Excluding non-English publications from evidence-syntheses did not change conclusions: a meta-epidemiological study

The Tryptophan-Kynurenine pathway in people living with HIV: a systematic review

PURPOSE

HIV-1 disrupts the metabolic profile of people living with HIV (PLWH), including the Tryptophan-Kynurenine (Trp-Kyn) pathway, linked to disease outcomes and comorbidities. Despite numerous studies, consensus on key dysregulated metabolites in antiretroviral therapy (ART)-treated PLWH is lacking. This systematic review compiles data to identify and highlight the most noteworthy Trp-Kyn metabolites.

METHODS

PubMed, Scopus, and Web of Science databases were searched using a search protocol specifically designed for this study. Studies that investigated the levels of metabolites in the Trp-Kyn pathway in the peripheral blood of PLWH on ART, as well as in healthy control groups were included.

RESULTS

Thirteen metabolomic studies that investigated this pathway met our inclusion criteria. The findings revealed that Trp, Kyn, and the Kyn/Trp ratio (indicative of indoleamine 2,3-dioxygenase IDO activity) were the most investigated metabolites in this metabolic pathway. Evidence consistently demonstrated that Trp levels were lower in PLWH, while predicted IDO activity was consistently higher. Despite the widespread investigation of Kyn, there was no clear consensus on its levels in PLWH, with some studies reporting higher levels and others finding no significant differences compared to HIV-negative controls.

CONCLUSION

In the modern ART era, Trp metabolism and IDO activity may play key regulatory roles in HIV-1 pathogenesis, as evidenced by the consistent patterns observed across various studies. These metabolites and related pathways warrant further investigation as potential targets for improved diagnostics, prognostics, and therapeutics in the context of HIV-1.

Emergency department's patient safety culture perceived by healthcare workers: A scoping review protocol

A strong patient safety culture is critical for ensuring effective healthcare systems, particularly in high-risk environments such as emergency departments. Assessing patient safety culture requires the identification of strengths and weaknesses within clinical departments to enable targeted improvement. Patient safety in emergency departments is especially vulnerable due to overcrowding, necessity for rapid decision-making, and high pressure. However, the existing literature has not been systematically mapped to understand how healthcare workers perceive the patient safety culture in these settings. This scoping review aims to synthesize and map available evidence on patient safety culture as perceived by healthcare workers in emergency departments. This review will be conducted following the Joanna Briggs Institute methodology designed explicitly for scoping reviews, and the results will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). The inclusion criteria will be based on the Population (healthcare workers), Concept (patient safety culture), and Context (emergency department settings) framework. A comprehensive search will be conducted in PubMed, CINAHL (EBSCOhost), Web of Science, Embase, Cochrane Library, KISS, and grey literature sources, such as ProQuest Dissertation & Theses Global and Google Scholar. Study selection and data extraction will be performed independently by two researchers, with a third researcher resolving discrepancies. Descriptive analysis will summarize the study characteristics, while content and thematic analyses will identify key themes related to patient safety culture. The findings will be presented at academic conferences and published in a peer-reviewed journal.

Kidney health outcomes in children born very prematurely compared to full-term counterparts: a systematic review and meta-analysis

BACKGROUND

Advances in neonatal care have improved survival rates in preterm neonates. However, concerns persist regarding the long-term kidney implications of prematurity. Nephrogenesis is disrupted, particularly in those born very preterm (≤ 32 weeks of gestation), increasing the risk of early kidney dysfunction and hypertension later in life.

OBJECTIVES

This systematic review and meta-analysis aimed to evaluate kidney health outcomes in former very preterm children and adolescents compared to full-term peers.

DATA SOURCES

A systematic literature search was conducted in MEDLINE/PubMed, Scopus, and Web of Science from their earliest available records to October 9, 2024.

STUDY ELIGIBILITY CRITERIA

We included observational studies comparing kidney health parameters between children/adolescents born very preterm (gestational age - GA ≤ 32 weeks) and their full-term counterparts (gestational age > 36 weeks or birth weight > 2000 g) within the age range of 6 to 18 years.

PARTICIPANTS AND INTERVENTIONS

Children and adolescents aged 6-18 years born very preterm were compared to their full-term counterparts. The analyzed kidney function markers included serum Cystatin C, serum creatinine (sCr), estimated glomerular filtration rate (eGFR) based on sCr (Cr-eGFR), and blood pressure (systolic and diastolic, SBP/DBP).

STUDY APPRAISAL AND SYNTHESIS METHODS

The Newcastle-Ottawa Scale was used to assess study quality. The mean difference with 95% confidence intervals was used for continuous outcomes. Statistical significance was set at p < 0.05. Sensitivity, subgroup and meta-regression analyses were conducted for further exploration of the outcomes. Statistical analyses were performed using R software (Version 4.3.2).

RESULTS

Thirteen studies (16 reports; 2,112 participants) were included. Very preterm children and adolescents had higher serum Cystatin C (0.05 mg/L; 95%CI: 0.02-0.08), lower Cr-eGFR (-11.87 mL/min/1.73 m2; 95%CI: -22.44 to -1.31), and higher SBP (1.96 mmHg; 95%CI: 0.21-3.71). Sensitivity analysis confirmed Cystatin C findings but rendered Cr-eGFR and SBP differences non-significant. Subgroup analysis showed a significant GA effect on sCr (p < 0.0001), though the ≥ 28 weeks subgroup included only two studies.

LIMITATIONS

Considerable heterogeneity across studies persisted despite sensitivity and subgroup analyses. The lack of randomized controlled trials and longitudinal studies limits result interpretation, while non-significant meta-regression findings hinder full explanation of heterogeneity. Insufficient data prevented the assessment of additional kidney function parameters.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

Cystatin C was elevated in very preterm individuals compared to full-term peers, reinforcing its role as an early marker of kidney dysfunction. While differences in Cr-eGFR and SBP lost significance after sensitivity analysis, these markers remain relevant for long-term follow-up in this vulnerable population.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO (CRD42024554702).

The use of implementation science theoretical approaches in hybrid effectiveness-implementation type 1 randomised trials of healthcare interventions: A scoping review

BACKGROUND

Hybrid type 1 effectiveness-implementation randomised controlled trials (RCTs) aim to accelerate the translation of proven clinical interventions into routine care by concurrently investigating the effectiveness of clinical interventions and the context for real-world implementation. Hybrid type 1 RCTs can make use of implementation science theoretical approaches (i.e., theories, models, and frameworks) to understand barriers and facilitators to sustainable implementation of clinical interventions; however, the extent to which these approaches have been used in hybrid type 1 RCTs has not been systematically investigated. This scoping review aimed to investigate the extent to which implementation science theoretical approaches have been used in hybrid type 1 RCTs of healthcare interventions and describe which approaches have been reported and how they have been used.

METHODS

The review was conducted in accordance with the pre-registered protocol ( https://doi.org/10.17605/OSF.IO/CJ8A7 ). Searches of six electronic databases were conducted for published hybrid type 1 RCTs evaluating any clinical intervention in any healthcare setting. The included trials were full-text, peer-reviewed primary research articles written in English, and reporting the findings of hybrid type 1 RCTs of healthcare interventions. Non-English language reports, reviews, protocols without a linked trial results report, methodological papers, opinion pieces, commentaries, books/book chapters, dissertations, and conference abstracts were excluded. Two reviewers independently selected studies, extracted data, and assessed use of theoretical approach/es.

RESULTS

We identified 8,878 citations, screened 673 full-text records, and included 37 trials. Most trials were conducted in North America (68%), investigating clinical interventions for mental health problems (32%) in adults (43%). Twenty-eight (76%) trials cited use of at least one theoretical approach. The most common was the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework (43%). Theoretical approaches were most often applied (62%) to justify the implementation study design, guide selection of study materials or analyse implementation outcomes.

CONCLUSION

The majority of published hybrid type 1 effectiveness-implementation RCTs of healthcare interventions report using at least one theoretical approach to explore the context for implementation. Use of implementation science theories, models, and/or frameworks to understand the barriers and facilitators to implementation and sustainability of proven clinical interventions is likely to accelerate future translation of evidence-based practices into routine care and thus optimise patient outcomes.

Language barriers in conservation science citation networks

Using relevant scientific evidence is crucial to effectively conserve species and ecosystems worldwide. Currently, evidence that is available only in non-English languages is severely underutilized. We examined many underutilized non-English languages in the conservation evidence literature and factors that facilitate the use of non-English-language evidence based on citation patterns of articles testing the effectiveness of conservation actions published in English and 15 non-English languages. Multivariate models incorporated explanatory variables, such as lexical distance from English, availability of an English abstract, study design complexity, conservation status of studied species, and language of citing articles. Non-English-language articles received significantly fewer English citations (i.e., citations in English-language articles) than English-language articles. Hungarian, Polish, Korean, and Russian articles were particularly undercited in English. Despite fewer English citations, many non-English-language articles had high citation rates in their own languages, indicating their value in local conservation communities. Non-English-language articles with English abstracts received more English citations. The content of the article, such as a more robust study design or assessment of threatened species, was not significantly associated with the number of English citations received. Our findings highlight the importance of increasing the visibility and recognition of non-English-language articles, especially those in currently underutilized languages, for a more comprehensive understanding of global conservation challenges. Providing a translated English abstract has the potential to increase readership of an article by increasing the accessibility to those who can understand English.

The epidemiological trends and projected future of primary sclerosing cholangitis by 2040: An updated meta-analysis and modeling study

BACKGROUND AND AIMS

Primary sclerosing cholangitis (PSC) exhibits varying incidence and prevalence rates across different regions; however, comprehensive global studies examining its geographic distribution and future trends are scarce. This study presents an updated meta-analysis through 2024 and projects the global and regional prevalence of PSC from 2024 to 2040 using an illness-death multi-state model.

METHODS

We conducted a thorough systematic search across multiple databases to identify all primary studies published until 2024 that reported on the incidence, prevalence, and mortality rates of PSC in various regions. Using the gathered data, we developed an illness-death model to forecast the future prevalence of PSC, covering the years 2024-2040.

RESULTS

Our meta-analysis revealed that the global pooled incidence and prevalence rates of PSC are 0.65 and 7.52 per 100,000 persons, respectively. Projections indicate that the global prevalence of PSC will rise to 22.98 cases per 100,000 (95% CI: 21.0-24.95), corresponding to an overall increase of 28.3%. Specifically, North America is forecasted to experience a 5.45% increase in PSC cases, reaching 24.76 cases per 100,000 (95% CI: 19.63-29.88), while Western Europe is anticipated to see a more pronounced rise of 28.79%, resulting in a prevalence of 21.48 cases per 100,000 (95% CI: 18.3-24.65) by 2040.

CONCLUSIONS

Our findings indicate a substantial rise in the number of individuals affected by PSC in recent years and estimate a significant future burden of the disease.

Individual Education for Patients With Chronic Low Back Pain: Likely a Clinically Relevant Effect for Long-term Disability Compared to Noneducational Interventions. A Systematic Review With Meta-Analysis

OBJECTIVE: To assess the effectiveness of individual education for patients with chronic low back pain (CLBP), compared to no intervention, placebo, noneducational interventions, or other type of education. DESIGN: Intervention systematic review with meta-analysis of randomized controlled trials (RCTs). LITERATURE SEARCH: PubMed, CINAHL, PEDro, Embase, and Scopus (up to January 14, 2024); citation tracking in Web of Science, grey literature and reference lists of previous systematic reviews. STUDY SELECTION CRITERIA: We included RCTs that evaluated individual patient education interventions for adults with CLBP. DATA SYNTHESIS: Random-effects meta-analysis for clinically homogeneous RCTs. We assessed risk of bias using the Cochrane Risk of Bias 2.0, and applied the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to assess the certainty of evidence. RESULTS: We included 17 RCTs (n = 1893). There was moderate-certainty evidence that individual patient education had a clinically relevant effect compared to noneducational interventions on long-term disability (standardized mean difference, -0.23; 95% confidence interval [CI]: -1.13, 0.66). There was moderate-certainty evidence that individual patient education had no effect on short-term health-related quality of life compared to no intervention (mean difference, -0.003; 95% CI: -0.04, 0.04), and no effect on medium-term disability (SMD, 0.10; 95% CI: -0.37, 0.57) and long-term pain intensity (mean difference, -2.20; 95% CI: -14.43, 10.03) compared to noneducational interventions. CONCLUSION: Individual patient education provided a clinically relevant effect on long-term disability when compared to noneducational interventions. There were no other clinically relevant effects of individual patient education for CLBP. J Orthop Sports Phys Ther 2025;55(5):1-13. Epub 20 March 2025. doi:10.2519/jospt.2025.12794.

The risk of intellectual disability in offspring of diabetic mothers: A systematic review and meta-analysis

Epidemiological evidence on association between maternal diabetes and intellectual disability (ID) in offspring is mixed. This systematic review and meta-analysis aimed to synthesise the existing evidence to determine the extent and nature of this association. We systematically searched Embase, Web of Science, Scopus, PubMed, PsycINFO, and CINAHL databases from inception to March 14, 2023. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale. Effect estimates for each exposure-outcome association were synthesised using a random-effects model Sensitivity and subgroup analyses were performed to identify potential sources of heterogeneity. A total of ten studies, comprising 8,927,706 mother-child pairs, met the inclusion criteria. Our analyses revealed that children exposed to any form of maternal diabetes had higher odds of ID compared to unexposed counterparts. Specifically, we found a 61 % higher risk of ID in offspring of mothers with any pre-existing diabetes. However, no significant association was found between gestational diabetes mellitus (GDM) and ID risk in offspring. The present meta-analysis suggests that exposure to pre-existing type 1 diabetes (T1D) and type 2 diabetes (T2D), but not GDM, is associated with increased risks of ID in offspring. Further high-quality studies, adequately adjusted for potential confounders, are needed to confirm these findings.

Health Inequities in the Epidemiology, Diagnosis, Treatment, and Outcomes of Plastic Surgery: A Scoping Review

Background: Plastic surgery is routinely sought after for the treatment of breast cancer, cleft lip and palate, and gender-affirming care. Inequities exist in plastic surgery in regard to the epidemiology, diagnosis, treatment, and outcomes experienced by patients. The purpose of our scoping review was to (1) outline current literature addressing health inequities in plastic surgery and (2) draw attention to the gaps in this literature. Methods: This scoping review was developed following guidelines from the Joanna Briggs Institute and PRISMA extension for scoping reviews. An initial search of MEDLINE (via PubMed), Ovid Embase, Cochrane Database of Systematic Reviews, and Scopus databases was performed to locate published articles on health inequities in plastic surgery. Articles had to address at least one of the National Institutes of Health's inequity groups we examined. Results: After reviewing full text, 153 studies were included in our final sample. We found race/ethnicity (94/153) and age (90/153) to be the 2 most commonly evaluated inequities in the scoping review. We discovered that patient populations that were older had public or no insurance and/or were in historically marginalized racial/ethnic groups were often less likely to be offered plastic surgery treatments. Conclusion: This scoping review describes the current literature on health inequities in plastic surgery and highlights gaps in the literature that warrant further research. We found significant findings regarding how vulnerable patient populations are affected by health inequities. Research should be conducted to investigate these inequities more thoroughly and discover the best solutions to bridge the gaps in providing equitable care.

A scoping review of the ethical issues in gender-affirming care for transgender and gender-diverse individuals

BACKGROUND

Globally, there is a notable increase in recognising the health needs of transgender and gender-diverse individuals. As a result, gender-affirming care services are evolving and expanding in many parts of the world, and this has provoked increased debate on various aspects of the interventions that comprise such care. Resolution of these debates depends on addressing important ethical issues. This scoping review aims to identify the key ethical issues and arguments regarding gender-affirming care across various medical interventions.

METHODS

We searched Embase, PubMed and SCOPUS to identify peer-reviewed publications that could meet some eligibility criteria such as publications presenting an ethical issue, argument, or principle related to gender-affirming care for transgender and gender-diverse individuals and having been published from 2012 to 2023. We applied Arksey and O'Malley's scoping review framework. The text of included publications was analysed inductively.

RESULTS

Eighty-two publications were identified for inclusion. Sixty-two publications (76%) were published in or after 2019, and 20 (24%) between 2012 and 2018. Five aspects of gender-affirming care that draw ethical analysis or debates were identified: decision-making process, guideline and model of care, deletion of health data, funding, and fertility preservation and services. Ethical issues and arguments were identified within each aspect of care. The arguments are organised according to the four principles of biomedical ethics: autonomy, beneficence, non-maleficence and justice.

CONCLUSION

This scoping review captures the key ethical issues in various aspects of gender-affirming care. There were substantial differences in the depth to which each aspect of gender-affirming care was discussed, with ethical issues in decision-making processes receiving the most attention, and deletion of health data given the least attention. This review also characterises the dominant ethical arguments and underlying principles used to justify positions on the issues. Within each ethical issue, the four principles of biomedical ethics featured commonly, but were applied very differently and accorded unequal weighting. Additionally, in some discussions, arguments supporting medical interventions were given more attention; in others, the rationales opposing medical interventions were dominant. Perhaps unsurprisingly, there was limited resolution and increasing disagreement. Important constraints in the methodologies of argumentation used to support or oppose aspects of gender-affirming care were also identified.

Comparative effectiveness of electroencephalogram-neurofeedback training of 3-45 frequency band on memory in healthy population: a network meta-analysis with systematic literature search

OBJECTIVE

To investigate which brain activity frequency of electroencephalogram (EEG)-neurofeedback training (NFT) was the most effective for enhancing working memory (WM) and episodic memory (EM) in healthy participants through network meta-analysis (NMA).

METHODS

Searched PubMed, Embase, and Cochrane Library for studies published from January 1990 to January 2025. We performed Bayesian NMA, pooling continuous outcome data using the standardized mean difference effect size (ES). Global and local evaluations of inconsistency were conducted using the chi-square test, side-splitting, and loop-specific approaches. A consistency model was applied and the global approach to inconsistency showed no significance. Efficacy ranks were determined using the surface under the cumulative ranking curve (SUCRA) for each intervention. Publication bias was assessed using the comparison-adjusted funnel plot and Egger's test. Finally, sensitivity analysis confirmed our findings' robustness.

RESULTS

Sixty studies were included, comprising 50 trials on WM and 24 trials on EM. While the global inconsistency analysis showed no significant inconsistency for WM (χ2(22) = 30.89, p = 0.10) and EM (χ2(10) = 13.48, p = 0.19), the consistency model exhibited the most significant difference between active control (AC) and alpha combined with working memory training (WMT) (ES of 6.64, p < 0.001) for WM, and between AC and alpha (ES of 0.84, p = 0.01) for EM. Alpha combined with WMT for WM (100%) and alpha NFT for EM (87.0%) also showed the highest efficacy according to the SUCRA. No publication bias was found for either type of memory. The sensitivity analysis for WM and EM aligns with the original results.

CONCLUSION

Through NMA, alpha activity (7-13 Hz) may be a crucial frequency impacting memory. Brain activity combined with other training methods requires more robust studies for future investigation. This study registered with www.crd.york.ac.uk/prospero/ (CRD42024539656).

The prevalence and correlates of dual diagnosis among adults in custody: A systematic review and meta-analysis

BACKGROUND

Incarcerated individuals experience mental illness (MI), substance use disorders (SUD), and their co-occurrence - dual diagnosis - at higher rates than the general population. By systematically reviewing the literature on dual diagnosis in custody, we aimed to (1) estimate the pooled prevalence of dual diagnosis among adults in custody, and (2) identify the psychosocial, health-related, and criminal justice correlates of dual diagnosis.

METHOD

We searched CINAHL, CINCH, Embase, Medline, PsycINFO, and Web of Science for studies investigating dual diagnosis among adults in custody. We also conducted backward citation chaining of a previous systematic review of dual diagnosis in Australian prisons. We used random-effects meta-analysis to generate a pooled prevalence estimate of dual diagnosis and conducted a narrative synthesis of the identified correlates of dual diagnosis in the literature.

RESULTS

Twenty-five studies met the inclusion criteria; 20 had sufficient data for meta-analysis. The pooled prevalence estimate of dual diagnosis among adults in custody was 25.3 % [95 %CI: 18.6, 32.7]. Correlates of dual diagnosis included illicit substance use before 15 years old, living with someone who used substances before incarceration, violence victimisation, increased suicide risk, and a lifetime history of multiple convictions.

CONCLUSIONS

Our findings suggest that approximately one out of every four adults in custody have a dual diagnosis, highlighting the need for coordinated mental health and alcohol and other drug services for justice-involved individuals. It is crucial that correctional healthcare providers have the capacity and resources necessary to address the complex needs of adults with dual diagnosis in custody.

Systematic Review and Meta-Analysis: Attention-Deficit/Hyperactivity Disorder Symptoms in Children With Neurofibromatosis Type 1

OBJECTIVE

This meta-analysis aimed to robustly estimate differences in attention-deficit/hyperactivity disorder (ADHD) symptoms between children and adolescents with and without neurofibromatosis type 1 (NF1).

METHOD

Systematic literature searches were conducted in Scopus, PsycINFO, Web of Science, PubMed, and ProQuest in September 2022, with a supplemental search conducted in Google Scholar in February 2023. The searches identified 2,153 unique articles. Screening identified 114 academic journal articles that assessed parent/caregiver- or teacher-reported ADHD symptoms for children/adolescents with NF1. Two researchers independently screened articles and extracted data. The primary outcome was group differences in ADHD symptoms between children/adolescents with and without NF1 (Hedges g). Data were analyzed using robust variance estimation and random-effects models.

RESULTS

The meta-analysis included 70 studies (138 effect sizes), involving 3,653 children/adolescents with NF1 (46% female; mean age = 9.69 years, SD = 2.60 years) and 4,895 children/adolescents without NF1 (48% female; mean age = 10.03 years, SD = 3.10 years). According to parent/caregiver reports, children/adolescents with NF1 exhibited more severe inattentive symptoms (g = 1.20; 95% CI = 1.06-1.35), hyperactive/impulsive symptoms (g = 0.85; 95% CI = 0. 68-1.03), and combined ADHD symptoms (g = 1.02; 95% CI = 0.87-1.17) than unaffected controls. Inattentive ADHD symptoms were more elevated than hyperactivity/impulsivity for children/adolescents with NF1. Larger effect sizes for inattention and hyperactivity/impulsivity were associated with older age, lower intelligence quotient (IQ), and parent/caregiver vs teacher reports.

CONCLUSION

NF1 is a monogenic condition that has strong associations with elevated ADHD symptoms. Findings highlight the importance of early intervention and targeted support for ADHD-related problems in children with NF1.

PLAIN LANGUAGE SUMMARY

Increasing evidence has suggested a higher risk for attention-deficit/hyperactivity disorder (ADHD) in individuals with neurofibromatosis type 1 (NF1). In this study of ADHD symptom severity in youth with NF1, the authors analyzed data from 70 articles. The authors found much more severe ADHD symptoms in children and adolescents with NF1 compared to youth without NF1. Inattentive symptoms were more pronounced in children with NIF who were older or had a lower IQ.

STUDY PREREGISTRATION INFORMATION

Compare the ADHD problems between NF1 and control groups; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=462063.

Pharmacologic Treatment of Acute Attacks of Episodic Migraine: A Systematic Review and Network Meta-analysis for the American College of Physicians

BACKGROUND

Migraine is common, affecting 15% of Americans.

PURPOSE

To compare benefits and harms of pharmacologic treatments for acute attacks of episodic migraine in adults and assess cost-effectiveness.

DATA SOURCES

Three electronic databases searched to October 2024, gray literature, and reference lists.

STUDY SELECTION

Two investigators independently selected English-language randomized trials.

DATA EXTRACTION

Single reviewer data extraction with second review. Dual independent risk of bias and certainty of evidence (COE) assessment.

DATA SYNTHESIS

Twenty-one head-to-head and 165 placebo-controlled trials were included in meta-analyses and network meta-analyses. Triptans were more effective than acetaminophen (low COE) and nonsteroidal anti-inflammatory drugs (NSAIDs) (high COE) for pain outcomes at 2 hours and pain freedom up to 48 hours. Triptan and acetaminophen combinations were more effective than acetaminophen alone (moderate COE) for pain outcomes at 2 hours and pain freedom up to 48 hours but not more than triptans alone (low COE). Triptan and NSAID combinations were more effective for pain outcomes at 2 hours and pain freedom up to 48 hours compared with acetaminophen (low COE), gepants (low COE), NSAIDs (high COE), and triptan monotherapy (moderate COE). Triptan regimens, however, often had a higher risk for adverse events. One study found triptans more cost-effective than ditans and gepants.

LIMITATIONS

Harms assessment was limited to randomized trials. Many comparisons lacked sufficient evidence to draw conclusions.

CONCLUSION

Triptans and combinations of triptans were more effective than NSAID and acetaminophen alone.

PRIMARY FUNDING SOURCE

American College of Physicians. (PROSPERO: CRD42023441146).

Chlorhexidine solutions are more effective than povidone-iodine solutions as skin disinfectants for the prevention of intravascular catheter-related infections: A meta-analysis

Catheter-related infections pose a significant risk to critically ill patients, making it crucial to select an appropriate sterilization solution. However, there is currently no consensus on the use of chlorhexidine-containing solutions or povidone-iodine (PVI) and the auxiliary ingredients in solutions. Meta-analysis. PubMed, EMBASE, OVID, Web of Science, and Cochrane Library databases. Two reviewers independently performed study screening and data extraction and used the Cochrane risk-of-bias tool 2.0 (RoB 2.0) for quality assessment. We included 10 fully published RCTs with 12 pairs of comparisons, which included a total of 9,689 catheters. The analysis revealed that chlorhexidine gluconate (CHG)-containing solutions were significantly more effective than PVI in preventing CRBSI (RR = 0.460, 95% CI 0.323-0.654, P < 0.001), catheter-related sepsis (RR = 0.419, 95% CI 0.206-0.853, P = 0.016), and catheter colonization (RR = 0.409, 95% CI 0.266-0.630, P < 0.001). Further subgroup analysis demonstrated that, regardless of the concentration of CHG (≤ 1% or > 1%), it was superior to PVI in preventing CRBSI and catheter colonization (RR = 0.271 ~ 0.585, 95% CI 0.110 ~ 0.400‒0.590‒0.926). CHG-alcohol is most effective at preventing catheter-related infections, especially those caused by 70% alcohol. Compared to PVI, CHG-70% alcohol is the most effective disinfectant for preventing catheter-related infections, as it combines the rapid disinfection and evaporation properties of alcohol with the prolonged antimicrobial effects of chlorhexidine.PROSPERO registration number: CRD42024507163.

Does antibiotic prophylaxis have an effect on postoperative infection in temporomandibular joint surgery? - A systematic review

There is ongoing debate about the necessity of antibiotic prophylaxis regarding temporomandibular joint (TMJ) surgery. With antibiotic resistance being a major concern and challenge, developing solid recommendations on antibiotic use is essential to prevent overuse, misuse, and to enhance patient safety. The aim of this systematic review (SR) was to evaluate the scientific evidence regarding the effectiveness of antibiotics in preventing postoperative infections following TMJ surgery. Comprehensive literature searches were conducted using The Cochrane Library, Medline, EMBASE, and Web of Science. The selection process was based on predefined criteria, followed by a quality assessment of the retrieved SRs and primary studies using ROBIS and GRADE, respectively. Out of 8976 studies identified, 20 were reviewed in full text, and two were included in this SR for a risk of bias assessment. The quality assessment revealed a generally high risk of bias. In conclusion, no evidence-based recommendation can currently be made regarding antibiotic usage in relation to TMJ surgery. There is a knowledge gap concerning the impact of antibiotics on postoperative infection in TMJ surgeries, underscoring the need for further research in this field.

Diagnostic value of contrast-enhanced ultrasound for the depth of myometrial infiltration in early endometrial cancer: a meta-analysis

Objectives

Globally, endometrial cancer (EC) is currently one of the most common gynecologic malignancies among females. Preoperative infiltration depth analysis is important for disease progression and prognostic impact. This study aimed to evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) in the infiltration depth analysis of EC.

Method

Electronic databases PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP were searched for more extensive literature on CEUS in the diagnosis of myometrial infiltration in EC patients up to March 29, 2024. Cochran Q and I² were used to assess the heterogeneity of eligible studies. Sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were analyzed for each clinical outcome using a bivariate random effects model. Summary receiver operating characteristic (SROC) curves were also generated.

Results

In total, 23 papers with 1247 EC patients were included in the meta-analysis. The SEN, SPE, PLR, NLR, and DOR for the diagnosis of deep myometrial infiltration (DMI) of EC using CEUS were 0.84 [95% confidence interval (CI): 0.79, 0.89], 0.92 (95%CI: 0.90, 0.94), 11.05 (95%CI: 8.00, 15.25), 0.17 (95%CI: 0.12, 0.23), and 64.91 (95%CI: 37.11, 113.52), respectively. The area under the curve (AUC) was 0.95 (95%CI: 0.93, 0.97). For the diagnosis of superficial myometrial invasion (SMI) of EC by CEUS, the SEN, SPEN, PLR, NLR, DOR and AUC were 0.91 (95%CI: 0.85, 0.95), 0.80 (95%CI: 0.64, 0.90), 4.55 (95%CI: 2.34, 8.85), 0.11 (95%CI: 0.06, 0.21), 41.40 (95%CI: 12.14, 141.13), and 0.94 (95%CI: 0.91, 0.95), respectively.

Conclusion

CEUS might be a reliable and practical technique for EC myometrial infiltration diagnosis. More clinical data and studies are still needed to confirm these results in the future.

Psychological Interventions in Patients with Physical Pain: A Focus on Catastrophizing and Resilience-A Systematic Review

Background: Cognitive processes play a crucial role in the perception of pain. Catastrophizing, defined as a tendency to focus on a painful experience or amplify its unpleasantness, even in an anticipated form, might increase patients' negative expectations and feelings of helplessness. In fact, high levels of pain catastrophizing are associated with a reduction in resilient behaviors among patients with physical pain. The objective of the present study is to investigate the employment of psychological and psychotherapeutic interventions in patients reporting pain, focusing on their improvements in terms of resilience and catastrophizing. Methods: This review was conducted following the PRISMA guidelines using three databases including articles published from 2006 to February 2024: PubMed, Scopus, and Web of Science. The search strategy was based on the PIO (Population, Intervention, Outcome) scheme. Following the Cochrane recommendations, quality assessment was performed using the Cochrane Risk of Bias tool (RoB 2.0) for randomized studies and the Cochrane Risk of Bias for NonRandomized Studies (ROBINS-I). We included all English language studies reporting on psychological interventions in the context of pain management and related catastrophic thinking and resilience behaviors. Reviews, book chapters, editorials, conference abstracts and notes, observational studies, and non-English studies were excluded. Two independent authors were involved in the screening and data extraction phase. Results: A total of 10 studies were finally selected. The selected studies included five randomized controlled trials (RCTs); three single group, nonrandomized pilot trials; one single case study; and one nonrandomized pilot trial. The studies were mostly conducted in the United States (n = 7). Overall, the studies reported that psychological interventions in patients with physical pain may improve their psychological health and pain management. Reduced levels of catastrophic thinking and improved psychological resilience were found in subjects undergoing psychological treatments in most selected studies. Conclusions: Further studies are needed, above all controlled trials, to confirm the impact of these interventions in improving patients' emotional and physical health in the long-term management of physical pain, improving their resilience and reducing catastrophic thinking.

Optimising the Dose of Static Stretching to Improve Flexibility: A Systematic Review, Meta-analysis and Multivariate Meta-regression

BACKGROUND

Static stretching is widely used to increase flexibility. However, there is no consensus regarding the optimal dosage parameters for increasing flexibility.

OBJECTIVES

We aimed to determine the optimal frequency, intensity and volume to maximise flexibility through static stretching, and to investigate whether this is moderated by muscle group, age, sex, training status and baseline level of flexibility.

METHODS

Seven databases (CINAHL Complete, Cochrane CENTRAL, Embase, Emcare, MEDLINE, Scopus, and SPORTDiscus) were systematically searched up to June 2024. Randomised and non-randomised controlled trials investigating the effects of a single session (acute) or multiple sessions (chronic) of static stretching on one or more flexibility outcomes (compared to non-stretching passive controls) among adults (aged ≥ 18 years) were included. A multi-level meta-analysis examined the effect of acute and chronic static stretching on flexibility outcomes, while multivariate meta-regression was used to determine the volume at which increases in flexibility were maximised.

RESULTS

Data from 189 studies representing 6654 adults (61% male; mean [standard deviation] age = 26.8 ± 11.4 years) were included. We found a moderate positive effect of acute static stretching on flexibility (summary Hedges' g = 0.63, 95% confidence interval 0.52-0.75, p < 0.001) and a large positive effect of chronic static stretching on flexibility (summary Hedges' g = 0.96, 95% confidence interval 0.84-1.09, p < 0.001). Neither effect was moderated by stretching intensity, age, sex or training status, or weekly session frequency and intervention length (chronic static stretching only) [p > 0.05]. However, larger improvements were found for adults with poor baseline flexibility compared with adults with average baseline flexibility (p = 0.01). Furthermore, larger improvements in flexibility were found in the hamstrings compared with the spine following acute static stretching (p = 0.04). Improvements in flexibility were maximised by a cumulative stretching volume of 4 min per session (acute) and 10 min per week (chronic).

CONCLUSIONS

Static stretching improves flexibility in adults, with no additional benefit observed beyond 4 min per session or 10 min per week. Although intensity, frequency, age, sex and training status do not influence improvements in flexibility, lower flexibility levels are associated with greater improvement following both acute and chronic static stretching. These guidelines for static stretching can be used by coaches and therapists to improve flexibility.

CLINICAL TRIAL REGISTRATION

PROSPERO CRD42023420168.

Availability bias in road safety systematic reviews and its impact on the meta-analysis findings

Meta-analyses, which present the best source of information on the effectiveness of interventions, are influenced by several biases. One category relates to the convenience of selective inclusion of those primary studies, which are more easily available than others. This availability bias includes bias from excluding the grey literature, bias from excluding non-English literature, and bias from excluding older studies. Existing studies are not conclusive about the impacts of this bias; in addition, none of them focus on road safety meta-analyses. To fill this gap, the present paper consisted of two studies: (1) exploring the presence of availability bias in road safety meta-analyses, and (2) demonstrating the impact of availability bias in several example meta-analyses. Based on an analysis of 80 existing meta-analyses, the first study concluded that compared to the medicine meta-analyses, the road safety meta-analyses use a longer time range, are more often restricted in terms of language, and less often involve the grey literature. The second study utilized selected unrestricted data samples to demonstrate the impact of availability bias in seven meta-analyses. The differences in intervention effectiveness in terms of crash frequency changes between unrestricted and restricted scenarios were identified. This shows that the search restrictions clearly lead to availability bias, which influences the differences in meta-analysis results.

Predictive factors of incidental prostate cancer in patients undergoing surgery for presumed benign prostatic hyperplasia: an updated systematic review and meta-analysis

Purpose

We aimed to identify the clinical predictors of incidental prostate cancer (IPCa) after surgery for presumed benign prostatic hyperplasia (BPH).

Methods

The literature was comprehensively searched using PubMed, Web of Science, Embase, and Cochrane databases in December 2024. We used pooled standardized mean difference (SMD) and odds ratio (OR) to describe the correlation between relevant risk factors and IPCa.

Results

Twenty-one studies included 10,842 patients that were available for further analysis. After BPH surgery, 957 patients were histopathologically diagnosed with IPCa. The IPCa rate was 8.83%. Most importantly, our results identified that IPCa was significantly associated with age (pooled SMD = 0.36, P < 0.001), body mass index (BMI) (pooled SMD = 0.23, P < 0.001), preoperative prostate-specific antigen (pre-PSA) (pooled SMD = 0.43, P < 0.001), preoperative prostate-specific antigen density (pre-PSAD) (pooled SMD = 0.62, P = 0.028), resected prostate weight (pooled SMD = -0.22, P < 0.001), preoperative treatment with 5-alpha reductase inhibitors (5αRIs) (yes/no) (pooled OR = 0.60, P < 0.001), family history (yes/no) (pooled OR = 3.81, P = 0.029), digital rectal examination (DRE) findings (abnormal/normal) (pooled OR = 5.15, P < 0.001), and transrectal ultrasonography (TRUS) findings (abnormal/normal) (pooled OR = 2.92, P < 0.001). Additionally, sensitivity and subgroup analyses indicated that our findings were reliable and robust. However, we found no significant associations between IPCa and prostate volume, preoperative negative prostate biopsy, smoking history, history of hypertension, history of diabetes, history of dyslipidemia, and abnormal magnetic resonance imaging findings (all P > 0.05).

Conclusions

Age, BMI, pre-PSA, pre-PSAD, resected prostate weight, preoperative treatment with 5αRIs, family history, abnormal DRE findings, and abnormal TRUS findings are independent factors predicting IPCa following BPH surgery. Before BPH surgery, factors such as age, BMI, pre-PSA, and pre-PSAD should be considered to assess the risk of IPCa. For high-risk patients, more detailed imaging and needle biopsy are recommended before surgery to avoid missed diagnosis. In the future, more large-scale and well-designed studies are needed to validate our results further.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42025631346.

Efficacy and safety of balneotherapy in rheumatology: a systematic review and meta-analysis

OBJECTIVE

The efficacy of balneotherapy in rheumatology remains unclear. We aimed to estimate its benefits and risks in rheumatology.

METHODS

We conducted a systematic review of randomised trials assessing any European balneotherapy for a rheumatological indication in adults versus any control, on clinical outcomes. We searched PubMed, Cochrane Library, Embase and https://clinicaltrials.gov/ (up to 28 November 2023). We used the Cochrane risk of bias tool version 2, funnel plot and asymmetry tests. We used a random effects model with an inverse-variance weighting method for standardised mean difference (SMD) and risk ratio (RR). We used the Grading of Recommendations Assessment, Development and Evaluation approach for two primary outcomes, pain and quality of life (QoL) at 3 months, and two safety outcomes, withdrawal and any adverse event (AE).

RESULTS

We included 29 trials in mechanical disorders, 9 in inflammatory diseases and 4 in fibromyalgia. The synthesis suggested a decrease in pain of a very low level of certainty (SMD: -0.72 (95% CI (-1.00; -0.44)), very serious risk of bias and of inconsistency, publication bias strongly suspected); an increase in QoL of a very low level of certainty (SMD: 0.56 (95% CI (0.37; 0.75)), very serious risk of bias and serious risk of inconsistency); inconclusive results regarding the risk of withdrawal (RR: 0.75 (95% CI (0.46; 1.20)), very serious risk of bias and serious risk of imprecision) and of AE (RR: 0.80 (95% CI (0.43; 1.50)), serious risk of bias and of inconsistency and very serious risk of imprecision).

CONCLUSION

The certainty of the effect of balneotherapy in rheumatology was very low.

PROSPERO REGISTRATION NUMBER

CRD42023448206.

Barriers and enablers to pharmacist involvement in social prescribing: a protocol for a systematic review of qualitative studies

INTRODUCTION

Social prescribing is an innovative approach to healthcare that involves referring patients to non-medical services and activities in the community to improve health and well-being. Pharmacists are well-positioned to contribute to social prescribing initiatives given their accessibility and expertise, but their involvement remains limited. Qualitative studies have explored pharmacists' perspectives and experiences regarding social prescribing, but their findings have not been systematically synthesised. This protocol outlines a systematic review of qualitative studies to identify and synthesise the barriers and enablers influencing pharmacist involvement in social prescribing.

METHODS AND ANALYSIS

We will conduct a comprehensive search of electronic databases (PubMed, Web of Science, Embase, CINAHL, MEDLINE, The Cochrane Library, PsycINFO, Scopus) and grey literature sources for qualitative studies published in English from each database inception to January 2025 that explore barriers and facilitators to pharmacist involvement in social prescribing. Two reviewers will independently screen titles, abstracts and full texts for eligibility based on predefined criteria. Eligible studies will include those that use qualitative methods (eg, interviews, focus groups, observations) to explore the perspectives of pharmacists on factors influencing their involvement in social prescribing initiatives. Data will be extracted using a standardised form and synthesised using thematic analysis. The methodological quality of included studies will be appraised using the Critical Appraisal Skills Programme Qualitative Checklist. Confidence in the review findings will be assessed using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research approach.

ETHICS AND DISSEMINATION

Ethics approval is not required as this study will merely synthesise data from published studies. The results will be disseminated through peer-reviewed publications as well as conference presentations.

PROSPERO REGISTRATION NUMBER

CRD42024600968.

Identifying Research Priorities in Digital Education for Health Care: Umbrella Review and Modified Delphi Method Study

BACKGROUND

In recent years, the use of digital technology in the education of health care professionals has surged, partly driven by the COVID-19 pandemic. However, there is still a need for focused research to establish evidence of its effectiveness.

OBJECTIVE

This study aimed to define the gaps in the evidence for the efficacy of digital education and to identify priority areas where future research has the potential to contribute to our understanding and use of digital education.

METHODS

We used a 2-stage approach to identify research priorities. First, an umbrella review of the recent literature (published between 2020 and 2023) was performed to identify and build on existing work. Second, expert consensus on the priority research questions was obtained using a modified Delphi method.

RESULTS

A total of 8857 potentially relevant papers were identified. Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology, we included 217 papers for full review. All papers were either systematic reviews or meta-analyses. A total of 151 research recommendations were extracted from the 217 papers. These were analyzed, recategorized, and consolidated to create a final list of 63 questions. From these, a modified Delphi process with 42 experts was used to produce the top-five rated research priorities: (1) How do we measure the learning transfer from digital education into the clinical setting? (2) How can we optimize the use of artificial intelligence, machine learning, and deep learning to facilitate education and training? (3) What are the methodological requirements for high-quality rigorous studies assessing the outcomes of digital health education? (4) How does the design of digital education interventions (eg, format and modality) in health professionals' education and training curriculum affect learning outcomes? and (5) How should learning outcomes in the field of health professions' digital education be defined and standardized?

CONCLUSIONS

This review provides a prioritized list of research gaps in digital education in health care, which will be of use to researchers, educators, education providers, and funding agencies. Additional proposals are discussed regarding the next steps needed to advance this agenda, aiming to promote meaningful and practical research on the use of digital technologies and drive excellence in health care education.

Exploring the efficacy and potential of large language models for depression: A systematic review

BACKGROUND AND OBJECTIVE

Depression is a substantial public health issue, with global ramifications. While initial literature reviews explored the intersection between artificial intelligence (AI) and mental health, they have not yet critically assessed the specific contributions of Large Language Models (LLMs) in this domain. The objective of this systematic review was to examine the usefulness of LLMs in diagnosing and managing depression, as well as to investigate their incorporation into clinical practice.

METHODS

This review was based on a thorough search of the PubMed, Embase, Web of Science, and Scopus databases for the period January 2018 through March 2024. The search used PROSPERO and adhered to PRISMA guidelines. Original research articles, preprints, and conference papers were included, while non-English and non-research publications were excluded. Data extraction was standardized, and the risk of bias was evaluated using the ROBINS-I, QUADAS-2, and PROBAST tools.

RESULTS

Our review included 34 studies that focused on the application of LLMs in detecting and classifying depression through clinical data and social media texts. LLMs such as RoBERTa and BERT demonstrated high effectiveness, particularly in early detection and symptom classification. Nevertheless, the integration of LLMs into clinical practice is in its nascent stage, with ongoing concerns about data privacy and ethical implications.

CONCLUSION

LLMs exhibit significant potential for transforming strategies for diagnosing and treating depression. Nonetheless, full integration of LLMs into clinical practice requires rigorous testing, ethical considerations, and enhanced privacy measures to ensure their safe and effective use.

Efficacy and safety of antifibrotic drugs for interstitial lung diseases other than IPF: A systematic review, meta-analysis and trial sequential analysis

BACKGROUND

The therapeutic role of antifibrotic therapy has been well-established in idiopathic pulmonary fibrosis (IPF). However, its efficacy and safety for interstitial lung diseases (ILDs) other than IPF are not fully understood.

METHODS

We updated a systematic review with meta-analysis and trial sequential analysis (TSA) of randomized controlled trials and prospective studies on antifibrotic drug (nintedanib or pirfenidone) vs other intervention (placebo, no intervention or conventional treatment) in non-IPF ILDs. The primary outcomes were absolute change in forced vital capacity (FVC), all-cause mortality and serious adverse events (SAEs). The risk of bias was rated with the RoB2 tool and certainty of evidence was assessed by the GRADE approach.

RESULTS

17 studies with 1908 patients were included. For the primary outcomes, pooled analyses of four trials with low risk of bias showed that antifibrotic drugs significantly ameliorated FVC decline (mean difference 86.21; 95% CI 49.38 to 123.03; I2 = 64%; TSA-adjusted CI 40.86 to 131.56). Based on five trials with low risk of bias, no difference was observed in all-cause mortality (RR 0.87; 95% CI 0.53 to 1.43; I2 = 0%; TSA-adjusted CI 0.12 to 6.53) and SAEs (RR 0.97; 95% CI 0.83 to 1.13; I2 = 0%; TSA-adjusted CI 0.74 to 1.28) between groups. However, based on two studies with 324 patients, benefit of antifibrotic drugs in FVC was not shown in the subgroup taking mycophenolate (mean difference 17.08; 95% CI -56.22 to 90.37), which also had higher risk of SAEs (RR 1.71; 95% CI 1.09 to 2.70), although both were contested by TSA.

CONCLUSION

Our study suggests that antifibrotic drugs are beneficial for patients with non-IPF ILDs in slowing disease progression, whereas may not correlate to all-cause mortality and SAEs. However, for patients taking mycophenolate, antifibrotic drugs may do more harm than good. More investigations are warranted to validate current findings.

Diagnosis of subarachnoid haemorrhage: Systematic evaluation of CT head diagnostic accuracy and comparison with the 2022 NICE guidelines

Introduction

Aneurysmal subarachnoid haemorrhage has a high incidence, and morbidity. It has been suggested that a negative non-contrast CT head can rule out SAH if performed within 6 h of symptom onset.

Research question

What is the sensitivity of CT head at ruling out SAH stratified by time-point, and what is the potential impact of omitting Lumbar Puncture (LP) from the diagnostic pathway?

Material and methods

Systematic review and meta-analysis (PROSPEROID CRD42022379929). Three databases were searched, and articles published between January 2000-May 2022 included (Search date 27th November 2022). Primary objective was diagnostic accuracy of CT scans for detecting SAH at <6 h from symptom onset, including reported sensitivity, and specificity values.

Results

63 articles were included (38,237 patients, 7673 with SAH). Pooled CT head sensitivity was 0.94 for excluding SAH (22 studies, 95% Confidence Interval [CI] 0.90-0.97). At <6 h, CT head sensitivity was 0.995 (6 studies, 95% CI 0.941-1.000). Most studies (57.1%, n = 36/63) were classified as high risk of bias. If LP was removed from the diagnostic pathway in the UK, assuming an incidence of 4800 SAH per-year, 336 SAH would be missed per-year, 24 per-year if LP was removed for negative CT < 6 h (95% CI 0-278) and 58 per-year if mean sensitivity is used (95% CI 0-240).

Discussion and conclusion

CT head appears to be highly sensitive at excluding SAH <6 h from symptom onset. High quality, prospective data is required to further established the utility of early (<6 h) negative CT head. We recommend that if there is strong clinical suspicion of SAH, yet CT head is reported negative <6 h of symptom onset, that a LP be performed.

Reliability and validity of instruments containing reported sleep measures among children from birth to <5 years of age: A systematic review

Valid and reliable sleep measures during the early years are crucial for practitioners and researchers seeking accurate evaluation methods. The authors in this review systematically examined the psychometric properties of instruments containing reported sleep measures in children from birth to <5 years of age. The search was conducted using several electronic databases, including MEDLINE, EMBASE, PsycINFO, Web of Science, CINAHL, SPORTDiscus, Scopus and HaPI, with the most recent update on August 30, 2022. The quality of the included studies was assessed using the COSMIN methodology. A total of 79 studies were analyzed. However, none of these measures had undergone a comprehensive evaluation of all psychometric properties. Unfortunately, suitable reported sleep measures for children aged 0-4.99 years could not be identified through this review. Further research is needed to develop and validate psychometrically robust sleep assessment tools for this specific age group.

Global emergency medicine research priorities: a mapping review

Recognizing and prioritizing research areas in emergency care is crucial for generating evidence and advancing research programs, aiming to enhance health outcomes for both individuals and populations. The objective of this review is to document global clinical and nonclinical research priorities. The Emergency Medicine Education and Research by Global Experts network, consisting of 22 sites across six continents, conducted a mapping review of publications on emergency medicine research priorities (2000-2022) across seven databases. We included studies with replicable methodologies for determining research priorities, excluding those limited to individual diseases. Three reviewers independently screened, selected, and categorized results into clinical and nonclinical topics. Discrepancies were resolved by an independent investigator and consensus. Outcomes measures and analysis include descriptive analysis of research priorities grouped into clinical and nonclinical topics, characteristics of publications including countries represented in the author list, target audience (such as researchers or policy makers), participants (e.g. patients), and methods (e.g. Delphi) of priority setting. Among 968 screened papers, 57 publications from all WHO regions were included. Most (36, 63%) had authors from only a single country, primarily in North America and Europe. Patient representatives were included in only 10 (18%). Clinical research priorities clustered into resuscitation, cardiology, central nervous system, emergency medical services, infectious disease, mental health, respiratory disease, and trauma. Distribution was broad in North America and Europe but focused on infectious diseases and resuscitation in Africa and Asia. Eleven nonclinical topics included access to care, health policy, screening/triage, social determinants of health, staffing, technology/simulation, shared decision making, cross-sectoral collaboration, education, patient-centered care, and research networks. Nonclinical topics were broad in Europe and America, focused on access to care and health screening in Africa, and mostly absent in other WHO regions. Published research priorities in emergency medicine are heterogeneous and geographically limited, mostly containing groups of authors from the same country. The majority of publications in global research priority setting stem from Western countries, covering a broad spectrum of clinical and nonclinical topics. Research priorities from Africa and Asia tend to focus on specific issues more prevalent in those regions of the world.

Occurrence of Dumping Syndrome After Esophageal Cancer Surgery: Systematic Review and Meta-analysis

BACKGROUND

Dumping syndrome occurs frequently after esophageal cancer surgery, but the reported prevalence varied across previous studies. This systematic review and meta-analysis aimed to clarify the prevalence of dumping syndrome after esophageal cancer surgery, particularly exploring the sources of heterogeneity in previous studies.

METHODS

A comprehensive literature search was conducted in PubMed, MEDLINE, Web of Science, Embase, and the Cochrane Library databases, supplemented by hand-search of reference lists, through March 2023. Random-effects meta-analysis estimated the average prevalence of dumping syndrome after esophageal cancer surgery. Heterogeneity across studies was examined by the I2 statistic and Cochran's Q test.

RESULTS

Among the 2949 articles retrieved from the databases, 16 articles (15 cohort studies and 1 randomized controlled trial) met the inclusion criteria. The prevalence of dumping syndrome ranged 0-74% in these studies, showing high heterogeneity (I2 = 99%, P < 0.01), with the pooled prevalence of 27% (95% confidence interval [CI] 14-39%). The pooled prevalence in the three studies using specialized questionnaires was 67% (95% CI 60-73%), with reduced heterogeneity (I2 = 43%, P = 0.17). The prevalence also varied by year of publication, study population, and length and completeness of follow-up.

CONCLUSIONS

Our findings revealed that dumping syndrome is common after esophageal cancer surgery. The varying prevalence across previous studies was probably owing to differences in measurement of dumping syndrome. Using specific patient reported outcome questionnaires is recommended for future investigations on dumping syndrome after esophageal cancer surgery.

Ablative techniques in colorectal liver metastases: A systematic review, descriptive summary of practice, and recommendations for optimal data reporting

BACKGROUND

Radiofrequency Ablation (RFA) and Microwave Ablation (MWA) are alternative treatments for colorectal liver metastasis (CRLM) patients that are unsuitable for resection. However, consensus is lacking regarding selection criteria, tumour characteristics, ablation technique delivery, and device settings. This study aims to summarise current evidence to inform future prospective studies.

METHODS

A systematic review was conducted following PRISMA guidelines. Studies assessing RFA and MWA treatment of CRLM were identified in Medline, Embase, Web of Science and the Cochrane database of systematic reviews, from inception until 31st August 2024.

RESULTS

Fifty-two studies were included (retrospective cohort n = 45, prospective cohort n = 5, non-randomized comparative studies n = 2). Fifty-four inclusion criteria were used across 45 studies and were not stated in 7 studies. Tumours varied in mean number [1-8] and diameter (1.54-4.35 cm). Neoadjuvant chemotherapy use (10-100 % of patients), ablation delivery approach (open n = 4, laparoscopic n = 11, percutaneous n = 26, mixed n = 5), anaesthetic mode (GA n = 18, LA n = 11, mixed n = 2) and delivering clinician (radiologist n = 11, surgeon n = 16, both n = 1) all varied. Thirty-two studies lacked complete ablation device settings. Six studies followed a standardized ablation algorithm and 14 studies had specific settings. Five-year survival ranged from 0 to 69.7 % for ablation.

CONCLUSIONS

There is significant heterogeneity in the reporting of study design, patient selection, and ablation techniques for CRLM. The lack of standardized approaches and inconsistent reporting of methodology and outcomes make it challenging to determine the optimal ablative treatment for CRLM. We recommend that future research should focus on clearly defining selection and treatment criteria, as well as treatment delivery.

The Level of Adherence to Organic Food Consumption and Risk of Cancer: A Systematic Review and Meta-Analysis

The available literature reports inconclusive findings regarding the frequency of organic food consumption and cancer incidence. This systematic review evaluated the effect of the frequency of organic food consumption on overall and site-specific cancer risk. Four electronic databases (PubMed, Scopus, Web of Science Core Collection, and Embase), the gray literature, and the reference lists of the included reports were searched for eligible studies. Study screening, data abstraction, and risk of bias assessment were performed by two independent examiners. Hazard ratios (HRs) and 95% confidence intervals using a random effects model were utilized to synthesize the available data from the included studies. There was no difference between the two interventions regarding overall cancer (HR = 0.93, 95% CI: 0.78-1.12), breast cancer (HR = 1.01, 95% CI: 0.81-1.26), colorectal cancer (HR = 1.01, 95% CI: 0.93-1.10), and non-Hodgkin lymphoma risks (HR = 0.70, 95% CI: 0.17-2.94). The findings suggest that the overall and site-specific cancer risk are not associated with the frequency of consumption of organic foods. Further research is necessary to provide more evidence for the role of organic food consumption on the incidence of cancer using homogeneous methodologies to define the frequency of organic food consumption.

Optimal Timing and Treatment Modalities of Arytenoid Dislocation and Subluxation: A Meta-Analysis

Background and Objective: Arytenoid dislocation (AD) and subluxation (AS) impact vocal fold mobility, potentially affecting the quality of life. Their management, including the timing and modality of treatment, remains a subject of research. Our primary objective was to assess and compare the available treatment strategies for AS and AD. Material and methods: the protocol was registered on PROSPERO (CRD42023407521). Manuscripts retrieved from a previously published systematic review were evaluated. To comprehensively cover the last 25 years, an updated literature search was conducted, screening PubMed, Scopus, and Cochrane databases. Review Methods: We included studies that reported treatment modalities and the time to treatment (TT) for AS/AD, with outcomes objectively evaluated. Data on treatment success were pooled, and the impact of TT on recovery outcomes was analyzed. Results: Thirteen studies involving 361 patients were included. The majority of cases were attributed to iatrogenic trauma following intubation. Closed reduction (CR) was the primary treatment, with high success rates for both general (success rate: 77%, CI: 62-87%) and local anesthesia (success rate: 89%, CI: 70-97%). The standardized mean difference for the TT effect on treatment outcome was -1.24 (CI: -2.20 to -0.29). Conclusions: The absence of randomized controlled trials and the overall moderate-to-low quality of the studies highlighted the importance of the finding's careful interpretation. This meta-analysis underscores the effectiveness of CR in managing AS/AD, with both general and local anesthesia yielding high success rates. The findings highlight the importance of TT, suggesting that early intervention is paramount. Future clinical research is needed to further refine these findings and optimize treatment protocols.

Yet another problem with systematic reviews: a living review update

BACKGROUND

In February 2023, the Journal of Clinical Epidemiology published 'The Problems with Systematic Reviews: A Living Systematic Review.' In updating this living review for the first time a new problem and several themes relating to research culture have emerged.

METHODS

Literature searches were rerun to identify articles published or indexed between May 2022 and May 2023. Thematic analysis coded articles and problems across four domains of systematic review conduct (1. comprehensive, 2. rigour, 3. transparent, 4. objective).

RESULTS

One hundred fifty-two newly included articles bring the total number of relevant articles to 637. A new problem (the lack of gender diversity of systematic review author teams) brings the total number of problems with systematic reviews up to 68. This update also reveals emerging themes such as: fast science from systematic reviews on COVID-19; the failure of citation of methodological or reporting guidelines to predict high-quality methodological or reporting quality; and the influence of vested interests on systematic review conclusions. These findings coupled with a proliferation of research waste from "me-too" meta-research articles highlighting well-established problems in systematic reviews underscores the need for reforms in research culture to address the incentives for producing and publishing research papers. This update also reports where the identified flaws in systematic reviews affect their conclusions drawing on 77 meta-epidemiological studies from the total 637 included articles. These meta-meta-analytic studies begin the important work of examining which problems threaten the reliability and validity of treatment effects or conclusions derived from systematic reviews.

CONCLUSION

This living review has captured an emerging theme in the published literature relating to the composition of the review author team and highlights a potential effect on the equity reporting of the systematic reviews. We recommend that meta-research endeavors evolve from merely documenting well-established issues to understanding lesser-known problems or consequences to systematic reviews.

Is self-medication with antibiotics among the public a global concern: a mixed-methods systematic review

BACKGROUND

Irrational use of antibiotics is a major driver of antimicrobial resistance. Self-medication with antibiotics (SMA) may exacerbate antimicrobial resistance in the community without professional diagnosis by physicians, due to the complexity of the pharmacological mechanisms. There is still a lack of assessment of the global prevalence of SMA. We have evaluated the global prevalence of SMA and its associated factors, which could provide more reliable data to support global action.

METHODS

We searched PubMed, Embase, Web of Science, and EBSCO CINAHL Plus. Quantitative studies were combined using meta-analysis with random-effects models, and qualitative synthesis was performed using interpretive meta-ethnographic methods.

RESULTS

A total of 242 studies were included in this study. The pooled prevalence of SMA was 27.7% (95%CI: 24.9%-30.5%). Quantitative studies indicate that high income level, having family members working in the healthcare system, storing antibiotics at home, and purchasing antibiotics without prescriptions were associated with a greater likelihood of SMA. Qualitative findings revealed the following four factors: individual characteristics, healthcare, pharmacy, and social networks.

CONCLUSIONS

The prevalence of global SMA among the public remains high level. Multisectoral and community-based interventions are needed to reduce SMA, including targeted health education, improved access to healthcare, and regulation of antibiotics sales in pharmacies.

REGISTRATION

PROSPERO (CRD42023402206).

Psychological behavioral therapies to improve autistic children's behaviors during dental visits: A systematic review and meta-analysis

LAY ABSTRACT

This research review looked at how well different psychological behavioral therapies help improve the behavior of autistic children during dental visits. The researchers studied 18 different studies and found that, on average, about 56% of autistic children were able to cooperate with a dental exam using an oral mirror during their first visit. The number increased to about 64% during their second visit. However, using visual pedagogies or teaching aids did not seem to make a big difference in how many children could accept the dental exams. The results for other psychological behavioral techniques were also inconsistent, including Treatment and Education of Autistic and related Communication-handicapped CHildren, Picture Exchange Communication System, Applied Behavior Analysis, video modeling, and distractions. Many of the studies were small and did not include a comparison group. They also did not consider factors like how severe the autism was, other conditions the children had, or their previous dental experiences. Because of these limitations, the evidence supporting the use of psychological behavioral techniques to improve dental visits for autistic children is limited and uncertain. More research with larger studies and proper control groups is needed to better understand this topic.

Risk factors of under-five and infant mortality: An umbrella review of systematic reviews and meta-analyses

Background

Ensuring child survival is a critical global challenge, requiring a robust and comprehensive understanding of the risk factors contributing to under-five mortality (U5M). We aimed to synthesise and summarise the current available evidence on risk factors of U5M and infant mortality worldwide to inform global child health programmes.

Methods

We searched six major databases (Embase, Medline, Scopus, CINAHL, Web of Science, and Global Health) and repositories of systematic reviews, as well as grey literature sources to identify systematic reviews and meta-analyses that examined the associations between risk factors of U5M and infant mortality between 1 January 1990 and 4 March 2024. The quality of reviews was assessed using A Measurement Tool to Assess Systematic Reviews, Version 2 (AMSTAR 2). The strength of evidence and direction of associations was graded.

Results

Of 5684 records, we included 32 reviews (including five systematic reviews without meta-analysis) which comprised 1042 primary studies. We synthesised 28 and 29 unique risk factors associated with U5M and infant mortality, respectively. Although there was no convincing evidence for the risk factors, we found probable evidence of association between exclusive breastfeeding (consistent negative association), and maternal death (consistent positive association) with U5M. There was also probable evidence for the association of short (<18 months) interpregnancy intervals (less consistent negative association), pre-pregnancy maternal obesity (consistent positive association), and maternal HIV infection (consistent positive association) with infant mortality.

Conclusions

While the review identified a broad range of risk factors, the overall evidence for most factors associated with under-five and infant mortality was 'limited-suggestive' or 'limited and no conclusive'. Thus, further high-quality studies are required to strengthen the evidence on these risk factors.

Registration

PROSPERO CRD42023455542.

Effectiveness and equity of mHealth apps for preeclampsia management in LMICs: A rapid review protocol

INTRODUCTION

Preeclampsia remains a formidable public health challenge, particularly in low- and middle-income countries (LMICs), where it significantly contributes to the high rates of maternal and neonatal morbidity and mortality. The advent of mobile health (mHealth) applications presents a promising avenue for enhancing the management of preeclampsia. This review protocol is designed to systematically assess the effectiveness and equity of mHealth apps in managing preeclampsia within LMICs, with a focus on clinical outcomes and the broader implications for accessibility, affordability, and cultural relevance.

MATERIALS AND METHODS

To achieve the objectives of this review, a rapid review methodology will be employed, encompassing a structured search strategy to identify pertinent studies from databases such as PubMed, Cochrane Library, and Google Scholar, as well as grey literature. The inclusion criteria are set to encompass randomized controlled trials (RCTs), controlled clinical trials (CCTs), observational studies, and qualitative studies that offer insights into the effectiveness and user experience of mHealth apps for preeclampsia management. Participants in these studies will include pregnant women at risk for or diagnosed with preeclampsia, healthcare providers, and app developers. The quality of the included studies will be critically appraised using standardized tools, and data extraction will focus on study characteristics, interventions, outcomes, and equity considerations.

DISCUSSION

The implications of this review are far-reaching, offering the potential to inform stakeholders including policymakers, healthcare providers, and app developers about the deployment and development of mHealth solutions for preeclampsia management in LMICs. Ultimately, the anticipated findings of this review are expected to contribute significantly to the understanding of mHealth apps' role in improving preeclampsia management and addressing healthcare disparities, thereby guiding future strategies to enhance maternal and neonatal health outcomes in LMICs.

Severe mental illness and infectious disease mortality: a systematic review and meta-analysis

Background

Evidence from meta-analyses suggest that people with severe mental illness (SMI) are at increased risk of death from infectious diseases compared to those without SMI. However, few reviews have focused on mortality risk from specific infection types, apart from COVID-19. The aim of this systematic review and meta-analysis was to comprehensively describe and quantify the risk of death from infections (excluding COVID-19) in people with SMI, exploring specific infection types where possible.

Methods

PubMed, Web of Science, PsycINFO, and EMBASE were searched for relevant studies up to 18th June 2024. Studies were included if they assessed the impact of SMI (bipolar disorder, schizophrenia and schizoaffective disorders, other psychoses) on risk of mortality from any infectious disease excluding COVID-19. Random-effects meta-analyses of the risk of death from 'infectious diseases', respiratory infections, sepsis, and 'other' infections in SMI were performed. The review protocol was registered in PROSPERO (CRD42023422151).

Findings

Twenty-nine articles were included in the review. All were observational cohort studies carried out in high income countries and 59% were judged to be of good quality. Narrative analysis indicated that having SMI was associated with increased risk of death from infectious disease (23/29 studies), with mixed results for sepsis. People with SMI were more than twice as likely to die from 'infectious diseases' than the general population (pooled relative risk (RR) = 2.71, 95% confidence interval (CI) = 2.33-3.16, N = 739,852) and more than three times more likely to die from respiratory infections (pooled RR = 3.27, 95% CI = 2.57-4.17, N = 1,353,905). Sources of heterogeneity across studies included SMI diagnosis, gender, type of control group, and infection type.

Interpretation

People with SMI are at an increased risk of death from infection, particularly from respiratory infections like influenza and pneumonia and should be prioritised for preventative strategies including influenza and pneumococcal vaccines. More work is needed to fully understand why infection mortality risk is increased in SMI.

Funding

MQ Mental Health Research Fellowship MQF22∖12.

Effect of serious games over conventional therapy in the rehabilitation of people with multiple sclerosis - a systematic review and meta-analysis

PURPOSE

This meta-analysis aimed to quantify the effect of serious games over conventional therapy on upper-limb activity, balance, gait, fatigue, and cognitive functions in people with multiple sclerosis.

MATERIALS AND METHODS

Search strategies were developed for PubMed, Embase, Cochrane Library, and Scopus. Studies were selected if participants were adults with multiple sclerosis; the intervention consisted of a virtual reality serious game-based program; the control group received conventional therapy; outcomes included upper limb activity, balance, gait, fatigue, or cognitive functions; and used a randomized controlled trial design. Data were synthesized using a standardized mean difference with a random-effects model.

RESULTS

From 2532 studies, seventeen trials were selected (n = 740). Overall, serious games programs effect on upper limb activity, gait, verbal memory, verbal fluency and attention seemed neutral. Balance functions appeared to be improved by semi-immersive virtual reality serious games (SMD = 0.48;95%CI = 0.12-0.84;p = 0.01;I2=0%), fatigue by treadmill serious games (SMD = 0.80;95%CI = 0.40-1.20;p < 0.001) and visuo-spatial memory by semi-immersive virtual reality general cognitive serious games (SMD = 0.35;95%CI = 0.04-0.65;p = 0.03;I2=0%).

CONCLUSION

This review suggests, with a very-low-to-low certainty of evidence, that while some specific serious games may improve balance, fatigue and visuo-spatial memory, their overall effect on upper limb activity, gait, and other cognitive functions appears neutral.

Software using artificial intelligence for nodule and cancer detection in CT lung cancer screening: systematic review of test accuracy studies

OBJECTIVES

To examine the accuracy and impact of artificial intelligence (AI) software assistance in lung cancer screening using CT.

METHODS

A systematic review of CE-marked, AI-based software for automated detection and analysis of nodules in CT lung cancer screening was conducted. Multiple databases including Medline, Embase and Cochrane CENTRAL were searched from 2012 to March 2023. Primary research reporting test accuracy or impact on reading time or clinical management was included. QUADAS-2 and QUADAS-C were used to assess risk of bias. We undertook narrative synthesis.

RESULTS

Eleven studies evaluating six different AI-based software and reporting on 19 770 patients were eligible. All were at high risk of bias with multiple applicability concerns. Compared with unaided reading, AI-assisted reading was faster and generally improved sensitivity (+5% to +20% for detecting/categorising actionable nodules; +3% to +15% for detecting/categorising malignant nodules), with lower specificity (-7% to -3% for correctly detecting/categorising people without actionable nodules; -8% to -6% for correctly detecting/categorising people without malignant nodules). AI assistance tended to increase the proportion of nodules allocated to higher risk categories. Assuming 0.5% cancer prevalence, these results would translate into additional 150-750 cancers detected per million people attending screening but lead to an additional 59 700 to 79 600 people attending screening without cancer receiving unnecessary CT surveillance.

CONCLUSIONS

AI assistance in lung cancer screening may improve sensitivity but increases the number of false-positive results and unnecessary surveillance. Future research needs to increase the specificity of AI-assisted reading and minimise risk of bias and applicability concerns through improved study design.

PROSPERO REGISTRATION NUMBER

CRD42021298449.

Cognitive prehabilitation for older adults undergoing elective surgery: a systematic review and narrative synthesis

Background

Perioperative cognitive maintenance and protection in older adults is an important patient safety imperative. In addition to foundational care, one area of growing interest is integrating cognitive prehabilitation into the surgical trajectory. This review aimed to evaluate the effectiveness and safety of cognitive prehabilitation on cognitive functional capacity and postoperative cognitive outcomes among older adults undergoing elective surgery.

Methods

The MEDLINE, Embase, CENTRAL, CINAHL, PsycINFO, PEDro, CBM, CNKI, WANFANG, and VIP databases were systematically searched up to September 5, 2024, to identify randomized controlled trials published for English or Chinese. Two authors independently completed the study selection process, data extraction process and methodological quality assessment. The Patient, Intervention, Comparison, Outcome, Study design framework was used to construct the search strategy. The predefined primary outcomes of interest included the incidence of postoperative delirium (POD) and the incidence of delayed neurocognitive recovery (dNCR). The quality of the studies was evaluated by the PEDro scale. Owing to the small number of trials and clinical and methodological diversity, a narrative synthesis was undertaken in accordance with the Synthesis Without Meta-analysis guidelines. This study was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system.

Results

Six studies were analysed. These trials involved 645 total participants, with 316 in the intervention group (mean age, 66.0-73.8 years; 38.4-77.8% male) and 329 in the comparator group (mean age, 67.5-72.6 years; 31.8-88.9% male). The effects of preoperative cognitive training on reducing the incidence of dNCR, the incidence of POD, the length of hospital stay and the incidence of postsurgical complications as well as improving postoperative global cognitive function and activities of daily living are quite uncertain. The results of this study should be interpreted with caution owing to the limited number of trials and low to very low certainty of evidence.

Conclusion

Current evidence on the effectiveness and safety of cognitive prehabilitation on cognitive and noncognitive outcomes in older patients undergoing elective surgery is limited and unclear.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=277191, Identifier CRD42021277191.

High blood eosinophils predict the risk of COPD exacerbation: A systematic review and meta-analysis

BACKGROUND

The association between blood eosinophils and COPD exacerbation has been controversial. This study aims to investigate whether high blood eosinophils predict the risk of COPD exacerbation across different thresholds and subgroups.

METHODS

PubMed, Embase and Web of science were searched for randomized controlled trial (RCT) and observational studies regarding the relationship between blood eosinophils and COPD exacerbation. Pooled risk ratio (RR) for COPD exacerbation was calculated using the Mantel-Haenszel method with a random-effects model.

RESULTS

A total of 21 studies (1 RCT and 20 observational studies) with 79868 participants were included. Thresholds of high blood eosinophils including absolute counts (200, 300 and 400 cell/μL) and percentages (2%, 3% and 4%) were analyzed respectively. Pooled analyses suggested that high blood eosinophils were significantly associated with increased risk of COPD exacerbation when using the thresholds of 300 cells/μL (RR 1.21, 95%CI 1.12-1.30, P <0.001, 16 studies), 400 cells/μL (RR 1.79, 95%CI 1.41-2.28, P <0.001, 3 studies), 2% (RR 1.26, 95%CI 1.02-1.55, P = 0.030, 10 studies) and 4% (RR 1.44, 95%CI 1.05-1.96, P = 0.022, 4 studies), but not 200 cells/μL and 3% (P>0.05). Moreover, high blood eosinophils contributed to moderate-severe exacerbation of COPD by the cutoffs of 300 cells/μL (RR 1.30, 95%CI 1.16-1.45, P<0.001, 11 studies) and 2% (RR 1.33, 95%CI 1.02-1.76, P = 0.037, 8 studies). In subgroup analyses, the pooled results further showed a significant association between high blood eosinophils (especially over 300 cells/μL) and risk of COPD exacerbation among patients from Europe and Asia, and whether with stable or exacerbation phase at baseline, and regardless of the follow-up time (≤ or > 1year).

CONCLUSIONS

This study demonstrates that high blood eosinophils (over 300 cells/μL or 2%) could predict the risk of moderate-severe exacerbation of COPD in specific subgroups. However, large sample-sized, prospective, and well-designed studies are required to validate the present findings.

Prognostic Factors for Early Recurrence After Resection of Pancreatic Cancer: A Systematic Review and Meta-Analysis

BACKGROUND & AIMS

More than half of pancreatic ductal adenocarcinomas (PDACs) recur within 12 months after curative-intent resection. This systematic review and meta-analysis was conducted to identify all reported prognostic factors for early recurrence in resected PDACs.

METHODS

After a systematic literature search, a meta-analysis was conducted using a random effects model. Separate analyses were performed for adjusted vs unadjusted effect estimates as well as reported odds ratios (ORs) and hazard ratios (HRs). Risk of bias was assessed using the Quality in Prognostic Studies tool, and evidence was rated according to Grading of Recommendations Assessment, Development and Evaluation recommendations.

RESULTS

After 2903 abstracts were screened, 65 studies were included. Of these, 28 studies (43.1%) defined early recurrence as evidence of recurrence within 6 months, whereas 34 (52.3%) defined it as evidence of recurrence within 12 months after surgery. Other definitions were uncommon. Analysis of unadjusted ORs and HRs revealed 41 and 5 prognostic factors for early recurrence within 6 months, respectively. When exclusively considering adjusted data, we identified 25 and 10 prognostic factors based on OR and HR, respectively. Using a 12-month definition, we identified 38 (OR) and 15 (HR) prognostic factors from unadjusted data and 38 (OR) and 30 (HR) prognostic factors from adjusted data, respectively. On the basis of frequency counts of adjusted data, preoperative carbohydrate antigen 19-9, N status, nondelivery of adjuvant therapy, grading, and tumor size based on imaging were identified as key prognostic factors for early recurrence.

CONCLUSIONS

Reported prognostic factors of early recurrence vary considerably. Identified key prognostic factors could aid in the development of a risk stratification framework for early recurrence. However, prospective validation is necessary.

Strategies to Prevent Violence Against Children in the Home: A Systematic Review of Reviews

Violence against children (VAC) in the home, or by household members, is a human rights and social problem with long-lasting consequences for individuals and society. Global policy instruments like the INSPIRE package have proposed strategies to prevent VAC, including Implementation and enforcement of laws, Norms and values, Safe environments, Parent and caregiver support, Income and economic strengthening, Response and support services, and Education and life skills. This systematic review of reviews aimed to synthesize the recent evidence base (i.e., published since 2000) for each INSPIRE strategy to reduce VAC in the home or by household members. We searched four databases using controlled vocabularies and keywords and searched for additional records in prior reviews of reviews. A total of 67 studies were included in this review, including literature reviews, meta-analyses, systematic reviews, and other types of reviews. We found extensive evidence supporting the effectiveness of parent and caregiver support interventions. However, reviews on other INSPIRE strategies were scarce. We also found a vast underrepresentation of samples from low- and- middle-income countries, children with disabilities, and families affected by forced displacement and conflict. In sum, this systematic review suggests that there are several promising strategies to prevent VAC (e.g., home visiting and parent education), but further research is necessary to strengthen the current body of evidence and effectively inform the implementation and scale-up of evidence-based interventions to protect children from violence globally.

Improving transitional care after acute myocardial infarction: A scoping review

Cardiovascular disease remains the leading cause of morbidity and mortality, posing a significant challenge to healthcare systems worldwide. Transitional care interventions, which ensure coordination and continuity of care as patients move between different levels of healthcare, have been shown to reduce unnecessary healthcare utilization and improve patient outcomes. While much attention has been given to transitional care in heart failure, this review aims to map the interventions implemented for patients following an acute myocardial infarction (AMI). A scoping review was conducted following the Joanna Briggs Institute (JBI) methodology, with literature searches performed in the Cochrane, CINAHL, MEDLINE, JBI, and SciELO databases, focusing on publications from 2013 onwards in both Portuguese and English. Seventy-five studies were included, with most combining multiple interventions that contributed to improved cardiovascular health outcomes, including increased adherence to healthy lifestyle behaviors, enhanced medication compliance, and better healthcare self-management. These interventions were effective in reducing cardiovascular-related Emergency Department visits, unplanned 30-day readmissions, and mortality following a first-time myocardial infarction. Key strategies identified included discharge planning, digital health solutions, outpatient care, and healthcare coordination. The findings of this review underscore the need for developing methodologies that enhance the transition of care from hospital to primary care following an AMI. There is an urgent need to design and implement new healthcare programs that integrate discharge interventions, digital health, outpatient care, and healthcare coordination to ensure continuity of care and optimize patient outcomes post-discharge.

eHealth early intervention programs to support premature parents transitioning from NICU to home on parental and infant outcomes: a systematic review protocol

OBJECTIVE

This review will assess the effectiveness of eHealth early intervention programs in supporting premature infants and their parents transition from neonatal intensive care units (NICUs) to home and the impact of such programs on parental and infant outcomes.

INTRODUCTION

The literature has shown the benefits of eHealth early intervention programs to support premature infants and their parents after discharge from NICUs. Parents have reported benefits such as enhanced user-friendliness, increased confidence in infant care, satisfaction, and knowledge acquisition. However, the effectiveness of these programs on parental and infant outcomes remains unclear.

INCLUSION CRITERIA

This review will consider studies that assess any early intervention program using eHealth to support premature infants and their parents after discharge from NICU. The programs may be initiated during hospitalization or within the first month of discharge. The programs will include interventions that use eHealth components (eg, teleconsultation), either alone or in combination with face-to-face interventions (eg, home visits). This review will consider parental outcomes, including stress, anxiety, competence, and satisfaction, as well as infant outcomes, including health service utilization and cognitive, motor, and social development.

METHODS

This review will follow the JBI methodology for systematic reviews of effectiveness. The search strategy will aim to find both published and unpublished quantitative studies in English, Spanish, and Portuguese, without any geographical or cultural limitations. Two reviewers will independently perform study selection, critical appraisal, and data extraction. The results will be accompanied by a narrative synthesis. If possible, a meta-analysis will be conducted and the Summary of Findings will be presented using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.

REVIEW REGISTRATION

PROSPERO CRD42023444721.

An exploration of available methods and tools to improve the efficiency of systematic review production: a scoping review

BACKGROUND

Systematic reviews (SRs) are time-consuming and labor-intensive to perform. With the growing number of scientific publications, the SR development process becomes even more laborious. This is problematic because timely SR evidence is essential for decision-making in evidence-based healthcare and policymaking. Numerous methods and tools that accelerate SR development have recently emerged. To date, no scoping review has been conducted to provide a comprehensive summary of methods and ready-to-use tools to improve efficiency in SR production.

OBJECTIVE

To present an overview of primary studies that evaluated the use of ready-to-use applications of tools or review methods to improve efficiency in the review process.

METHODS

We conducted a scoping review. An information specialist performed a systematic literature search in four databases, supplemented with citation-based and grey literature searching. We included studies reporting the performance of methods and ready-to-use tools for improving efficiency when producing or updating a SR in the health field. We performed dual, independent title and abstract screening, full-text selection, and data extraction. The results were analyzed descriptively and presented narratively.

RESULTS

We included 103 studies: 51 studies reported on methods, 54 studies on tools, and 2 studies reported on both methods and tools to make SR production more efficient. A total of 72 studies evaluated the validity (n = 69) or usability (n = 3) of one method (n = 33) or tool (n = 39), and 31 studies performed comparative analyses of different methods (n = 15) or tools (n = 16). 20 studies conducted prospective evaluations in real-time workflows. Most studies evaluated methods or tools that aimed at screening titles and abstracts (n = 42) and literature searching (n = 24), while for other steps of the SR process, only a few studies were found. Regarding the outcomes included, most studies reported on validity outcomes (n = 84), while outcomes such as impact on results (n = 23), time-saving (n = 24), usability (n = 13), and cost-saving (n = 3) were less often evaluated.

CONCLUSION

For title and abstract screening and literature searching, various evaluated methods and tools are available that aim at improving the efficiency of SR production. However, only few studies have addressed the influence of these methods and tools in real-world workflows. Few studies exist that evaluate methods or tools supporting the remaining tasks. Additionally, while validity outcomes are frequently reported, there is a lack of evaluation regarding other outcomes.

Inclusive Crisis Communication in a Pandemic Context: A Rapid Review

Background: Crisis communication might not reach non-native speakers or persons with low literacy levels, a low socio-economic status, and/or an auditory or visual impairments as easily as it would reach other citizens. The aim of this rapid review was to synthesize the evidence on strategies used to improve inclusive pandemic-related crisis communication in terms of form, channel, and outreach. Methods: After a comprehensive search and a rigorous screening and quality assessment exercise, twelve comparative studies were selected for inclusion in this review. Data were analyzed and represented by means of a structured reporting of available effects using narrative tables. Results: The findings indicate that a higher message frequency (on any channel) may lead to a lower recall rate, audio-visual productions and tailored messages prove to be valuable under certain conditions, and primary healthcare practitioners appear to be the most trusted source of information for most groups of citizens. Trust levels were higher for citizens who were notified in advance of potential exceptions to the rule in the effect of preventive and curative measures promoted. Conclusions: This review contributes to combatting information inequality by providing evidence on how to remove the sensorial, linguistic, cultural, and textual barriers experienced by minorities and other underserved target audiences in COVID-19-related governmental crisis communication in response to the societal, health-related costs of ineffective communication outreach.

How effective are allied health group interventions for the management of adults with long-term conditions? An umbrella review of systematic reviews and its applicability to the Australian primary health system

BACKGROUND

Group allied health interventions for people with chronic conditions may be a solution to increasing access to allied health in primary care. This umbrella review aimed to determine the effectiveness of allied health group interventions to improve health-related outcomes for adults with chronic conditions and the applicability of the findings to the Australian primary health care context.

METHODS

An umbrella review of systematic reviews conducted April-July 2022, searching eight databases. Systematic reviews were eligible if they included randomised controlled trials (RCT) or quasi-RCTs, community dwelling adults aged ≥ 18, at least one chronic condition, group intervention in scope for allied health professionals, and published in English after 2000. Studies were excluded if interventions were conducted in hospital or aged care facilities, out of scope for allied health, or unsupervised.

RESULTS

Two thousand three hundred eighty-five systematic reviews were identified: after screening and full text review 154 were included and data extracted from 90. The chronic conditions included: cancer (n = 15), cardiovascular disease (n = 6), mixed chronic conditions (n = 3), kidney disease (n = 1), low back pain (n = 12), respiratory disease (n = 8), diabetes (n = 14), heart failure (n = 9), risk of falls (n = 5), hypertension (n = 4, osteoarthritis (n = 6) and stroke (n = 8). Most group interventions included prescribed exercise and were in scope for physiotherapists and exercise physiologists. Overall, allied health group exercise programs for community dwelling adults improved health outcomes for most chronic conditions. Aggregated data from the systematic reviews suggests programs of 45-60 min per session, 2-3 times per week for 12 weeks. Lifestyle education and support for people with type-2 diabetes improved glycaemic control.

CONCLUSIONS

Prescribed group exercise delivered by allied health professionals, predominantly by exercise physiologists and physiotherapists, significantly improved health outcomes for community dwelling adults with a broad range of chronic conditions.