals of Concern in Children's Products in a Regulatory Context: A Systematic Evidence Mapping Approach

BACKGROUND

Children's vulnerability to chemical toxicant exposures demands strong consideration of the chemical composition of products designed for and marketed toward them. Inadequacies in health-protective legislation and lack of mandatory ingredient disclosure in most children's products have created significant gaps in protection and oversight. Scientific literature can provide insight into the chemical constituency of children's products that may be useful for prioritizing future regulatory efforts.

OBJECTIVE

We aimed to present a proof of concept for applying systematic evidence mapping methodology to identify which chemicals of potential concern have been reported in the scientific literature to be present in products marketed toward children, compile a compendium of data to inform future regulatory efforts, and identify research needs.

METHODS

We conducted a broad, all-encompassing survey of the available literature from four databases to identify chemicals present in children's products. Using systematic evidence mapping methodologies, we constructed a database of children's products and their chemical constituents (termed "product-chemical combinations") based on a broad survey of current and relevant environmental health literature. Our study focused on chemicals listed on the California Safer Consumer Products Program's Candidate Chemicals List, which includes chemicals with one or more known hazard traits. We then conducted an exploratory data analysis of product category and product-chemical combination frequencies to identify common chemicals in specific products.

RESULTS

Our systematic evidence mapping identified 206 potentially hazardous chemicals in children's products, 170 of which were found in toys. In total, we found 1,528 distinct product-chemical combinations; 582 product-chemical combinations included chemicals known to be hazardous or potentially hazardous. Ortho-phthalates in plastic toys, parabens in children's creams and lotions, and bisphenols in both baby bottles and teethers were the most frequently encountered product-chemical combinations of potential concern.

DISCUSSION

The frequently reported presence of endocrine-disrupting chemicals in multiple types of children's products raises concerns for aggregate exposures and reveals gaps in regulatory protections for this sensitive subpopulation. Our reproducible and systematic evidence-based approach serves as a case study that can guide other prioritization efforts for transparent regulatory action aimed at improving the safety of chemicals in consumer products. https://doi.org/10.1289/EHP15394.

Dietary inflammatory potential and severe headache or migraine: a systematic review of observational studies

OBJECTIVES

We conducted the current systematic review to investigate the association between dietary inflammatory index (DII) and severe headaches or migraine among adults via synthesizing observational evidence.

METHOD

We conducted a systematic literature search of observational studies through PubMed, Scopus, and Web of Science databases from inception until July 2024. The PECO framework was implemented to select eligible studies as follows: Population (adults with severe headache or migraine), Exposure (individuals with the highest adherence to a pro-inflammatory diet), Comparison (individuals with the lowest adherence to a pro-inflammatory diet), Outcome (risk of developing severe headache or migraine, headaches frequency, duration, severity, and migraine-related disability).

RESULTS

After reviewing six studies involving 31,958 individuals, we found that following an anti-inflammatory diet is associated with a lower frequency and severity of migraine headaches. Additionally, our research revealed that individuals with migraines tend to have lower adherence to an anti-inflammatory diet when compared to people without migraines. Surprisingly, adherence to a pro-inflammatory diet was linked to a reduced risk of chronic daily headaches.

CONCLUSION

Present findings imply a negative link between an inflammatory diet and severe headaches or migraine. However, further well-designed longitudinal studies are needed to interpret the causality and shed light on the underlying mechanisms.

Prone position applied to COVID-19 patients: Systematic review-meta-analysis

BACKGROUND

Position change and interventions to increase lung capacity should be considered in mechanically ventilated patients. The most effective of these is the prone position.

AIM

This systematic review and meta-analysis aimed to determine the effects of the prone position on respiratory parameters and outcomes and to guide nurses working in the intensive care unit.

STUDY DESIGN AND METHODS

This systematic review-meta-analysis was conducted in accordance with the Preferred Reporting in Systematic Reviews and Meta-Analyses guideline. ScienceDirect, CINAHL, Academic Search Complete (EBSCOhost), MEDLINE, EMBASE, Web of Science, Cochrane and PubMed databases were searched between January 2022 and January 2023 to access studies related to prone position in COVID-19 patients.

RESULTS

Twenty-three studies were included. This meta-analysis shows that a prone position is feasible and can achieve improvements in gas exchange. Prone position increases PaO2/FiO2 in the majority of patients followed with a diagnosis of COVID-19 and severe hypoxemic.

CONCLUSIONS

The study has shown that the prone position is effective in improving patients' respiratory function and oxygenation.

RELEVANCE TO CLINICAL PRACTICE

The results presented in this article support the notion that the prone position can be an effective strategy in the clinical management of COVID-19 patients.

Surgical treatment of synchronous liver-only oligometastatic pancreatic adenocarcinoma: a systematic review and meta-analysis of long-term outcomes

BACKGROUND

The potential long-term survival benefits of surgical resection for synchronous liver-only metastases of pancreatic ductal adenocarcinoma (liver oligo-PDAC) remain controversial. This systematic review and meta-analysis aim to compare the current evidence on long-term survival outcomes between surgical treatment of liver oligo-PDAC and conventional systemic chemotherapy.

MATERIALS AND METHODS

A systematic review and meta-analysis were conducted using the PubMed and Scopus databases to identify studies comparing surgery and systemic chemotherapy in terms of long-term survival in oligo-PDAC patients. The search included studies published up to October 2024. The meta-analysis was performed using the Jamovi software.

RESULTS

Eleven retrospective studies were selected for a total of 897 patients: 565(63%) underwent synchronous resection of liver metastases and the primary tumor, while 332(37%) received conventional chemotherapy. The majority of patients presented a pancreatic head tumor, and the median number of liver metastases ranged between 1 and 3 in the surgical cohort and 1 and 2 in the nonsurgical cohort. The rate of major surgical complications was 14.4% while the cumulative incidence of postoperative mortality was 2.8%. The median overall survival(OS) in the surgical group ranged from 7.6 to 18.4 months, while a lower value comprised between 6 and 9.9 months was evidenced in the nonsurgical cohort. Six studies were included in the meta-analysis for the OS evaluation, showing significantly better survival outcomes in the surgical group (OR: 0.286, 95% CI: 0.100-0.409; P < 0.0001). According to the Q-test, there was no significant heterogeneity in the true outcomes ( Q = 4.063, P = 0.541, I2  = 0 %). A sensitivity analysis, conducted by excluding one study at a time, confirmed the robustness of the meta-analysis findings.

CONCLUSIONS

Surgical resection of oligo-PDAC may represent a valuable treatment option with potential long-term survival benefits. However, prospective randomized trials are required to further validate these findings.

Risk factors for complications of tissue expansion: An updated systematic review and meta-analysis

BACKGROUND

This study aimed to summarize risk factors for complications of tissue expansion using a meta-analysis of cohort studies.

METHODS

PubMed, Embase, and Cochrane Library were searched from January 1985 to January 2025 for retrospective cohort studies investigating at least one potential risk factor for complications of tissue expansion. The quality of individual studies was assessed using the Newcastle-Ottawa scale. We conducted meta-analysis with risk ratios calculated for complication event rates.

RESULTS

This review included 19 studies involving 1,673 participants. Two distinct subgroups (children only, adults and children) were identified. Strong evidence indicated that lower limb (relative ratio, 1.73; 95% confidence interval, 1.27-2.37), burn (relative ratio, 1.45, 95% confidence interval, 1.07-1.95), and myelomeningocele (relative ratio, 1.82; 95% confidence interval, 1.22-2.70) were the risk factors for premature removal of expansion in both children and adults.

CONCLUSION

This review identified lower limb, burn, and myelomeningocele are risk factors for complications of tissue expansion. Identifying modifiable risk factors is an urgent priority to improve prevention and treatment outcomes.

A systematic review and synthesis of 489 studies investigating treatments for negative symptoms in the schizophrenia spectrum: Trial designs, demographics and clinical characteristics

Negative symptoms in schizophrenia spectrum are associated with minimal treatment responses. The search for effective treatments is potentially hampered by heterogenous study-designs and sample characteristics depending on the intervention category. This PRISMA-compliant systematic review/synthesis aims to describe the literature on negative symptoms interventions for schizophrenia spectrum disorders by comparing 12 study design, demographical and clinical variables in different intervention categories: antipsychotics (AP), other pharmacological agents (OPA), brain stimulation (BS), psychological/psychosocial (PSI), lifestyle (LS), mixed interventions. Kruskal-Wallis and Chi-square tests measured differences between intervention-groups. Out of 19,935 articles, 489 (AP=149/OPA=187/BS=49/PSI=79/LS=19/mixed=6) were selected for data extraction. Concerning study designs, AP had the largest average arm size (mean ± SD=91.1 ± 122.8participants), OPA the highest double/triple-blinding (97.9 %) rates, PSI the longest follow-up (26.7 ± 21.8weeks). Age/gender demographical differences were significant but of negligible magnitude. OPA illness duration (14.8 ± 9.0years) was longer compared to AP (11.4 ± 6.7years). Positive and Negative Syndrome Scale (PANSS) negative scores were milder in PSI (18.6 ± 6.9) compared to AP/OPA/BS (23.8 ± 6.4/23.4 ± 4.9/24.2 ± 9.2). PANSS total scores were worse in AP (83.6 ± 18.2) than in OPA/BS/PSI (77.1 ± 20.5/75.5 ± 14.7/67.0 ± 23.3). The same was true for dropout rates (AP=25.5 %, OPA/BS/PSI=14.3/9.7/14.5 %). Prevalent treatment as usual was "none" for AP (36.7 %) and "antipsychotic" for other categories (42.3-82.8 %). Implementing cross-over, factorial or multi-arm designs may increase the comparability between studies investigating different intervention categories. Concerning clinical differences, reporting individual treatments at baseline and clinical severity, evaluating cognitive profiles and considering patients' perspectives will allow to better understand the efficacy of the available treatments and develop tailored interventions.

A Theory-Guided Literature Review: A Knowledge Synthesis Methodology

BACKGROUND

There are no detailed, step-by-step descriptions of a process for conducting rigorous literature reviews for Doctor of Nursing Practice (DNP) projects.

METHOD

After a search for a theory-guided literature review (TGLR) process for practice projects resulted in no established process, authors created a methodology by review of PRISMA guidelines, nursing theory experts' feedback, and a Think-Aloud process.

RESULTS

A 10-step formal process for conducting a TGLR to support practice change was established.

CONCLUSION

The aims of developing this methodology include providing a formal process for DNP students to apply nursing theories to guide literature reviews and building nursing knowledge from a nursing disciplinary perspective to support practice change projects. [J Nurs Educ. 2025;64(5):279-285.].

Antioxidants for the management of oral leukoplakia: A systematic review of randomized controlled trials

Introduction

Oral leukoplakia (OL) is a potentially malignant disorder characterized by non-scrabble white lesions that may turn into invasive carcinoma if left untreated. Few antioxidant treatments have shown promising results in the regression of lesions and prevention of their progression to carcinoma. We aim to summarize the current evidence on the effectiveness of antioxidants in the management of OL.

Materials and methods

The present systematic review followed PRISMA guidelines and involved a thorough search of three scientific databases: PubMed, Scopus, and Cochrane. We used specific algorithms related to the keywords "antioxidant" and "Oral leukoplakia" to identify randomized controlled trials (RCTs) that have explored the utility of antioxidants in the management of OL. The risk of bias assessment was conducted using the Cochrane risk of bias tool (ROB 2.0), ensuring the reliability of our findings.

Results

Out of 2490 articles retrieved, only thirteen RCTs involving 1147 participants fulfilled the inclusion criteria. Lycopene was found to be the most consistently effective antioxidant, showing significant effectiveness in reducing lesion size, both in oral and topical forms. The trials incorporating other antioxidants, including vitamin A, vitamin C, β-carotene, and curcumin, demonstrated mixed results. Severe heterogeneity was detected in treatment forms, dosage, administration frequency, treatment duration, and follow-up time among all included trials.

Conclusion

Lycopene may play a significant role in the non-surgical management of OL. Future research with large-scale, well-designed, randomized controlled trials with standardized dosing, delivery methods, and outcome measures is mandatory to provide more robust evidence on the available antioxidant therapy for OL.

Cardiovascular outcomes with SGLT-2 inhibitors in individuals with diabetes and co-existing atrial fibrillation: A systematic review and meta-analysis

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a major risk factor for cardiovascular disease and atrial fibrillation. Sodium-glucose cotransporter 2 inhibitors (SGLT-2i) have demonstrated benefit in reducing T2DM-related morbidity and mortality, but their effects in individuals with concomitant T2DM and atrial fibrillation remain unclear. This meta-analysis is the first to evaluate impact of SGLT-2i in this patient population.

METHODS

PubMed/MEDLINE, Cochrane Library, and reference lists of the included articles were systematically searched. Results were pooled using a random-effects model and outcomes were reported as risk ratios (RR) with 95 % confidence intervals (CIs). Meta-regression analyses based on baseline patient characteristics were conducted to assess potential sources of heterogeneity.

RESULTS

Seven retrospective cohort studies and one randomized controlled trial corresponding to 37,229 patients were included, of whom 13,030 received SGLT-2i and 24,199 received other oral anti-diabetic drugs. Follow-up ranged from 2 to 5 years. SGLT-2i use was associated with decreased risk of all-cause mortality (RR = 0.37; 95 % CI: 0.28-0.50), heart failure (RR = 0.66; 95 % CI: 0.53-0.83), stroke (RR = 0.76; 95 % CI: 0.66-0.88), and cardiovascular mortality (RR = 0.57; 95 % CI: 0.44-0.74). No significant difference was observed for myocardial infarction (RR = 0.94; 95 % CI: 0.78-1.12). Results were largely consistent across shorter (<3 years) and longer (≥3 years) follow-up durations. Meta-regression demonstrated no significant associations with baseline patient characteristics (age, gender, prior MI, or prior stroke).

CONCLUSION

SGLT-2i reduced all-cause mortality, heart failure, stroke, and cardiovascular mortality in individuals with T2DM and atrial fibrillation. Large-scale, randomized controlled trials are warranted to confirm these findings.

Prognostic and Associative Significance of Malnutrition in Sarcopenia: A Systematic Review and Meta-Analysis

Malnutrition is a common phenomenon, particularly in those at an increased risk of muscle mass and function losses. In this systematic review and meta-analysis, we aimed to explore the association of malnutrition with sarcopenia in middle-aged and older adults and the prognostic association of malnutrition and sarcopenia compared with sarcopenia alone on all-cause mortality. PubMed, Scopus, Web of Science, and Cochrane Library were searched from inception until January 2024. A meta-analysis using a random-effect model was employed, utilizing the Mini Nutritional Assessment malnutrition tool as a continuous and categorical variable. The study protocol was registered in the International Prospective Register of Systematic Reviews (CRD42024501521). Malnutrition was significantly associated with a greater risk of sarcopenia [continuous: k = 12, odds ratio (OR): 1.38, 95% confidence interval (CI): 1.18, 1.61, I2 = 94.8%, P < 0.01; categorical: k = 37, OR: 2.99, 95% CI: 2.26, 3.96, I2 = 78.3%, P < 0.01]. Sarcopenia and malnutrition were associated with a higher risk of mortality compared with sarcopenia alone (k = 5, hazard ratio: 4.04, 95% CI: 1.36, 11.94, I2 = 92.8%, P < 0.01). Metaregression showed age, sex, and number of adjustments did not explain heterogeneity among studies. The included studies had a moderate risk of bias. Malnutrition is associated with higher odds of sarcopenia and their combined presence is a better predictor of all-cause mortality compared with sarcopenia alone, further highlighting the importance of applying interventions to counteract these two closely related phenomena.