PICO, PICOS and SPIDER: a comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews

Comparative efficacy of leading COVID-19 vaccines: A network meta-analysis

In the fight against the COVID-19 virus, various vaccines using different technologies such as mRNA, viral vectors, protein subunits, and inactivated whole viruses have become primary defence strategies. This study aims to compare their effectiveness in controlling the spread of the pandemic. Using the comprehensive resources from three major databases-PubMed, EMBASE, and the Cochrane Library-we conducted an extensive literature review up to April 30, 2023. By employing a frequentist network meta-analysis, we analysed both direct and indirect estimates of vaccine efficacy, providing a clear comparison of the leading candidates in the global fight against COVID-19. Fifteen vaccines from 26 articles were used in our network meta-analysis. The statistically significant direct estimates were obtained by Spikevax [VE: 93.29 (91.31, 95.27); P<0.05], Pfizer BioNTech [VE: 92.07 (90.03, 94.12); P<0.05], Sputnik [VE: 91.60 (85.60, 97.60); P<0.05], Novavax [VE: 88.99 (83.55, 94.42); P<0.05], Sinovac [VE: 83.50 (65.40, 101.60); P<0.05], Covifenz [VE: 77.27 (68.48, 86.06); P<0.05], Zifivax [VE: 75.94 (70.86, 81.02); P<0.05], Covishield [VE: 72.34 (67.12, 77.56); P<0.05], S-Trimer [VE: 71.61 (56.23, 86.98); P<0.05], Covaxin [VE: 70.81 (65.33, 76.29); P<0.05], Soberna [VE: 69.70 (56.50, 82.90); P<0.05], Zydus Cadila [VE: 66.60 (47.60, 85.60); P<0.05], CVnCoV [VE: 63.70 (52.20, 75.20); P<0.05], Convidecia [VE: 57.50 (39.70, 75.30); P <0.05], and Jcovden [VE : 52.42 (47.28, 57.57); P<0.05]. Spikevax emerged triumphant with an unparalleled P score of 0.95, solidifying its status as a top ranking prevention tool against the COVID-19 in our investigation. Our analysis reveals a ranking of vaccine efficacy, with Spikevax emerging as the most effective, followed closely by Comirnaty, Sputnik, and others, collectively providing strong protection against the ongoing threat of COVID-19.

The Health and Well-Being of Women in Farming: A Systematic Scoping Review

OBJECTIVES

Health and well-being have long been identified as key issues for investigation within agricultural communities. While myriad studies have been conducted to investigate causation, impact, outcomes and interventions among farming populations, the overall emphasis has been disproportionately weighted away from the experiences of women. This systematic scoping review determines the prevalence of topics, identifies the target populations and geographical locations of studies, outlines methodological approaches to the subject area, and summarizes the key findings and conclusions of the available literature.

METHODS

With the guidance of the Arksey and O'Malley framework for conducting a scoping review, a single database search for publications focusing on the health and well-being of women in farming (including primary farmers, members of farm households, and farmworkers), in the Global North, published between 1990 and 2023, was conducted. Data were organized, thematically coded, critically appraised and analyzed using the systematic review online tool CADIMA.

RESULTS

In total, 93 studies met the inclusion criteria for full review. The majority of studies were conducted in the United States, with the number of publications steadily increasing since the 1990s. Of studies, 68% were wholly quantitative in nature, and 23% wholly qualitative. Key findings suggest women are at particular risk from certain illnesses associated with some aspects of agricultural work and face a number of stressors (including gender-specific issues) that can lower well-being, but evidence is scarce in a number of areas. Clear gaps in research exist in relation to reproductive health, caring responsibilities, or help-seeking and support. Women primary farmer and farmworkers are particularly neglected as study cohorts.

CONCLUSION

Numbers of studies related to the health and well-being of women in farming are still relatively small in comparison with the wider body of related literature, and there exists an obvious need for further studies with a specific emphasis on particular cohorts, issues pertaining to the contemporary climate, and issues specific to women, as well as greater geographical reach. By emphasizing such research gaps, opportunities exist to improve the health and well-being situation of women in agriculture through more explicit studies with the intention of developing more effective, targeted solutions.

What are the experiences of people with motor and sensory functional neurological disorder? A systematic review and thematic synthesis of qualitative studies

PURPOSE

Functional neurological disorders are common, highly stigmatised and associated with significant disability. This review aimed to synthesise qualitative research exploring the experiences of people living with motor and/or sensory FND. Identifying their needs should inform service development, education for healthcare professionals and generate future research questions.

METHOD

Five databases were systematically searched (Medline, PsychInfo, Web of Science, Embase and Cinahl) in November 2022, updated in June 2023. Data from included papers was extracted by two authors and studies were critically appraised using the Critical Appraisal Skills Programme (CASP). Data was thematically analysed and synthesised.

RESULTS AND CONCLUSIONS

12 papers were included in the synthesis describing the views of 156 people with FND. The overarching theme was uncertainty; about what caused FND and how to live with it. Uncertainty was underpinned by four analytic themes; challenging healthcare interactions, loss of power and control, who or what is responsible and living with a visible disability and an invisible illness. Early and clear diagnosis, validation and support for living with FND should form part of multidisciplinary care. Co-produced service development, research agendas and education for clinicians, patients and the public would reduce stigma and improve the experiences of people with FND.

Cost-Effectiveness of Perinatal Depression Screening: A Scoping Review

OBJECTIVE

Perinatal depression (PND) has emerged as a significant public health concern. There is no consensus among countries or organizations on whether to screen for PND. Despite the growing body of evidence regarding the economic value of PND screening, its cost-effectiveness remains inadequately understood due to the heterogeneity of existing studies. This study aims to synthesize the available global evidence on the cost-effectiveness of PND screening compared to routine or usual care to provide a clearer understanding of its economic value.

METHODS

A detailed search strategy was predetermined to identify peer-reviewed publications that evaluated the cost-effectiveness of PND screening. We designed a scoping literature review protocol and searched electronic databases, including MEDLINE, EMBASE, and Web of Science, for studies published from inception to 10 December 2023. We included studies that conducted full economic evaluations comparing PND screening with usual care or other comparators and excluded studies that were not in English or lacked full texts. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used to evaluate the reporting quality of the studies. Then, the data regarding costs and effectiveness were extracted and summarized narratively.

RESULTS

A total of ten eligible studies were included, all of which were evaluated as being of high reporting quality. Nine of these studies compared the economic value of PND screening with usual care without screening, with eight finding that PND screening was generally more cost-effective. The remaining study evaluated the cost-effectiveness of two psychosocial assessment models and indicated that both effectively identified women "at risk". Across studies, PND screening ranged from being dominant (cheaper and more effective than usual care without screening) to costing USD 17,644 per quality adjusted life year (QALY) gained. Most included studies used decision trees or Markov models to test if PND screening was cost-effective. Although current economic evaluation studies have mostly suggested PND screening could be more cost-effective than usual care without screening, there is high heterogeneity in terms of participants, screening strategies, screening settings, and perspectives across studies.

CONCLUSIONS

Despite varied settings and designs, most studies consistently indicate PND screening as cost-effective. Further evidence is also required from low- and middle-income countries (LMIC), non-Western countries, and randomized controlled trials (RCTs) to draw a more robust conclusion.

Sperm concentration remains stable among fertile American men: a systematic review and meta-analysis

IMPORTANCE

Findings from several high profile meta-analyses have raised concerns about an ongoing global decline in sperm concentration and male fertility. However, these studies exhibit considerable heterogeneity in key variables including study population, methodology, fertility status, and geographic region.

OBJECTIVE

To perform a systematic review and meta-analysis exploring temporal trends in sperm concentration among fertile men and men unselected for fertility status in the United States.

DATA SOURCES

A literature search performed in Scopus and PubMed databases for studies published between 1970 and 2023. Additional studies were included from citations of prior global meta-analyses and reviews evaluating temporal trends in sperm count.

STUDY SELECTION AND SYNTHESIS

Studies were included if they presented original data on sperm concentration in US men without known infertility from 1970 to 2023. Aggregate data were assessed across all study populations, with additional subgroup analyses stratified by fertility status and US region.

MAIN OUTCOMES

Weighted generalized linear models were generated to evaluate the association between mean sperm concentration and sample collection year.

RESULTS

A total of 874 articles were screened, with 58 meeting the inclusion criteria. These represented 75 unique study populations totaling 11,787 men in the United States. Across all study populations, no change in sperm concentration was observed between 1970 and 2018 in unadjusted models (β = 0.14 million/mL per year). When adjusting for US region, no statistically significant decline in sperm concentration was seen. When adjusting for both region and fertility status, a modest annual decline was observed to meet statistical significance (β = -0.35 million/mL per year). Of the 49 study populations reporting adequate data to determine mean total sperm count, there was a significant increase in total sperm count of 2.9 million per year between 1970 and 2018. Subgroup analysis found no statistically significant change in mean sperm concentration among any US census region or fertility status cohort.

CONCLUSION AND RELEVANCE

In contrast to prior global studies, this analysis suggests no clinically significant decline in sperm concentration among confirmed fertile men and the general male US population without known infertility. Although these findings provide some reassurance against a widespread rapid decline, further studies are necessary to better understand this important topic.

Patient education for the management of subacromial pain syndrome: A scoping review

OBJECTIVE

To identify the extent of the literature on patient education for subacromial pain syndrome (SAPS).

METHODS

A scoping review was conducted in accordance with PRISMA-ScR standards. Nine databases were searched until November 2022 to identify articles describing patient education interventions for the management of SAPS. Interventions were extracted and described according to the Template for intervention description and replication (TIDieR) checklist and the core sets for shoulder-related health conditions of the International Classification of Functioning, Disability and Health (ICF).

RESULTS

Sixty studies of various designs met the inclusion criteria, including thirty RCTs. Patient education was a primary intervention in seven of the included RCTs. In most of the educational interventions identified in the included studies, the descriptions did not adequately cover a majority of the TIDieR's checklist items. Patient education content was often mentioned and covered most, but not all, of the ICF core sets for shoulder disorders.

CONCLUSION

Available data in current literature on patient education interventions for SAPS is scarce and lacks description.

PRACTICE IMPLICATIONS

This study presents the content elements of patient education for the management of SAPS that are described in the literature and that clinicians could consider when treating individuals with SAPS.

Examining barriers to access mental health services among patients with mental health issues in SAARC nations: A systematic review and meta-synthesis of qualitative studies

BACKGROUND

Inspite of high prevalence of mental illness in developing countries, access to health care for addressing mental health issues has several existing barriers at different levels leading to disproportionate adverse health outcomes, summarised as the three Ds of death, disability, and health-economic deficit. This study aims at examining the perspectives of patients with mental illness on barriers to access mental care.

METHODS

In this study, we searched EMBASE, PubMed, Scopus and PsycNet databases. Database search examined qualitative articles on barriers to access mental health care published from January, 2013 to January, 2023. Papers appropriate for inclusion were selected in the South Asian Association for Regional Cooperation (SAARC) nations, employed qualitative methodologies, and focused on patients, caregiver, or healthcare practitioners' perspective on challenges to access care. The Mixed Methods Appraisal Tool (MMAT) - Version 2018 was used to assess quality.

RESULTS

Out of 351 papers, only 24 met the inclusion requirements. A multilevel conceptual framework guided the reporting of emergent themes. Patient with mental disorder experienced four levels of barriers while receiving mental health services: 1. sociocultural (family support, community support networks, and cultural attitudes), 2. organizational (organizational characteristics, service access, and inadequacy of resources), 3. structural (poor implementation of existing policy) and 4. individual levels (knowledge, attitudes, and individual characteristics).

CONCLUSIONS

Complex, interlinked, multilevel barriers existed while accessing MHS for patient in SAARC nations. To improve access to MHS, multilevel solutions ought to tackle individual, organizational, societal, and structural barriers at various phases of the care pathway is imperative.

Dapagliflozin treatment decreases visceral and subcutaneous adipose tissue: a systematic review and meta-analysis

Aims

Sodium-glucose co-transporter-2 inhibitors (SGLT2i) have been shown to reduce visceral (VAT) and subcutaneous (SAT) adipose tissue. Although many systematic reviews have examined SGLT2i's effect on VAT and SAT, a focus analysis of dapagliflozin, one of the more commonly prescribe SGLT2i, has yet to been done. This study aims to determine the effect of dapagliflozin on reducing VAT and SAT in patients with chronic disease.

Methods

SCOPUS, PubMed, EBSCO, and LILACS databases were searched until December 26, 2023. Heterogeneity was determined using Cochran's Q test and quantified using the inconsistency index. The random-effects model was used to calculate the pooled standardize difference in means (SDM) and 95% confidence intervals (95% CI). Duval and Tweedie trim and fill (DT), Egger's test, and Beggs-Muzamar's test were used to assess publication bias. PROSPERO: CRD42023426208.

Results

Twelve reports were included (treated = 299 and controls = 301). Overall, dapagliflozin treatment reduced VAT (SDM = - 0.406, 95% CI: - 0.526 to - 0.286, p < 0.001) and SAT (SDM = - 0.439, 95% CI: - 0.601 to - 0.278, p < 0.001). These results were stable as determined with a sensitivity analysis; however, there was potential publication bias. Two and three imputed studies were determined by the DT method for VAT and SAT, respectively. When stratified by pathology (obesity, T2D, and T2D/NAFLD), dapagliflozin treatment decreased VAT and SAT for all conditions. However, for specifically SAT, only when compared between T2D and T2D/NAFLD, T2D/NAFLD was associated with a twofold decrease (p = 0.003).

Conclusion

Treatment with dapagliflozin resulted in a significant reduction in VAT and SAT in patients with obesity, T2D, or T2D/NAFLD.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13340-024-00765-y.

Outcomes of Minimally Invasive Glaucoma Surgery (MIGS) in Glaucoma Patients With Coexisting Cataract: A Systematic Review and Meta-Analysis

Glaucoma and cataracts frequently occur together in elderly populations, demanding combined surgical therapeutic strategies. Therefore, this study aimed to assess the clinical outcomes of minimally invasive glaucoma surgery (MIGS) in patients with coexisting open-angle glaucoma (OAG) and cataracts by adopting a meta-analysis research approach. The current meta-analysis followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines in selecting and screening the studies. A computer-based search of the PubMed, EMBASE, and Cochrane Library databases was carried out using the last search up to November 2024. The quality of the studies included in this review was evaluated by methodological quality using the Joanna Briggs Institute (JBI) checklist while the risk bias of the included randomized controlled trials (RCTs) was assessed using Cochrane Library tools. All statistical analyses were performed using Review Manager (RevMan) version 5.4.0 (The Cochrane Collaboration). Seven studies (five cohort studies and two RCTs) involving 669 eyes of 651 patients were included. Pooled analysis showed that MIGS combined with cataract surgery significantly reduced intraocular pressure (IOP) compared to cataract surgery alone (mean difference: 1.58 mmHg, 95% CI: 0.30 to 2.87, p<0.00001). Additionally, MIGS decreased postoperative medication use (mean difference: -0.79, 95% CI: -1.28 to -0.30, p<0.0001). However, significant heterogeneity was observed (I2=85-100%), likely due to variations in study designs, patient characteristics, and surgical techniques. These findings indicate that MIGS is a reasonable approach to decreasing IOP and reducing glaucoma medications in patients with cataracts and OAG. Due to the small size of the incision, it might be useful for individuals who are older and would still like to get the surgery done but with minimum surgery required. However, the durability and safety of several MIGS procedures have not been consistently determined by different techniques and long-term assessments of MIGS need to be evaluated.

Impact of Melatonin Supplementation on Glycemic Parameters in Patients with Type 2 Diabetes: A Systematic Review and Meta-analysis

BACKGROUND

Several previous studies indicated that melatonin supplementation may positively affect glycemic control in patients with diabetes. However, research on the influence of melatonin supplementation on glycemic parameters remains inconclusive. Therefore, this study aimed to assess the impacts of melatonin supplementation on glycemic parameters in type 2 diabetes by conducting a meta-analysis.

METHODS

PubMed/Medline, Scopus, and Web of Science were comprehensively searched until July 2024 to find eligible randomized clinical trials (RCTs). The overall effect sizes were estimated by using the randomeffect model and presented as weighted mean differences (WMD) with a 95% confidence interval (CI). Furthermore, the heterogeneity among the included trials was assessed by performing the Cochran Q test and interpreted based on the I² statistic.

RESULTS

Of the 1361 papers, eight eligible RCTs were included in this meta-analysis. Our findings indicated that melatonin supplementation significantly decreased fasting blood glucose (WMD = -12.65 mg/dl; 95% CI: -20.38, -4.92; P = 0.001), insulin (WMD = -2.30 μU/ml; 95% CI: -3.20, -1.40; P < 0.001), hemoglobin A1c (WMD = -0.79 %; 95% CI: -1.28, -0.29; P = 0.002), and HOMA-IR (WMD, -0.83; 95% CI: -1.59 to - 0.07; P = 0.03).

CONCLUSION

According to the results of the current meta-analysis, persons with type 2 diabetes who supplement with melatonin had improved glycemic control. It looks that supplementing with melatonin at a dose exceeding 6 mg daily for over a period of 12 weeks may be more successful than other forms of intervention. Nevertheless, further research with larger sample sizes is necessary to draw definitive conclusions.

Immunogenicity and safety of the MF59-adjuvanted seasonal influenza vaccine in non-elderly adults: A systematic review and meta-analysis

OBJECTIVE

In Europe, the age indication for the MF59-adjuvanted quadrivalent influenza vaccine (aQIV) has recently been extended from ≥65 to ≥50 years. Considering that the earliest approval of its trivalent formulation (aTIV) in Italy was for people aged ≥12 years, we aimed to systematically appraise data on the immunogenicity, efficacy, and safety of aTIV/aQIV in non-elderly adults.

METHODS

A systematic literature review was conducted according to the available guidelines and studies were searched in MEDLINE, Biological Abstracts, Web of Science, Cochrane Library and clinical trial registries. Studies on absolute and relative immunogenicity, efficacy, effectiveness, and safety of aTIV/aQIV in non-elderly adults (<65 years) were potentially eligible. These endpoints were analyzed by virus (sub)types and characteristics of vaccinees. Fixed- and random-effects meta-analyses were performed for data synthesis. Protocol registration: CRD42024512472.

RESULTS

Twenty-four publications were analyzed. aTIV/aQIV was more immunogenic than non-adjuvanted vaccines towards vaccine-like strains: the absolute differences in seroconversion rates were 8.8% (95% CI: 3.7%, 14.0%), 13.1% (95% CI: 6.7%, 19.6%) and 11.7% (95% CI: 7.2%, 16.2%) for A(H1N1), A(H3N2), and B strains, respectively. This immunogenicity advantage was more pronounced in immunosuppressed adults. Additionally, aTIV/aQIV was more immunogenic than non-adjuvanted counterparts towards heterologous A(H3N2) strains with a 10.7% (95% CI: 3.2%, 18.2%) difference in seroconversion rates. Data on antibody persistence and efficacy were limited and inconclusive. Overall, aTIV/aQIV was judged safe and well tolerated, although reactogenic events were more frequent in aTIV/aQIV recipients versus comparators. Serious adverse events were uncommon and no difference (risk ratio 1.02; 95% CI: 0.64, 1.63) between aTIV/aQIV and non-adjuvanted formulations was found.

CONCLUSIONS

In non-elderly adults, aTIV/aQIV is safe and generally more immunogenic than non-adjuvanted standard-dose vaccines.

Digital Interventions for Promoting Skin Self-Examination Behaviors of Melanoma Survivors: A Systematic Review

BACKGROUND

Regular and thorough skin self-examination (SSE) is an important strategy to reduce mortality among melanoma survivors. However, less than a quarter of melanoma survivors participate in skin self-examination.

OBJECTIVE

The aim of this study was to systematically review the effectiveness of digital interventions on SSE-related practices in melanoma survivors.

METHODS

Cochrane Library, Web of Science, PubMed, and EBSCO were used to identify literature with a search period from January 1, 2000, to June 11, 2024. Two researchers conducted the quality evaluation and summarized and analyzed the included literature.

RESULTS

Twelve articles were included, with a quality score of 5-9 and an average score of 7.67 for the included studies. The digital intervention methods are web based (n = 5), mobile applications (n = 5), videos (n = 1), and interactive multimedia (n = 1). Eleven studies used at least 1 theoretical framework to guide their intervention design. Ten studies reported SSE rates, 2 studies reported SSE areas, and 2 studies reported SSE frequencies and other practical effects. Compared with the control group, the increase in SSE rate ranged from 26.2% to 78.9%; 90% of participants had a frequency of SSE ≥ 2 times per month, with an average of 5.14 areas of SSE; the usage rate of mirrors ranged from 67% to 88%.

CONCLUSIONS

Digital intervention can effectively improve the rates, frequency, and number of areas of SSE for melanoma survivors.

IMPLICATIONS FOR PRACTICE

Digital intervention can be used in clinical practice to provide efficient and effective SSE for melanoma survivors in the short to medium term.

Effectiveness and safety of echinocandins combination therapy with the standard of care compared to the standard of care monotherapy for the treatment of invasive aspergillosis infection: a meta-analysis

Background

This meta-analysis aims to evaluate the effectiveness and safety of combining echinocandins with standard of care (SOC) antifungal drugs for treating invasive aspergillosis infection (IAI).

Method

We searched PubMed, Embase, and Cochrane Library from their inception to 25 July 2024. Our outcomes included clinical cure, mortality, and adverse drug reactions (ADRs). We compared echinocandins in combination with SOC antifungal agents against SOC monotherapy therapy. We used the random-effects model for the meta-analysis, and our estimated effects were reported as odds ratios (ORs) with 95% confidence intervals (CI).

Results

Ten studies were included in our meta-analysis comprising 1100 patients: 415 were in the echinocandin combination groups, and 685 were in the SOC groups. The clinical cure rate (OR 1.35, 95% CI: 0.75-2.42, p = 0.27), mortality (OR 0.90, 95% CI: 0.50-1.63, p = 0.73), and ADRs rate (OR 0.95, 95% CI: 0.49-1.82, p = 0.87) were not statistically different in echinocandins combination with SOC compared to SOC monotherapy. Notably, there is a signal for a better clinical cure rate in echinocandins in combination with SOC.

Conclusion

Our meta-analysis found no differences in clinical cure and mortality rate when using combination therapy of echinocandin antifungal agents with the SOC compared to SOC monotherapy. However, there is a signal for better outcomes with the echinocandins combination group. The ADRs in the echinocandins combination group were not worse than SOC monotherapy.

Metabolomics analyses and physical interventions in soccer: a systematic review

BACKGROUND

Soccer is the most recognized sports worldwide. It is a fertile ground for the use of metabolomics analyses, considering the multifactorial nature of soccer's physical demands on the body. Although scientific studies have tried using it to better understand the impacts of soccer into different contexts of the sport, no systematic review is available on metabolomics analyses in soccer athletes subjected to physical exertion interventions.

AIM OF REVIEW

Retrieve scientific articles that conducted metabolomics analyses on soccer athletes subjected to physical exertion interventions.

KEY SCIENTIFIC CONCEPTS OF REVIEW

Initially, 271 studies were screened, and 48 were retrieved for abstract analysis. Of these, 26 met the eligibility criteria, but 5 failed to meet inclusion criteria. The 21 studies included in this systematic review demonstrate that responses from physical training or acute exercise sessions, followed by the effects of soccer matches, have been the primary focus of researchers to date, highlighting alterations on metabolites from the energy metabolism, immunological pathway, purines, tryptophan/phenylalanine metabolism, as well as oxidative species and antioxidant capacity. Other studies suggest, albeit preliminarily, that organic metabolites have the potential to distinguish soccer players' performance and physical fitness, as well as provide valuable insights into diet, physical condition, training load, and recovery throughout the season. Despite metabolomics great potential to understand physiological alterations provoked by soccer as shown by the included studies, future studies should consider female athletes, explore the cause-and-effect relationship between metabolites and soccer performance more deeply, and examine the effects of different training periodizations on these markers.

Seroprevalence of Antibodies to Filoviruses with Outbreak Potential in Sub-Saharan Africa: A Systematic Review to Inform Vaccine Development and Deployment

Background/Objectives: Orthoebolaviruses and orthomarburgviruses are filoviruses that can cause viral hemorrhagic fever and significant morbidity and mortality in humans. The evaluation and deployment of vaccines to prevent and control Ebola and Marburg outbreaks must be informed by an understanding of the transmission and natural history of the causative infections, but little is known about the burden of asymptomatic infection or undiagnosed disease. This systematic review of the published literature examined the seroprevalence of antibodies to orthoebolaviruses and orthomarburgviruses in sub-Saharan Africa. Methods: The review protocol was registered on PROSPERO (ID: CRD42023415358) and previously published. Eighty-seven articles describing 85 studies were included, of which seventy-six measured antibodies to orthoebolaviruses and forty-one measured antibodies to orthomarburgviruses. Results: The results highlight three central findings that may have implications for vaccine development and deployment. First, substantial antibody seropositivity to Ebola virus (EBOV) and Sudan virus (SUDV) was observed in populations from outbreak-affected areas (≤33% seroprevalence among general populations; ≤41% seroprevalence among healthcare workers and close contacts of disease cases). Second, antibody seropositivity to EBOV, SUDV, and Marburg virus (MARV) was observed among populations from areas without reported outbreaks, with seroprevalence ranging from <1 to 21%. Third, in Central and East Africa, MARV antibody seroprevalence was substantially lower than EBOV or SUDV antibody seroprevalence, even in outbreak-affected areas and in populations at a moderate or high risk of infection (with MARV seroprevalence mostly ranging from 0 to 3%). Conclusions: Whilst gaps remain in our understanding of the significance of antibody seropositivity in some settings and contexts, these findings may be important in considering target indications for novel filovirus vaccines, in defining study designs and strategies for demonstrating vaccine efficacy or effectiveness, and in planning and evaluating vaccine deployment strategies to prevent and control outbreaks.

Measurement Properties of Wearable Kinematic-Based Data Collection Systems to Evaluate Ball Kicking in Soccer: A Systematic Review with Evidence Gap Map

Kinematic assessment of ball kicking may require significant human effort (e.g., traditional vision-based tracking systems). Wearables offer a potential solution to reduce processing time. This systematic review collated measurement properties (validity, reliability, and/or accuracy) of wearable kinematic-based technology systems used to evaluate soccer kicking. Seven databases were searched for studies published on or before April 2024. The protocol was previously published and followed the PRISMA 2020 statement. The data items included any validity, reliability, and/or accuracy measurements extracted from the selected articles. Twelve articles (1011 participants) were included in the qualitative synthesis, showing generally (92%) moderate methodological quality. The authors claimed validity (e.g., concurrent) in seven of the eight studies found on the topic, reliability in two of three, and accuracy (event detection) in three of three studies. The synthesis method indicated moderate evidence for the concurrent validity of the MPU-9150/ICM-20649 InvenSense and PlayerMaker™ devices. However, limited to no evidence was identified across studies when considering wearable devices/systems, measurement properties, and specific outcome variables. To conclude, there is a knowledge base that may support the implementation of wearables to assess ball kicking in soccer practice, while future research should further evaluate the measurement properties to attempt to reach a strong evidence level.

Serum 25(OH)D levels and obstructive sleep apnea syndrome severity in patients without comorbidities: a systematic review and meta-analysis

PURPOSE

The aim of the present systematic review was to corroborate existing evidence on how serum25(OH)D levels affect obstructive sleep apnea syndrome (OSAS) severity in the absence of comorbidities.

METHODS

From inception to May 2024, PubMed, Scopus, and Embase electronic databases were systematically screened to identify randomized controlled trials (RCTs), quasi-RCTs, prospective, and retrospective studies. A strict search protocol was applied following the application of PROSPERO, under the registration number CRD42023468744. The formulated question based on PICO process was: "how do serum25(OH)D levels affect the severity of OSAS or result in enhanced sleep function?". Collected results were finally reviewed for meta-analysis and quality assessment according to the ROBINS-I tool.

RESULTS

Data from 24 studies were pooled and divided into 15 case-control studies and 9 cross-sectional studies. All studies involved a total of 2640 OSAS subjects and 933 healthy subjects. All studies underwent qualitative analysis whereas only 20 were collected for meta-analysis. Mild OSAS showed 25(OH)D levels non-statistically significant (P = 0.12) than the healthy patients whereas moderate OSAS (P = 0.004) and severe OSAS (P < 0.001) differed significantly from control groups. Meta-regression suggested that OSAS severity correlated inversely to the deficiency of 25(OH)D serum levels. Qualitative assessment and Egger's test revealed an elevated risk of bias but low presence of publication bias, respectively.

CONCLUSION

Serum levels of 25(OH)D were observed to be inversely proportional to OSAS severity in patients without coexisting morbidities. 25(OH)D levels in mild OSAS patients were not significantly different from non-OSAS patients, suggesting vitamin supplementation to improve potential sleep disorders.

Thinking outside the shoulder: A systematic review and metanalysis of kinetic chain characteristics in non-athletes with shoulder pain

INTRODUCTION

The kinetic chain is important in the proximal-distal energy transfer along body segments. Although biomechanical impairments in components of the kinetic chain have already been reported in athletes with shoulder pain, such investigations in non-athlete individuals have not yet been synthesized.

OBJECTIVE

To systematically review the literature and analyze the quality of evidence on the characteristics of the kinetic chain of non-athletes with shoulder pain compared to asymptomatic individuals.

METHODS

Studies published until February 2024 (without language restrictions) that quantitatively assessed outcomes related to the kinetic chain of non-athlete individuals were searched in five databases (MEDLINE, CINAHL, Web of Science, EMBASE, and SCOPUS). The risk of bias and quality of evidence were analyzed using the Joanna Briggs Institute Critical Appraisal Tool for Analytical Cross-Sectional Studies and the Grading of Recommendations, Assessment, Development, and Evaluation approach, respectively. To summarize the findings, meta-analyses with random-effects models were performed.

RESULTS

Six cross-sectional studies (n = 562 [282 with shoulder pain], mean age = 48.7 ± 8.1 years) with low risk of bias were included in this review. Very low-quality evidence suggests that individuals with shoulder pain may present a lower active range of motion and muscular endurance/strength in the cervical spine, thoracolumbar region, and hip, as well as deficits in neuromuscular control of the lower extremities. Findings related to thoracic spine posture were conflicting and no differences were found in cervical spine isometric muscular strength between individuals with and without shoulder pain.

CONCLUSION

Individuals with shoulder pain may present alterations in active mobility, muscular endurance, and neuromuscular control in kinetic chain segments. These findings suggest that broader physical assessments considering components of the kinetic chain may be clinically relevant in this population. However, based on the very low quality of evidence, the findings of this review should be interpreted with caution.

Patient-Reported Experience Measures in Pediatric Healthcare-A Rapid Evidence Assessment

This study aimed to describe what is known in the scientific literature about patient-reported experience measures (PREMs) in pediatric healthcare and identify areas for further exploration. PubMed, Web of Science, CINAHL, Google Scholar, COCHRANE, and SveMed+ combined with free text search in FireFox and Safari web browsers using Medical Subject Headings terms were used. Outcomes of interest were patient experience and measures of these constructs. Of the 316 studies identified, 68 met the inclusion criteria. Forty-eight studies (72%) were published between 2015 and 2020 and more than half (53%) were published in Europe. Most studies of PREMs in pediatric healthcare included adult proxies as participants. Seventy-eight percent of studies consisted of > 100 participants. Thirty-six studies (53%) were quantitative studies, 26 (38%) were evaluative studies of patient experience measures, and 6 (9%) were qualitative in design. Three hundred eleven domains were identified and further categorized into 14 domain areas. This research is important because it aims to amplify the voices of children in healthcare and establish a foundation for developing validated pediatric-PREMs that is grounded in children's firsthand experiences of care, rather than relying primarily on proxy accounts.

Efficacy of Oral Rehabilitation Techniques in Patients With Oral Cancer: A Systematic Review and Meta-Analysis

Oral cancer commonly affects various parts of the oral cavity, including the lips, tongue, gums, palate, and inner cheeks. Oral rehabilitation involves multiple approaches aimed at restoring and improving oral function, esthetics, and overall well-being. This study assessed the functional outcomes and quality of life in patients who underwent rehabilitation following an oral cancer diagnosis. A comprehensive literature search was performed across PubMed, Cochrane Library, Dimensions, ScienceDirect, CINAHL, and Google Scholar databases. The study included patients diagnosed with oral cancer who had undergone oral rehabilitation. Functional outcomes and quality of life were key selection criteria. The methodological quality of the included studies was assessed, and data were systematically extracted and analyzed. A significant relationship was observed between the type of maxillectomy and quality of life, with obturator retention and stability being critical factors. Radiotherapy was found to adversely impact oral function and implant survival rates, with a strong correlation between radiation treatment and reduced implant survival (p < 0.00001). Additionally, dentition and the timing of implant placement were associated with recurrence rates and adverse effects. The findings highlight the crucial role of oral rehabilitation in improving both functional outcomes and quality of life in oral cancer patients. This study underscores the importance of incorporating oral rehabilitation into oral cancer treatment to enhance patient recovery and overall health.

Exploring patient perception of decision-making in carpal tunnel release surgery: A systematic review and thematic synthesis of qualitative studies

Background

Carpal tunnel syndrome is a common condition, but some controversies remain regarding diagnostics and the most effective treatments. As a result, patients often experience decisional conflicts, especially when considering carpal tunnel release surgery. Understanding factors that influence decision-making in surgery can help clinicians better grasp patient treatment preferences and priorities, reducing decisional conflicts, and enabling patients to make informed, value-aligned choices through shared decision-making. This qualitative evidence synthesis aims to explore patient perceptions of carpal tunnel release, examine the decision-making factors, and critically appraise and synthesise the existing evidence.

Methods

A systematic search was conducted across four electronic databases (MEDLINE, EMBASE, CINAHL Ultimate, PsycINFO) from inception to August 2023, supplemented by referencing and citation searching to identify eligible qualitative studies. Thematic synthesis was adopted as synthesis methodology, involving a line-by-line coding of the primary study findings, and the development of descriptive and analytical themes. Quality appraisal was conducted using the modified Critical Appraisal Skills Programme checklist, supplemented with the COnsolidated criteria for REporting Qualitative research checklist.

Results

Synthesis of six qualitative studies encompassing 66 participants generated five analytical themes: (1) Journey to normalcy, (2) Patient-centred care, (3) Work and life considerations, (4) Weighing up alternatives, and (5) Shaping the expectations, highlighting the complexity of patient decision-making in carpal tunnel release.

Discussion

In the management of carpal tunnel syndrome, therapists should consider various decision-making factors, prioritising communication and shared decision-making. This, along with personalised interactions, achieves patient-centred care and enhances patient care quality and therapeutic alliance.

Lower extremity muscle hypertrophy in response to resistance training in older adults: Systematic review, meta-analysis, and meta-regression of randomized controlled trials

OBJECTIVES

This study aimed to investigate the effects of resistance training (RT) on knee extensor muscle hypertrophy in adults 65 years and older.

METHODS

A systematic search was carried out in PubMed, Embase, and Scopus to review randomized controlled trials that assessed the effects of supervised RT on 1) muscle size, 2) fiber area, and 3) leg lean mass (LLM). Random-effects meta-analyses of standardized mean difference (SMD) and raw mean difference (RMD) for LLM were calculated. We performed a meta-regression to examine the interference of age, training volume, and duration on the results related to hypertrophy at muscle and fiber levels.

RESULTS

Thirty-two studies were included in the review, and 28 were meta-analyzed. The meta-analysis found a significant effect of RT on muscle size (SMD = 0.34; 95 % CI: 0.16-0.52; p < 0.001) and fiber area (SMD = 0.54; 95 % CI: 0.24-0.84; p < 0.001), but not on LLM (RMD = 0.22; 95 % CI: -0.22-0.66 p = 0.321). A subanalysis of studies that assessed quadriceps femoris size (excluding isolated quadriceps femoris muscles from the analysis) also revealed a significant effect of RT (95 % CI: 0.20-0.69; p < 0.001). Regression analysis indicated a significant influence of intervention duration on type II fiber area (p = 0.034), while no significant influence was detected for weekly sets or age for any outcome measure.

CONCLUSIONS

RT promotes muscle hypertrophy in older adults at both whole-muscle and fiber levels, with training duration potentially influencing the response. Measures of leg lean mass may not capture RT-induced adaptation.

The Role of Mitomycin C in Intermediate-risk Non-muscle-invasive Bladder Cancer: A Systematic Review and Meta-analysis

BACKGROUND AND OBJECTIVE

Intravesical mitomycin C (MMC) instillations are recommended to prevent recurrence of intermediate-risk non-muscle-invasive bladder cancer (IR-NMIBC); however, the optimal regimen and dose are uncertain. Our aim was to assess the effectiveness of adjuvant MMC and compare different MMC regimens in preventing recurrence.

METHODS

We performed a comprehensive search in PubMed, Scopus, and Web of Science in November 2023 for studies investigating recurrence-free survival (RFS) among patients with IR-NMIBC who received adjuvant MMC. Prospective trials with different MMC regimens or other intravesical drugs as comparators were considered eligible.

KEY FINDINGS AND LIMITATIONS

Overall, 14 studies were eligible for systematic review and 11 for meta-analysis of RFS. Estimates of 1-yr, 2-yr, and 5-yr RFS rates were 84% (95% confidence interval [CI] 79-89%), 75% (95% CI 68-82%), and 51% (95% CI 40-63%) for patients treated with MMC induction plus maintenance, and 88% (95% CI 83-94%), 78% (95% CI 67-89%), and 66% (95% CI 57-75%) for patients treated with bacillus Calmette-Guérin (BCG) maintenance, respectively. Estimates of 2-yr RFS rates for MMC maintenance regimens were 76% (95% CI 69-84%) for 40 mg MMC (2 studies) and 66% (95% CI 60-72%) for 30 mg MMC (4 studies). Among the studies included, BCG maintenance provided comparable 2-yr RFS to 40 mg MMC with maintenance (78% vs 76%). RFS did not differ by MMC maintenance duration (>1 yr vs 1 yr vs <1 yr).

CONCLUSIONS AND CLINICAL IMPLICATIONS

MMC induction and maintenance regimens seem to provide short-term RFS rates equivalent to those for BCG maintenance in IR-NMIBC. For adjuvant induction and maintenance, 40 mg of MMC appears to be more effective in preventing recurrence than 30 mg. We did not observe an RFS benefit for longer maintenance regimens.

PATIENT SUMMARY

For patients with intermediate-risk non-muscle-invasive bladder cancer, bladder treatments with a solution of a drug called mitomycin C (MMC) seem to be as effective as BCG (bacillus Calmette-Guérin) in preventing recurrence after tumor removal. Further trials are needed for stronger evidence on the best MMC dose and treatment time.

Systematic literature review comparing clinical utility of heparin-bonded expanded polytetrafluoroethylene graft with autologous saphenous vein graft for the management of below-the-knee peripheral arterial disease

BACKGROUND

This systematic literature review compares the clinical outcomes of heparin-bonded expanded polytetrafluoroethylene with autologous saphenous vein in the management of patients undergoing below-the-knee bypass to treat peripheral arterial disease.

METHODS

An electronic literature search was conducted in MEDLINE and Embase to identify comparative studies in patients who underwent below-the-knee surgical bypass. Studies were screened at abstract and full text review using predefined inclusion criteria by two independent reviewers and critically appraised for risk of bias. Meta-analyses were conducted using Review Manager 5 software (Nordic Cochrane Centre).

RESULTS

Eight retrospective cohort studies were identified. Meta-analysis of primary patency demonstrated no significant difference between heparin-bonded expanded polytetrafluoroethylene and autologous saphenous vein grafts after 1 (odds ratio: 0.91, 95% confidence interval: [0.52-1.59]; P = .74), 2 (1.12 [0.60-2.10]; P = .77), 3 (0.62 [0.26-1.48]; P = .28), and 4 years (0.70 [0.36-1.39]; P = .31). Similarly, for secondary patency, no significant difference was detected at 1 (0.62 [0.33-1.15]; P = .13), 2 (0.83 [0.32-2.13]; P = .69), 3 (0.60 [0.27-1.32]; P = .20), and 4 years (0.66 [0.32-1.36]; P = .26). There was no significant difference between autologous veins and heparin-bonded expanded polytetrafluoroethylene for limb salvage and mortality at all time points. A sensitivity analysis to compare outflow vessels was conducted in only tibial bypass and identified no differences. All analyses were considered at high-risk bias because of heterogeneity in study populations and attrition in follow-up.

CONCLUSIONS

This meta-analysis demonstrates similar outcomes between autologous saphenous vein and heparin-bonded expanded polytetrafluoroethylene for patency, limb salvage, and mortality through 4 years. The use of heparin-bonded expanded polytetrafluoroethylene synthetic grafts is a satisfactory option to prevent amputation, particularly when autologous saphenous vein grafts are not available. Controlled clinical studies are needed to further inform future decision-making and economic modeling related to the choice of conduit for below-the-knee graft construction.

Diagnostic value of ultrasound elastography in polycystic ovary syndrome: a systematic review and meta-analysis

OBJECTIVE

The main purpose of this systematic review and meta-analysis was to investigate the diagnostic value of ultrasound elastography in the evaluation of polycystic ovary syndrome (PCOS).

METHODS

A comprehensive and methodical investigation was carried out in the databases of PubMed, EMBASE, Cochrane, Scopus, Web of Science, and China National Knowledge Infrastructure, covering the entire duration of these databases until October 18, 2023. The primary purpose of this research was to evaluate and contrast ovarian tissue elasticity in people with and without PCOS. The elasticity of ovarian tissue was quantified using standardized mean difference (SMD).

RESULTS

A total of eight studies were ultimately selected for systematic evaluation and meta-analysis. Five studies used shear wave elastography (SWE) as a diagnostic tool, and it was discovered that women with PCOS had higher levels of ovarian shear wave elasticity than their healthy counterparts. The SMD was determined to be 1.86 kilopascal (95% CI: 1.27 to 2.44). Three studies were conducted using strain elastography (SE) to compare the ovarian strain ratio of patients with PCOS to that of a healthy control group. The SMD for the PCOS group was 2.07 (95% CI: 1.79 to 2.34), which indicated that the ovarian strain ratio was significantly higher in that group.

CONCLUSION

This systematic review and meta-analysis found that women with PCOS had stiffer ovarian tissue than women without the disorder. Ultrasound elastography may provide clinicians with value beyond 2D ultrasound in the diagnosis of PCOS.

Healthcare providers' advocacy approaches and ethical challenges in delivering healthcare to undocumented migrants: a scoping review

Delivering healthcare to undocumented migrants presents a complex challenge for healthcare providers. Integrating advocacy efforts into their daily practices can be ambiguous in practical terms, stemming from the intricate task of addressing the health needs of this population while simultaneously advocating for their health rights within the constraints imposed on them. This study seeks to consolidate findings from literature regarding the advocacy approaches employed by healthcare providers and the correlated ethical challenges. We conducted a scoping review of qualitative literature by systematically searching four databases-PubMed/Medline, Embase, Cinahl, and Cochrane Library. For developing our search strategy, we employed the PICO (Population, Intervention, Comparison, Outcome) scheme. Our analysis followed the qualitative content analysis approach proposed by Graneheim and Lundman. 30 studies were included, revealing a cumulative total of 915 healthcare providers who were interviewed. A total of 30 themes emerged comprising 14 advocacy approaches and 16 ethical challenges. Healthcare providers made a deliberate choice to engage in advocacy, responding to injustices experienced by undocumented migrants. The spectrum of advocacy initiatives varied, encompassing voluntary participation in healthcare provision, empathetic understanding, and healthcare-focused strategies. We also identified numerous correlated ethical challenges, necessitating healthcare providers to strike a balance between their eagerness to assist and their professional competence, respect the autonomy of undocumented migrants, and establish trust with them. These findings not only offer practical guidance for healthcare providers to enhance accessibility to healthcare services for undocumented migrant patients but also foster awareness of the ethical challenges that may arise in their advocacy roles.

Use of phytocanabinoids in animal models of Parkinson's disease: Systematic review

This systematic review was carried out with the aim of evaluating the use of medicinal Cannabis for the treatment of Parkinson's disease in experimental models. Furthermore, we sought to understand the main intracellular mechanisms capable of promoting the effects of phytocannabinoids on motor disorders, neurodegeneration, neuroinflammation and oxidative stress. The experimental models were developed in mice, rats and marmosets. There was a predominance of using only males in relation to females; in three studies, the authors evaluated treatments in males and females. Drugs were used as inducers of Parkinson's disease: 6-hydroxydopamine (6-OHDA), 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), lipopolysaccharide (LPS), and rotenone. Substances capable of promoting catalepsy in animals were also used: haloperidol, L-nitro-N-arginine (L-NOARG), WIN55,212-2, and reserpine. The inducing agent was injected stereotaxically or intraperitoneally. The most commonly used treatments were cannabidiol (CBD), Delta-9-tetrahydrocannabinol (Δ-9 THC) and Delta-9-tetrahydrocannabivarin (Δ-9 THCV), administered intraperitoneally, orally, subcutaneously and intramuscularly. The use of phytocannabinoids improved locomotor activity and involuntary movement and reduced catalepsy. There was an improvement in the evaluation of dopaminergic neurons, while in relation to dopamine content, the treatment had no effect. Inflammation, microglial/astrocyte activation and oxidative stress were reduced after treatment with phytocannabinoids, the same was observed in the results of tests for allodynia and hyperalgesia.

Parental Identity and Lived Experiences when Parenting a LGBTQIA+2 Child: A Critical Narrative Synthesis of Current Evidence

PURPOSE

Most LGBTQIA + 2 studies focus on the core sexually and gender diverse population without exploring the peripheral familial perspectives. Current research needs to explore parental experiences of parenting a LGBTQIA+2 child, since parents undergo an identity change after their child's disclosure. This parental identity change may affect parental well-being and add to the existing stress of parenting a LGBTQIA + 2 child.

METHODS

This paper uses the identity process theory (IPT) to review 18 studies on parental narratives to highlight the change in parental identity. Databases were searched for first-hand parenting experiences and shortlisted articles were qualitatively synthesized.

FINDINGS

We identified six main themes: I) Parental identity change is triggered by a child's disclosure. II) Parental identity change drives parental emotions that evolve from initial anger, shock, fear, concern, grief, etc. to eventual acceptance of their child. III) Parental identity and emotions change, as for any life change process, across assimilation, accommodation, adjustment, and evaluation phases of the IPT. IV) Parental identity change is motivated by continuity, coherence, self-efficacy, belongingness, distinctiveness, meaning and self-esteem principles of the IPT. V) Parental identity influences parental micro-individual, meso-interactional and macro-societal interactions of the IPT framework. VI) Parental mental well-being may be affected across the assimilation, accommodation, adjustment phases of the IPT before eventual acceptance of the child in the evaluation phase.

CONCLUSIONS

Parental lived experiences require a stronger consideration today within the wider, non-white, contexts. The effect of identity change on parental mental well-being and its intergenerational effect needs to be explored within the context of the IPT. Parental narratives will contribute towards creating appropriate counselling toolkits and interventions for health care providers and parents of LGBTQIA + 2 children.

Is zirconia surface etching a viable alternative to airborne particle abrasion? A systematic review and meta-analysis of in vitro studies

OBJECTIVES

This systematic review aimed to determine the effectiveness of various etching surface treatments on zirconia bond strength with the following research question: "Can zirconia etching serve as a viable alternative to airborne particle abrasion (APA) for achieving reliable bonding?".

DATA

In vitro studies comparing APA, performed with either conventional or silica-coated aluminum oxide (Al2O3) particles, with various etching protocols in terms of bonding performance were included. The risk of bias of the included studies was assessed using the QUIN's tool for in vitro studies. Meta-analyses were performed using RevMan; random-effects models were applied, and heterogeneity was tested using the I2 index. The significance level was set at p < 0.05.

SOURCES

A comprehensive literature search was conducted across electronic databases, including Clarivate Analytics' Web of Science, Cochrane Library, EMBASE, PubMed, Scopus and ProQuest.

STUDY SELECTION

Fifty-four relevant articles were included in this systematic review. According to the QUIN's tool, 7 studies were rated as "high risk of bias", 46 studies were rated as "medium risk", and 1 study was rated as "low risk". Nineteen studies were used for meta-analyses. Mostly, APA demonstrated significantly higher bond strength compared to various etching protocols (p < 0.05). However, no statistical difference was found between APA and high concentrations (40-48 %) of hydrofluoric acid (HF) in terms of immediate- and medium-term bond strength to resin composite (p > 0.05). On enamel, an experimental hot etching solution performed significantly better than APA in short-term follow-up (p < 0.05). A novel multi-acid solution exhibited significantly higher immediate shear bond strength to resin cement than APA (p < 0.05). Variable heterogeneity, ranging from low to high, was observed.

CONCLUSIONS

APA remains the surface treatment with the strongest evidence in the literature and it is usually more efficacious than zirconia etching. However, highly concentrated HF and an experimental hot etching solution have demonstrated similar or significantly higher bond strength values over time compared to APA, depending on the adhesive substrate. A recently introduced multi-acid solution (Zircos-E) needs to be further explored, especially in regards to long-term bond durability.

CLINICAL SIGNIFICANCE

This systematic review provides a comprehensive analysis of the existing in vitro evidence on the potential of zirconia etching and the bond durability of resin-based materials after artificial aging. Selecting appropriate surface treatment protocols is crucial for achieving optimal clinical outcomes.

Scoping review about well-being in the 'brain migration' studies

Research on advanced human capital migration has focused on the constructs: brain drain, brain gain and brain circulation (grouped as brain migration). The behavior of brain drainers and their migration flow is affected by perceived well-being. Our study comprehensively reviews research on the well-being of highly skilled migrants in search of the constructs and classes with which well-being in brain migration is studied. Research published in the WoSCC and Scopus databases was reviewed. Subsequently, a scoping review of the literature with the PRISMA - ScR guidelines, reporting information sources and search strategy, eligibility criteria (PICOS tool), mode of study selection and data extraction, and ways to assess quality, control bias, and synthesize results. Finally, nine papers were selected, with three types of populations analyzed and two epistemic-methodological approaches: 1) the effects of roots at origin, the ethical and moral dilemmas of the brain drain and the possibilities of return on the well-being of highly qualified emigrants, and 2) identification of the business, economic and political aspects of the destination country that condition individual well-being, adaptation and permanence. Future lines of research will focus on both categories and evaluate their effects on brain migration, and on the origin and destination countries.

Tips from an expert panel on the development of a clinical research protocol

A research protocol is a document that outlines the proposed research idea and is submitted to funding agencies, institutions, or journals for approval. Writing a research protocol represents a challenge, particularly for early-career researchers. In this guide, we aim to provide detailed guidance with the key components and offer practical tips for crafting a research protocol in line with the various study designs. Specifically, the structure of a research protocol should contain the following items: (1) a title that is specific, catchy, and impressive within the word limitation; (2) an abstract that briefs the critical points of the study; (3) an introduction highlighting the study context from broad to narrow and defining the knowledge gap; (4) a justification underlining the significance of the proposed study; (5) Specific, Measurable, Attainable, Relevant, and Time-bound (SMART) objective(s) and aim(s); (6) a methodology covering seven sub-items, including [i] study design and settings, [ii] study subjects, [iii] sample size calculation and sampling, [iv] participants recruitment and follow-up, [v] questionnaire development, [vi] potential variables and outcomes, and [vii] data analysis plan; (7) dissemination of the results; (8) ethics and conflict of interests; (9) budgets analysis/ funding disclosure; and (10) references. This guide will give an overview of these steps and provide clear and concise tips on how to successfully draft a scientific protocol. With careful planning and appropriate guidance, it is possible to develop a well-structured and compelling protocol to obtain approval for the conduction of the study or funding from agencies, institutions, or organizations.

Is virtual reality enhancing dental anatomy education? A systematic review and meta-analysis

BACKGROUND

Traditional dental anatomy education, reliant on cadaver dissections and lectures, faces challenges such as high costs, ethical concerns, and difficulty conveying complex 3D dental structures. Virtual reality (VR) offers a solution by providing immersive, interactive learning environments that can enhance students' understanding. This study systematically reviews the effectiveness of VR in dental anatomy education compared to traditional methods, focusing on its potential to improve learning outcomes.

METHODS

A comprehensive search was conducted across Web of Science (WoS), PubMed, and Scopus databases until May 2024. Data were extracted, summarized, and analyzed for qualitative synthesis. The following keywords and their combinations were used: " dental OR dentistry", "education OR teaching", "virtual AND reality OR VR", and "anatomy OR dental AND anatomy". Studies were included if they met the following criteria: Investigated the use of VR in anatomy education. Compared VR-based learning to other methods such as lecture-based teaching, 3D printed or natural models, or non-interactive 3D models. Quantitative synthesis was performed using standardized mean differences (SMD) with Hedges'd and 95% confidence intervals (CI).

RESULTS

Out of 178 records screened, seven studies were included in the meta-analysis and eight in the personal evaluation analysis. The analysis indicates a moderately positive effect of VR on dental anatomy education (SMD = 0.74, p = 0.05) compared to lecture-based education using X-ray, CBCT, or 3D models. However, at the same time, VR falls short compared to clinical experience, training with physical teeth, or quality printed models. Studies reported rare cases of discomfort, disorientation, diplopic image, and VR sickness.

CONCLUSIONS

The use of VR-based learning moderately positively affects educational outcomes, and enhances knowledge retention, especially before clinical experience. The personal evaluation of students showed a strong interest in VR, with positive feedback on its ease of use, accuracy, and educational value.

Non-pharmacological treatment strategies for anthropometric, physical capacity and physiological indicators among sarcopenic obesity patients: a systematic review of rigorous randomized controlled trials

OBJECTIVES

To investigate the effects of non-pharmacological treatments on sarcopenic obesity (SO).

METHODS

A search for randomized controlled trials (RCTs) on SO was conducted in PubMed, Web of Science, CINAHL, CENTRAL, SPORTDiscus, CNKI, Wanfang and VIP. A meta-analysis was conducted using random-effects models for MDs.

RESULTS

The meta-analysis on 21 RCTs showed that exercise improved PBF (MD: -1.67%, p < .01, I2 = 35%), grip strength (MD: 2.2 kg, p = .03, I2 = 61%), GS (MD: 0.08 m/s, p = .02, I2 = 0%), TCR (MD: 2.22 repetitions, p < .01, I2 = 0%), TUG (MD: -1.48 s, p < .01, I2 = 61%), UE strength (MD: 1.88 kg/kg, p < .01, I2 = 0%) and LE strength (MD: 2.19 kg/kg, p < .01, I2 = 0%). Nutritional interventions improved grip strength (MD: 1.52 kg, p < .01, I2 = 0%). Combine interventions improved PBF (MD: -1.97%, p < .01, I2 = 38%), ASMM (MD: 0.4 kg, p < .01, I2 = 6%), grip strength (MD: 1.83 kg, p < .01, I2 = 38%) and GS (MD: 0.04 m/s, p < .01, I2 = 0%). Combined interventions were more effective than nutrition alone for reducing PBF (MD: -0.8%, p = .05, I2 = 0%).

CONCLUSION

The effects of exercise and nutrition interventions on SO are limited individually, especially regarding muscle mass, but their combination can yield optimal results. Additionally, physical therapy also demonstrated some potential.

Systematic review and meta-analysis of COVID-19 mRNA vaccine effectiveness against hospitalizations in adults

Background

During the coronavirus disease 2019 (COVID-19) pandemic, Pfizer/BioNTech BNT162b2, and Moderna mRNA-1273 vaccines were central to the global pandemic control measures.

Methods

Here, we conducted a systematic review and meta-analysis to evaluate their real-world vaccine effectiveness (VE). Our study focussed on those that reported the efficacy of these vaccines against COVID-19 hospitalization. Hospitalization was chosen as the primary outcome as it directly reflects the ability of the vaccine to prevent severe disease. A literature search was undertaken using Medline and Embase on 25 February 2024. From this, 50 studies out of 18,347 articles were included for further analysis.

Results

High VE against hospitalization was reported for both the BNT162b2 and mRNA-1273 COVID-19 vaccines when used either as a primary vaccination series (2-dose) or following an additional booster dose (3-dose). Meta-analysis indicated that the pooled VE estimates for each of these vaccination protocols ranged from 84% to 86%, suggesting strong protectiveness. Our data also imply that booster doses can restore waning effectiveness, with no significant differences observed in VE between the 2-dose and 3-dose protocols. However, subgroup analysis revealed an association between the presence of the Omicron variant and a drop in VE, indicating that future emerging SARS-CoV-2 virus variants could similarly affect VE.

Conclusions

Our review underscores the importance of ongoing research to ensure vaccine strategies remain effective against evolving variants. Our study also identified the need for expanding data collection to include underrepresented populations.

Omega-3 Supplementation and Nutritional Status in Patients with Pancreatic Neoplasms: A Systematic Review

OBJECTIVES

The purpose of this study was to synthesize and evaluate the evidence regarding the effects of omega-3 supplementation on the nutritional status of pancreatic cancer patients.

METHODS

A systematic review of clinical trials was conducted, adhering to the PRISMA Statement. MEDLINE/PubMed, EMBASE, CENTRAL Cochrane, Scopus, and Web of Science databases were searched up to 31 December 2022 without restrictions on the publication date or language. Independent reviewers extracted data and assessed the risk of bias. The internal validity and risk of bias in randomized controlled trials (RCT) were assessed using the revised Cochrane risk of bias tool for randomized trials-RoB2, while the risk of bias in non-randomized intervention studies was evaluated using the ROBINS-I tool.

RESULTS

Eight studies met all the inclusion criteria and were analyzed. Five of them were RCT, with the majority (n = 4) classified as low risk of bias, and the three quasi-experiments were deemed to have a moderate risk of bias. Among the studies investigating the outcome of weight gain/maintenance, six reported statistically significant positive results (p < 0.05).

CONCLUSIONS

In conclusion, the presented evidence indicates that omega-3 supplementation in pancreatic cancer patients is safe, well-tolerated, and beneficial, as it contributes to the stabilization or increase in body weight, as well as a reduction in inflammatory biomarkers.

Disclosure Practices in Muslim Patients and the Impact on End-of-Life Care: A Narrative Review

Context: Non-disclosure practices hold significant weight in end-of-life care for Muslim communities, where cultural and religious beliefs are deeply intertwined with healthcare decision-making. This narrative review explores the complexities of medical decision-making and disclosure practices among terminally ill Muslim patients, examining how these factors shape palliative care delivery. Objectives: The primary objective of this review is to investigate the impact of non-disclosure practices on end-of-life care in Muslim populations, focusing on key themes that influence medical decision-making. Additionally, the review identifies ways in which Healthcare Provider (HCP) can navigate these culturally sensitive issues to enhance care. Methods: A comprehensive narrative review was conducted, utilizing articles from CINHAL, PsychINFO, Scopus, and PubMed databases published between 2009 and 2024. An initial search yielded 2025 articles. After applying inclusion and exclusion criteria, 12 studies were included for analysis. The SANRA guidelines for narrative reviews were followed, and the SPIDER framework was used for qualitative synthesis. Results: Of the 2041 articles initially retrieved, 2014 were excluded after screening, 8 were duplicates, and 7 full texts were excluded for not meeting the inclusion criteria. The final review included 12 studies. Three key themes emerged: (1) cultural, religious, and emotional factors driving requests for non-disclosure, (2) the prominent role of family in medical decision-making, and (3) healthcare provider communication challenges contributing to disparities in palliative care access. Conclusion: Non-disclosure practices present significant barriers to effective palliative care in Muslim communities. To improve care outcomes, culturally competent communication strategies and family-centered decision-making models are crucial.

Exploring and describing alcohol harm reduction interventions: a scoping review of literature from the past decade in the western world

CONTEXT

Regular alcohol use is a predominant risk factor for disease, injury, and social harm. While robust evidence is advocating for implementing interventions to reduce the harms of illegal substance use, less literature is dedicated to identifying and understanding interventions aiming at reducing the various harms associated with alcohol.

OBJECTIVES

This review describes how alcohol harm reduction (AHR) interventions are currently conducted and analyzes the facilitators and barriers identified by the studies on their efficacy.

METHOD

This scoping review with evidence appraisal included articles published between 2011 and 2022, addressing one or more AHR interventions for population of at least 18 years (including alcohol user who have an addiction but also alcohol user with harmful drinking), conducted in North industrialized countries (Europe, Nort America, Australia).

RESULTS

Among the 61 articles selected, we identified several forms of support (face-to-face or remote, support in residential settings, structural interventions, and interventions created upon spontaneous initiatives), and strategies of intervention were also analyzed (the ones based upon learning and skill development, the ones based upon psychological support, the ones focusing upon socio-economic conditions, strategies focusing on the coordination and adaptation of the care system, and those strategies based on peer support). The facilitators linked to fundamental characteristics of the interventions were the promotion of empowerment and autonomy of beneficiaries, setting objectives tailored to individual needs, professionals harmonizing their values, evidence-based interventions taking into account cultural contexts, and comprehensive and holistic support. Practical facilitators from the intervention process consist of increasing the number of sessions, involvement, and formation of members of staff, disposing of the necessary resources, and using technological tools.

DISCUSSION

The sheer variety of AHR interventions demonstrates that this is a fertile field in terms of intervention design and innovation. This work illustrates the importance of designing effective, adapted harm reduction interventions, prioritizing interventions that make support more accessible to more people. This also prompts us to consider the potential benefits of invoking proportionate universalism in the design of AHR interventions in order to operationalize alcohol harm reduction philosophy. accessible to more people.

Feasibility and effectiveness of telerehabilitation on mobility and balance function in multiple sclerosis: A systematic review and meta-analysis

BACKGROUND

Multiple Sclerosis (MS) is a chronic neurodegenerative disease of the central nervous system with a significant impact on mobility and balance function. Telerehabilitation is an emerging branch of telemedicine which has the potential to deliver rehabilitation remotely through the use of information and communication technology. The aim of this systematic literature review and meta-analysis is to synthesise and analyse the evidence on the effectiveness of telerehabilitation in improving mobility and balance function in MS and to determine its feasibility.

METHODS

Four electronic databases (PubMed, the Cochrane Library, Science Direct and Cinahl) were searched in January 2024 using some of the following terms: "Multiple Sclerosis" AND "Telerehabilitation" OR "Exergaming" OR" Virtual Reality". The risk of bias was assessed using the Cochrane Risk of Bias assessment tool. The meta-analysis was conducted using Cochrane Collaboration Review Manager Software (version 5.4.1).

RESULTS

Five Randomised Controlled Trials were included with a total sample size of 225 participants who had MS. The meta-analyses found significant statistical and clinical effects of telerehabilitation for both Mobility ((P = 0.02; SMD = 0.41; 95 % CI: 0.05, 0.77) and Balance (P = 0.0001; SMD = 0.64; 95 % CI: 0.31, 0.97) outcomes. Feasibility was found to be >90 %.

CONCLUSION

This review found evidence in favour of telerehabilitation using exergaming and Pilate-based interventions. Further studies are needed with larger sample sizes of high methodological quality. The findings of this review highlight the potential of telerehabilitation to fulfil an unmet need in care pathways which currently exists in MS rehabilitation.

Variability of energy cost in breaststroke technique: a systematic review

This study aimed to synthesise the body of knowledge on kinematics, active drag and energetics determinants of energy cost variability in the breaststroke technique. Methodological procedures considering the standards for systematic reviews according to the '"Preferred Reporting Items for Systematic Reviews and Meta-Analyses"' were employed. Searches were conducted in four prominent databases. A total of 1,464 articles were identified, of which 201 met the eligibility criteria. After evaluation, 73 articles were included for synthesis in this review. The included studies had a mean score (± SD) of 9.14 ± 1.76 points regarding the quality assessment. The present review identified three distinct domains of variables: kinematics (including stroke kinematics and coordination parameters), active drag, and energetics. The findings underscored the pivotal role of stroke kinematics, including stroke rate, stroke length, stroke index, and intra-cyclic variations of velocity, in influencing energy cost during breaststroke swimming. Additionally, the analysis highlighted the significance of propulsive and non-propulsive phases, arm-to-leg timing, and buoyancy in breaststroke technique. Notably, breaststroke exhibited higher values of active drag, frontal area, and energy cost, while maintaining lower velocity compared to other swimming techniques. Overall, this synthesis of literature highlights the holistic nature of energy cost in breaststroke swimming.

Accuracy Standards of Wearable Technologies for Assessment of Soccer Kicking: Protocol for a Systematic Literature Review

BACKGROUND

Wearable technology is widely applied in performance monitoring, an integral part of sports and exercise sciences. The kick movement in soccer exemplifies a sports technique that could benefit from appropriate biomechanics assessment methodologies. However, the accuracy of wearables in quantifying soccer kick mechanics, particularly under field conditions, remains unclear.

OBJECTIVE

This study aims to present a protocol for a systematic review to discuss the measurement properties (validity, reliability, and/or accuracy aspects) of wearable technology systems explicitly used to measure ball-kicking features in soccer.

METHODS

This review protocol was preregistered in the Open Science Framework. A total of 2 authors will perform searches in major electronic databases using specific keyword combinations in PubMed, Physical Therapy and Sports Medicine, Web of Science, ProQuest, IEEE Xplore, EBSCOHost, and Scopus. Following a specific population, intervention, comparison, outcome framework (population: soccer players and/or collected human data in a football-related environment; intervention: at least 1 wearable used; comparator: criterion measures, repeated testing sessions and/or actual values; outcome: ball kicking data), studies will be screened based on predetermined inclusion and exclusion criteria. The methodological quality of the included studies will be assessed using the "consensus-based standards for the selection of health measurement instruments" checklist (in studies concerning validity or reliability) or the "quality assessment of diagnostic accuracy studies" tool (in studies concerning accuracy). Data extraction will be conducted to determine the level of evidence according to the "best evidence synthesis method," and an evidence gap map will be constructed. The Cohen κ coefficient will be used to estimate the interevaluator agreement.

RESULTS

This ongoing systematic review has completed database searches and is currently in the screening phase. Depending on the number and consistency of studies, results may be presented by meta-analysis or qualitative synthesis, with subgroup analyses considering factors such as gender, age, and playing level. The final results are expected by July 2024, with manuscript submission anticipated by November 2024.

CONCLUSIONS

Our study will provide a comprehensive summary of the highest level of evidence available on the use of wearables for the assessment of soccer kick mechanics, providing practical guidance for athletes and sports sciences professionals regarding the validity and reliability aspects of using wearable technology to measure ball-kicking features in soccer.

TRIAL REGISTRATION

OSF registries https://osf.io/zm3j6.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/57433.

A systematic literature review on patient-reported outcome domains and measures in nonsurgical efficacy trials related to chronic pain associated with endometriosis: an urgent call to action

ABSTRACT

Endometriosis, a common cause for chronic pelvic pain, significantly affects quality of life, fertility, and overall productivity of those affected. Therapeutic options remain limited, and collating evidence on treatment efficacy is complicated. One reason could be the heterogeneity of assessed outcomes in nonsurgical clinical trials, impeding meaningful result comparisons. This systematic literature review examines outcome domains and patient-reported outcome measures (PROMs) used in clinical trials. Through comprehensive search of Embase, MEDLINE, and CENTRAL up until July 2022, we screened 1286 records, of which 191 were included in our analyses. Methodological quality (GRADE criteria), information about publication, patient population, and intervention were assessed, and domains as well as PROMs were extracted and analyzed. In accordance with IMMPACT domain framework, the domain pain was assessed in almost all studies (98.4%), followed by adverse events (73.8%). By contrast, assessment of physical functioning (29.8%), improvement and satisfaction (14.1%), and emotional functioning (6.8%) occurred less frequently. Studies of a better methodological quality tended to use more different domains. Nevertheless, combinations of more than 2 domains were rare, failing to comprehensively capture the bio-psycho-social aspects of endometriosis-associated pain. The PROMs used showed an even broader heterogeneity across all studies. Our findings underscore the large heterogeneity of assessed domains and PROMs in clinical pain-related endometriosis trials. This highlights the urgent need for a standardized approach to both, assessed domains and high-quality PROMs ideally realized through development and implementation of a core outcome set, encompassing the most pivotal domains and PROMs for both, stakeholders and patients.

Identifying health inequities faced by older adults with rare diseases: A systematic literature review and proposal for an ethical spectrum and resource allocation framework

Ageism in healthcare has received increased attention in recent years, but literature focusing on how it affects individuals living with rare diseases remains scant. The rare disease population already faces obstacles when navigating health systems, and ageism has the potential to exacerbate existing health inequities. We conducted a systematic review of peer-reviewed and gray literature on health inequities in rare disease populations, seeking to identify publications that reported primary or secondary data on the equitable or inequitable treatment of these populations, or that discussed related regulatory, moral, or philosophical issues. Our aims were to understand how health inequities in these populations arise, how they are justified from societal points of view, how they manifest themselves in laws and regulations, and what effects they have on health care access and health outcomes. We retrieved information from 63 publications, which we inductively synthesized into five categories: ethical discussions, societal preferences, regulations, access to care, and health outcomes. Integrating insights from these categories, we developed an Ethical Spectrum and Resource Allocation Framework, which explains the emergence of equity issues and how they are manifested in health systems. By providing a better understanding of the root causes of health inequities, particularly among older adults, the framework can inform health policymaking, improving access to care and health outcomes for rare disease patients.

Changes in energy and macronutrient intakes during Ramadan fasting: a systematic review, meta-analysis, and meta-regression

CONTEXT

Ramadan fasting (RF) is associated with various physiological and metabolic changes among fasting Muslims. However, it remains unclear whether these effects are attributable to changes in meal timing or changes in dietary energy and macronutrient intakes. Furthermore, the literature on the associations between RF, meal timing, and energy and macronutrient intakes is inconclusive.

OBJECTIVES

This systematic review aimed to estimate the effect sizes of RF on energy and macronutrient intakes (carbohydrates, protein, fats, dietary fiber, and water) and determine the effect of different moderators on the examined outcomes.

DATA SOURCES

The Cochrane, CINAHL, EMBASE, EBSCOhost, Google Scholar, PubMed/MEDLINE, ProQuest Medical, Scopus, ScienceDirect, and Web of Science databases were searched from inception to January 31, 2022.

DATA EXTRACTION

The studies that assessed energy, carbohydrate, protein, fat, fiber, and water intakes pre- and post-fasting were extracted.

DATA ANALYSIS

Of the 4776 identified studies, 85 relevant studies (n = 4594 participants aged 9-85 y) were selected. The effect sizes for the studied variables were as follows: energy (number of studies [K] = 80, n = 3343 participants; mean difference [MD]: -142.45; 95% confidence interval [CI]: -215.19, -69.71), carbohydrates (K = 75, n = 3111; MD: -23.90; 95% CI: -36.42, -11.38), protein (K = 74, n = 3108; MD: -4.21; 95% CI: -7.34, -1.07), fats (K = 73, n = 3058; MD: -2.03; 95% CI: -5.73, 1.67), fiber (K = 16, n = 1198; MD: 0.47; 95% CI: -1.44, 2.39), and water (K = 17, n = 772; MD: -350.80; 95% CI: -618.09, 83.50). Subgroup analyses showed age significantly moderated the 6 dietary outcomes, and physical activity significantly moderated water intake. There were significant reductions in energy, carbohydrate, and protein intakes during RF.

CONCLUSIONS

The change in meal timing rather than quantitative dietary intake may explain various physiological and health effects associated with RF.

Societal Preferences in Health Technology Assessments for Rare Diseases and Orphan Drugs: A Systematic Literature Review of New Analytic Approaches

OBJECTIVES

This systematic literature review aimed to explore experiences worldwide of societal preferences integration into health technology assessments (HTAs) for rare diseases (RDs) and orphan drugs (ODs) through the implementation of multicriteria decision analysis (MCDA), discrete choice experiments (DCEs), and person trade-off (PTO) methods, among others.

METHODS

A systematic search of the literature was conducted in April 2021 using PubMed, Cochrane, Embase, and Scopus databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach was used for the review phases. Finally, the Promoting Action on Research Implementation in Health Services framework was used to discuss the implementation of these instruments in the RD context.

RESULTS

A total of 33 articles met the inclusion criteria. The studies measured societal preferences for RD and OD as part of HTA using MCDA (n = 17), DCE (n = 8), and PTO (n = 4), among other methods (n = 4). These found that patients and clinicians do not prioritize funding based on rarity. The public is willing to allocate funds only if the OD demonstrates effectiveness and improves the quality of life, considering as relevant factors disease severity, unmet health needs, and quality of life. Conversely, HTA agency experts preferred their current approach, placing more weight on cost-effectiveness and evidence quality, even though they expressed concern about the fairness of the drug review process.

CONCLUSIONS

MCDA, PTO, and DCE are helpful and transparent methods for assessing societal preferences in HTA for RD and OD. However, their methodological limitations, such as arbitrary criteria selection, subjective scoring methods, framing effects, weighting adaptation, and value measurement models, could make implementation challenging.

Are tourniquets indicated in total knee arthroplasty in the era of tranexamic acid: A meta-analysis and systematic review

Introduction

There is conflicting evidence in the literature regarding the clinical utility of tourniquets in total knee arthroplasty (TKA), specifically in regards to perioperative blood loss. In this meta-analysis and systematic review, we aim to evaluate the clinical advantages and disadvantages associated with tourniquet use in the setting of TKA.

Methods

A systematic review was conducted through April 2017 using keywords: "tourniquet" and "total knee arthroplasty" or "total knee replacement". Perioperative variables including TXA use, blood loss, incidence of venous thromboembolism (VTE), and wound complications were either extracted from the studies or corresponding authors were contacted. A sub-analysis was conducted to evaluate the effects of TXA on intraoperative and total blood loss (TBL), and VTE incidence.

Results

After review of 558 articles, 19 studies reporting outcomes in 1094 patients were analyzed. Intraoperative blood loss was significantly lower in the tourniquet cohorts compared to non-tourniquet (p < 0.01). TBL was reduced in tourniquet groups but not significantly (p = 0.08). In contrast, calculated blood loss was greater in tourniquet groups, but this difference was not significant (p = 0.43). There was a greater likelihood for wound complications and VTE among tourniquet assisted TKA, albeit only significant for the former (p = 0.01). TXA sub-analysis demonstrated intraoperative blood loss was significantly reduced with tourniquet use regardless of TXA implementation (p < 0.01). In studies without TXA, tourniquet patients were at greater risk of developing VTE (p = 0.08). These risks decreased with TXA administration.

Conclusion

This meta-analysis demonstrates that tourniquets prevent intraoperative blood loss, yet within the postoperative period, there is no significant difference in TBL between tourniquet and non-tourniquet assisted TKA.

Level of evidence

Level II; Systematic Review and Meta-Analysis.

Effects of Hyrax Maxillary Expander on Nasal Cavity and Upper Airway in Adolescents: A Systematic Review and Meta-Analysis

BACKGROUND

Whether Hyrax maxillary expander is an effective treatment for maxillary transverse deficiency as well as expansion of the upper airway is still controversial. The study's purpose was to evaluate 3D changes in upper airway dimensions of adolescent patients measured primarily by cone-beam computed tomography (CBCT) after rapid maxillary expansion (RME) with the Hyrax maxillary expander.

METHODS

Studies up to 1 April 2024 were searched in the following databases: PubMed/MEDICINE, Web of Science, Cochrane Library, and Embase. Inclusion criteria were clinical trials and cohort studies that assessed the effect of RME in adolescent patients with upper airway stenosis using CBCT-based three-dimensional analysis. The risk of bias in the study outcomes was assessed using the Cochrane Collaboration's risk of bias tool, the GRADE method, and a tool for evaluating non-randomized controlled study (non-RCT) literature from a previous systematic review, depending on the types of articles. The study was reported in accordance with PRISMA guidelines.

RESULTS

The study conducted a random effects meta-analysis of mean differences and 95% confidence intervals for changes in upper airway volumes, including the nasal cavity (NC), in the outcomes of 16 included studies, followed by subgroup analyses.

CONCLUSION

A significant increase in nasopharynx volume was observed after rapid maxillary expansion (RME) by Hyrax maxillary expander (MD = 0.69, 95% CI (0.09~1.28), p = 0.02).

Factors associated with the permanence of doctoral students. A scoping review

The permanence of students in doctoral programs is a multi-causal phenomenon, which makes it difficult to address and leads to an isolated investigation of its causes, being necessary a joint understanding. The aim is to investigate, through a scoping review of quantitative studies published between 2015 and 2021, the influence of individual, academic, socioeconomic and institutional factors on retention, attrition and dropout. The 32 included studies evidenced a predominance of research focused on individual factors versus few that combined all possibly relevant factors. The present study provides evidence for the emergence of several subfactors: female students, self-efficacy and motivation (individual); the relationship with the supervisor (academic); support for psychological needs (institutional); and migratory status (socioeconomic). This article highlights the need for research that understands this problem with a multifactor approach and an impact on permanence.

Bibliometric analysis of genomic selection in breeding of animal from 1993 to 2024: global trends and advancements

Animal breeding became a difficult science when numerous genes influenced economically significant features. The major source of genetic improvement is selection, and as such, the large generation intervals in these strategies lead to reduced rates of improvement. Therefore, breeding control, genetic improvement research, and selection processes are accelerated by genomic selection. This article regarding global research interest trends in genomic selection in animal breeding themes was examined using bibliometric analysis, which employed papers from 1993 to 2024 from the SCI-Expanded, SSCI, AHCI, and E-SCI indexes. Over the period of 31 years, the first 3,181 published articles on genomic selection in animal breeding were gathered. Additionally, the study displays trends in co-authorships according to nations and academic institutions as well as co-occurrences of author keywords. There have been more articles since 2010 about the use of genomic selection in animal breeding, building up a sizable library of work that will last until 2024. Among the top academics in the field are Calus MPL, Li J, and Wang Y. The most productive institutions were The United Kingdom's University of Edinburgh, Aarhus University (Denmark) and China Agricultural University. The current hotspots in this field of study include "selection," and "association," according to keyword co-occurrence and frequency analysis. China, the United States, Brazil, Canada, and United Kingdom are the top five countries that produced the most papers with the highest levels of international collaboration and networking. The main topics of current study include prediction, accuracy, association, traits, and selection. New techniques for selection, prediction, accuracy, traits, and association were developed as the discipline matured. Research collaborations across countries, institutions, and writers promote knowledge sharing, effective issue resolution, and superior outcomes.

Exploring the Potential of Microservices in Internet of Things: A Systematic Review of Security and Prospects

With the rapid growth of Internet of Things (IoT) systems, ensuring robust security measures has become paramount. Microservices Architecture (MSA) has emerged as a promising approach for enhancing IoT systems security, yet its adoption in this context lacks comprehensive analysis. This systematic review addresses this research gap by examining the incorporation of MSA in IoT systems from 2010 to 2024. From an initial pool of 4388 studies, selected articles underwent thorough quality assessment with weighted critical appraisal questions and a defined inclusion threshold. This study represents the first comprehensive systematic review to investigate the potential of microservices in IoT, with a particular focus on security aspects. The review explores the merits of MSA, highlighting twelve benefits, eight key challenges, and eight security risks. Additionally, the eight best practices for implementing MSA in IoT systems are extracted. The findings underscore MSA's utility in fortifying IoT security while also acknowledging complexities and potential vulnerabilities. Moreover, the study calls attention to the importance of incorporating complementary technologies including blockchain and machine learning to address identified gaps effectively. Finally, we propose a taxonomic classification for Microservice-based IoT security patterns, facilitating the categorization and organization of security measures in this context. Such a review can help researchers and practitioners identify existing gaps, highlight potential research directions, and provide guidelines for designing secure and efficient microservice-based IoT systems.

Ethnic Differences in Response to Oral Vitamin D Supplementation: A Systematic Review and Meta-analysis

CONTEXT

Individual variability in oral vitamin D supplement response hinders the understanding of its clinical impact, and while ethnicity has been implicated in this variability it has not been well described.

OBJECTIVE

The aim was to systematically assess the impact of ethnicity on response to oral vitamin D supplementation.

DATA SOURCE

The Web of Science and PubMed databases were searched for articles published from 1960 to the end of 2020. All trials in adults measuring 25(OH)D3 blood levels were included.

DATA EXTRACTION

Two reviewers independently extracted the data from the eligible studies. The change in 25(OH)D3 blood levels (95% CI) and P values were extracted, and grouped according to ethnicity, then subjected to random-effects meta-analysis. The primary outcome measurement was mean serum 25(OH)D3 levels and the secondary outcome was dose-adjusted mean serum 25(OH)D3 levels, both compared with baseline.

DATA ANALYSIS

A total of 18 studies were identified, and data from 1131 participants were extracted. Body mass index (BMI) and dose were significant covariates (Pearson correlation coefficient, P = .016 and .017) and were normalized in the meta-analysis to minimize heterogeneity, but latitude was not (P = .66). Meta-analysis showed an effect of ethnicity on dose and BMI-adjusted mean serum 25(OH)D3 levels compared with baseline (P < .00001, I2 = 98%). Asian and White study participants demonstrated a statistically higher increase in dose and BMI-adjusted 25(OH)D3 blood levels (183 nmol/L [95% CI, 163-203] and 173 nmol/L [95% CI, 152-194], respectively), compared with Arab and Black study participants (37 nmol/L [95% CI, 35-39] and 99 nmol/L [95% CI, 90-108]) using repeated t tests. Sensitivity analysis demonstrated that these findings were not impacted by potential study bias or the inclusion of immigrant populations.

CONCLUSION

Ethnicity had an impact on oral vitamin D response. Further prospective studies should examine if ethnicity-based dose stratification in both clinical practice and clinical trials is warranted.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023410076.