What is an evidence map? A systematic review of published evidence maps and their definitions, methods, and products

A mapping review of studies exploring the barriers and facilitators to a dementia diagnosis through an intersectionality lens

BACKGROUND

Promoting a 'timely' diagnosis is a global policy directive.

AIMS

This review adopts an intersectional approach, visually mapping the existing literature to highlight gaps in the evidence base on barriers and facilitators to dementia diagnosis.

METHOD

A systematic approach was undertaken, following the PRISMA guidelines, updating previous reviews. The literature search was conducted on PubMed, PsycINFO, CINAHL Complete and Scopus. In line with mapping review methodology, we report the current state of the literature by describing the number of studies that outline barriers and facilitators to seeking help for a dementia diagnosis, split by social categorisation.

RESULTS

On the 7 June 2024, a total of 45 studies were identified. Our mapping demonstrated the majority of studies were derived from high-income countries and did not specify whether they were exploring barriers and facilitators through a specific social lens. Ethnicity was one of the few social categories where a range of evidence was reported. Other categories, such as socioeconomic status, gender and sexual orientation, received limited research attention.

CONCLUSIONS

Our mapping review suggests the large body of work within this field tends to treat people with dementia and their carers as homogenous and androgenous groups. To better inform this key policy directive, studies are needed that explore the influence of social determinants on people's experiences of seeking a dementia diagnosis. Such work would create a richer, more nuanced evidence base that better elicits ways of addressing inequalities and inequities that arise at this key stage of people's dementia care journey.

Exploring Non-invasive Brain Stimulation Effects on Physical Outcomes in People With Parkinson's Disease: An Umbrella Evidence Mapping Review With Meta-analyses

Background. Non-invasive brain stimulation (NIBS) is sometimes used alongside medication to alleviate motor symptoms in people with Parkinson's disease (PD). However, the evidence supporting NIBS's effectiveness for improving motor function in PD patients is uncertain. Objective. This umbrella review aims to synthesize recent systematic reviews and meta-analyses that have evaluated the effectiveness of NIBS in improving motor function in people with PD, with a key focus being to examine the quality of the evidence presented. Methods. The review protocol was registered in PROSPERO (CRD42022380544) and conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search strategy was guided by the Population, Intervention, Comparison, and Outcome framework, focusing on individuals with idiopathic PD (Hoehn and Yahr stages 1-4). The review included studies comparing various NIBS techniques (eg, repetitive transcranial magnetic stimulation and transcranial direct current stimulation) to sham or alternative treatments, targeting motor and cognitive regions. Six databases were searched up to June 2024. Methodological quality was assessed using Assessment of Multiple Systematic Reviews 2 (AMSTAR2), and random-effects meta-analyses were performed to pool standardized mean differences (SMDs). Results. The final analysis included 31 meta-analyses and 10 systematic reviews. Overall, the reviews were rated as moderate quality (54% average for AMSTAR2). NIBS showed a small-to-moderate effect on motor function (Unified Parkinson's Disease Rating Scale-Section III scores; SMD = -0.80), functional mobility (gait speed and timed-up-and-go; SMD = -0.39), and freezing of gait (SMD = -0.58), but no significant effect on balance. Conclusion. NIBS offers small-to-moderate benefits for motor symptoms and functional movement in PD, though it does not significantly impact balance. Practitioners should consider the variety of techniques and treatment parameters before application.

Comparability of Randomized Controlled Trials Evaluating Pharmacological Interventions for Pemphigus Vulgaris and Pemphigus Foliaceus: A Systematic Mapping Review

INTRODUCTION

Pemphigus diseases are a family of chronic, autoimmune, blistering skin conditions. Despite advances in treatment approaches, more effective and safer therapies for pemphigus are urgently needed. Trials investigating novel therapeutics must be designed to yield evidence that can be compared to existing data, necessitating a comprehensive understanding of the clinical trial landscape. We aimed to perform a mapping review to assess the comparability of randomized controlled trials (RCTs) evaluating existing treatments for pemphigus vulgaris (PV) and pemphigus foliaceous (PF).

METHODS

Embase, MEDLINE, and Cochrane Library were systematically searched from inception to July 2023, supplemented with conference abstracts, clinical trial registries, and grey literature searches, for RCTs evaluating pharmacotherapies in adults with moderate-to-severe PV or PF. Comparability of study populations (demographic and clinical characteristics), interventions and comparators (dose, administration route, regimen), and outcomes (definition, time point, measure) across trials was assessed.

RESULTS

Fifteen RCTs were eligible for inclusion. Substantial heterogeneity was observed in participant age, sex, and disease duration at baseline, and none of the studies used the same criteria to assess illness severity. Doses and regimens differed across trials assessing the same interventions. Across 16 outcome measures extracted, clinical remission outcomes had limited comparability across studies and were often not defined according to published guidelines. Cumulative corticosteroid dose during the study period had the highest comparability. Health-related quality of life data and serious adverse events were infrequently reported.

CONCLUSIONS

The lack of comparability across studies has major implications for developers of new treatments for PV and PF and for decision-makers who must evaluate the efficacy, safety, and cost-effectiveness of these treatments relative to existing therapeutics.

Exercise interventions for patients with heart failure: an evidence map

Background and aims

Although exercise performance is an essential tool for managing heart failure, there is still no consensus on whether exercise prescriptions can be universally applied to all types of heart failure patients. This study aimed to describe and evaluate the evidence on exercise interventions for patients with heart failure by creating an evidence map.

Methods

We searched PubMed, Web of Science, EMBASE, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database to identify systematic reviews and meta-analysis. We used A Measurement Tool to Assess Systematic Reviews (AMSTAR-2) to evaluate the quality of included systematic reviews and meta-analysis. Bubble charts were employed to visualize key characteristics like intervention effectiveness, literature quality, literature quantity, and heart failure types. Matrix bubble charts were used to show the distribution of outcome indicators, exercise methods, literature quantity, and heart failure types.

Results

A total of 113 systematic reviews/meta-analyses were included and over 80% of studies conclude that exercise is beneficial for heart failure patients. Three heart failure types involved varied due to different classification criteria used in the included literature. Eleven types of exercise interventions have been applied in patients with heart failure and mixed modality exercise is the exercise type with the highest attention. Existing researches focus more on the improvement of exercise capacity and cardiorespiratory function in heart failure patients. Most researchers tend to focus on conducting exercise intervention studies in HFrEF.

Conclusions

The evidence map provides a visual overview of the research volume and findings on exercise interventions for heart failure patients. Exercise interventions have significant advantages for heart failure patients, but there is room for improvement in study quality, heart failure classification, and outcome indicators. Future research should focus on designing more high-quality studies to provide more high-level evidence for this field.

Physical Therapies for Delayed-Onset Muscle Soreness: An Umbrella and Mapping Systematic Review with Meta-meta-analysis

BACKGROUND

Delayed-onset muscle soreness commonly arises from intense and unaccustomed physical exercise, leading to reduced muscle strength, increased pain and inflammation. A number of systematic reviews evaluating physiotherapeutic treatments for delayed-onset muscle soreness have been published since the 1990s. However, these systematic reviews frequently yield conflicting findings, further impeding clinical practice.

OBJECTIVES

The primary aim of this study was to summarise the effectiveness of physiotherapy interventions in alleviating delayed-onset muscle soreness through an umbrella review. Additionally, we evaluated the risk of bias in systematic reviews, synthesised their findings, and categorised the evidence strength to provide practical insights for clinicians and researchers.

METHODS

An umbrella review with a meta-meta-analysis was conducted. MEDLINE, Embase, Cochrane Database of Systematic Reviews, CINAHL, PEDro and Epistemonikos were searched from 1998 to February 2024. Systematic reviews of randomised controlled trials of any treatments used post-exercise by physiotherapists to reduce delayed-onset muscle soreness in healthy adults, regardless of their physical activity, were eligible. A MeaSurement Tool to Assess systematic Reviews-2 (AMSTAR-2) was used to evaluate the methodological quality of the included systematic reviews. Corrected covered areas were calculated to address the overlap of primary trials in the included systematic reviews. An evidence map was created to categorise and visualise the effects of interventions using a multi-dimensional approach, based on the effect size and strength of evidence (Class I-V), i.e. the number of cases, Hedges' g, p-value, heterogeneity, Egger's test and excess of significance bias test.

RESULTS

Twenty-nine systematic reviews with 863 unique randomised controlled trials, addressing 24 distinct physiotherapeutic treatments, met the inclusion criteria. Seventeen systematic reviews were of critically low methodological quality, with only two rated as high quality. The evidence map suggests significant effects in pain reduction immediately post-exercise for contrast therapy (Class II), cooling therapy and cryostimulation (Class IV); 24 h: massage therapy (Class III) and cooling therapy, contrast therapy, electrical stimulation, cryostimulation, phototherapy, heat therapy (Class IV); 48 h: compression, contrast therapy, kinesiotaping and cryostimulation (Class III) and cooling therapy, massage, phototherapy, heat therapy (Class IV); 72 h: kinesiotaping (Class III) and contrast therapy, cooling therapy, massage, phototherapy, vibration (Class IV); 96 h: compression, phototherapy, and contrast therapy (Class IV). The effect sizes (Hedges' g) ranged from 0.36 (95% confidence interval 0.46, 3.18) for cooling therapy to 1.82 (95% confidence interval 0.46, 3.18) for heat therapy indicating small and large effects, respectively.

CONCLUSIONS

There is a large body of evidence from predominantly low-quality systematic reviews of randomised controlled trials evaluating the effectiveness of physiotherapeutic treatments for delayed-onset muscle soreness. There is some strong evidence to support the effectiveness of cooling therapy, cryostimulation, contrast therapy, massage, phototherapy and kinesiotaping at various follow-up intervals, whereas evidence for stretching, exercises and electrical stimulation is weak. Uncertainties, heterogeneity and weaknesses of the available evidence partially limit the applicability and generalisability of the findings.

CLINICAL TRIAL REGISTRATION

PROSPERO registration number CRD42024485501 ( https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024485501 ).

Safety implications of mask use: a systematic review and evidence map

BACKGROUND

Widespread use of respiratory protection masks has become a critical component of public health response.

OBJECTIVES

This systematic review synthesises the evidence on the acute physiological, cognitive and psychological impacts associated with different types of masks and provides an evidence map of research gaps.

METHODS

A comprehensive search from 2000 to 2023 was conducted across multiple databases (MEDLINE, EMBASE, Cochrane databases, Scopus and PubMed). An umbrella systematic overview was conducted for physiological outcomes using existing systematic reviews. We conducted de novo systematic reviews for cognitive and psychological outcomes. Pairs of independent reviewers determined eligibility, extracted data and assessed risk of bias. Certainty at an outcome level was appraised using the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS

The search resulted in 13 370 potential citations, leading to the inclusion of nine systematic reviews for physiological outcomes (87 primary studies) and 10 primary studies for cognitive and psychological outcomes (3815 participants), with the majority of participants being healthy adults. Studies evaluating physiological outcomes demonstrated that various types of masks have little to no significant difference in heart rate (surgical mask (mean difference (MD): 0.96 (-1.01 to 2.93)), N95 mask (MD: 1.63 (-2.79 to 6.05)) and cloth mask (MD: -0.94 (-6.39 to 4.52))) or respiratory rate during rest or exercise (surgical mask (MD: -1.35 (-3.00 to 0.29)), N95 mask (MD: 0.10 (-3.10 to 3.29)) and cloth mask (MD: -2.57 (-6.44 to 1.29)) (low certainty for most outcomes)). Mask use may be associated with very small changes in minute ventilation (surgical mask (MD: -13.9 (-20.30 to -7.53)) and N95 mask (MD: -16.3 (-28.7 to -3.9))), tidal volume (surgical mask (MD: -0.14 (-0.23 to -0.05)) and N95 mask (MD: -0.10 (-0.33 to 0.13))), oxygen saturation (surgical mask (MD: -0.59% (-0.87 to -0.30)), N95 mask (MD: -0.35% (-0.75 to 0.05)) and cloth mask (MD: -0.50% (-1.23; 0.24))), carbon dioxide partial pressure (surgical mask (standardised MD (SMD): 1.17 (0.70 to 1.64)) and N95 mask (SMD: 0.43 (0.08 to 0.79))) and exercise performance (surgical mask (SMD: -0.12 (-0.39 to 0.15)), N95 mask (SMD: -0.42 (-0.76 to -0.08)) and cloth mask (SMD: -0.26 (-0.54 to 0.02)) (low certainty for most outcomes)). Studies evaluating cognitive outcomes showed mixed results. Some studies reported reduced mental workload, and others showed no significant effect or decreased performance. The impact on attention, errors and reaction time was variable. These studies were small and at moderate to high risk of bias. Evidence was insufficient to estimate the effect of mask use on psychological outcomes (claustrophobia, depression and anxiety) as these studies were small, non-longitudinal and at high risk of bias.

CONCLUSION

This evidence map provides a comprehensive insight into the multifaceted impact of respiratory protection mask use, and highlights the limited certainty in the available body of evidence. This evidence map supports the development of future research agenda.

Peer reviewers' conflicts of interest in biomedical research: scoping review

BACKGROUND

Peer review may improve the quality of research manuscripts and aid in editorial decisions, but reviewers can have conflicts of interest that impact on their recommendations.

OBJECTIVES

The objective was to systematically map and describe the extent and nature of empirical research on peer reviewers' conflicts of interest in biomedical research.

DESIGN

Scoping review METHODS: In this scoping review, we included studies investigating peer reviewers' conflicts of interest in journal manuscripts, theses and dissertations, conference abstracts, funding applications and clinical guidelines. We searched MEDLINE, Embase, The Cochrane Methodology Register, Google Scholar (up to January 2024) and other sources. Two authors independently included studies and extracted data on key study characteristics and results, and we organised data by study domain (eg, journal manuscripts) and study aims. We included studies directly investigating peer reviewers' conflicts of interest in our primary analysis, and studies investigating other questions (eg, reasons for retraction), but reporting relevant data on peer reviewers' conflicts of interest, were solely included in a supplementary analysis.

RESULTS

After screening 44 353 references, we included 71 studies, of which 41 were included in our primary analysis. The 41 studies were published between 2005 and 2023, and 34 (83%) were journal publications. 30 (73%) studies investigated journal manuscripts, 1 (2%) conference abstracts, 4 (10%) funding applications and 6 (15%) clinical guidelines. No studies investigated theses or dissertations. 37 (90%) studies used quantitative research methods, 2 (5%) qualitative and 2 (5%) mixed methods. 21 (51%) studies investigated both financial and non-financial interests, 6 (15%) solely financial interests, 5 (12%) solely non-financial interests and 9 (22%) did not report the type of interest. We organised included studies based on study aims, with some studies having multiple aims: impact on recommendations (one study), occurrence of peer reviewers' conflicts of interest (11 studies), stakeholders' experiences (13 studies) and policy and management (22 studies). One (2%) study investigated the impact of peer reviewers' personal connections with authors on reviewers' recommendations. Nine (22%) studies estimated prevalences of conflicts of interest among peer reviewers, ranging from 3%-91%. Two (5%) studies both reported that conflicts of interest were a reason for declining to review in 1% of cases. 13 (32%) studies investigated stakeholders' experiences with peer reviewers' conflicts of interest, primarily using questionnaires of reviewers, editors and researchers. 16 (39%) studies estimated prevalences of having conflict of interest policies for peer reviewers, ranging from 5%-96%, among journals, conferences and clinical guideline organisations. Finally, six (15%) studies estimated prevalences of public availabilities of reviewers' conflicts of interest declarations, ranging from 0%-71%.

CONCLUSIONS

Most studies addressed conflicts of interest in peer review of journal manuscripts, primarily through surveys of journal policies or questionnaires of researchers, editors and peer reviewers. The impact of peer reviewers' conflicts of interest on recommendations and their prevalence is still poorly understood. Our results can guide future studies and be used to align policies and management of peer reviewers' conflicts of interest.

STUDY REGISTRATION

Open Science Framework (DOI: 10.17605/OSF.IO/9QBMG).

Evidence Mapping of Clinical Practice Guideline Recommendations for Self-Management Strategies of Diabetic Foot Ulcers

Significance: Diabetic foot ulcer (DFU) is a common complication of diabetes, characterized by chronic, hard-to-heal wounds that can lead to serious infections and amputations. Effective self-management is crucial for treatment and prevention. Recent Advances: A comprehensive literature search was conducted across academic databases, clinical practice guideline (CPG) databases, and the websites of diabetes societies. The characteristics, recommendations, and evaluation criteria of the CPGs were extracted and organized using Excel. Four researchers independently assessed the methodological and reporting quality of the CPGs using the Appraisal of Guidelines Research and Evaluation II instrument and the Reporting Items for practice Guidelines in HealThcare checklist. Data were synthesized and visualized through evidence mapping to provide an overview of current guideline coverage and key recommendations. Critical Issues: This study included 13 CPGs and synthesized 46 recommendations. Self-management strategies for patients with DFU mainly involve health education, foot self-care, lifestyle change, comorbidity/symptom management, as well as follow-up and medical help-seeking. The identified CPGs were of mixed quality, with four classified as high quality. With respect to methodology, the CPGs performed well in scope and purpose (82.6%±10.9%) and clarity (80.77%±9.19%), but showed deficiencies in stakeholder involvement (52.8%; interquartile range [IQR]: 17.3%) and editorial independence (58.3%; IQR: 82.3%). For reporting quality, limitations were noted in transparency regarding review and quality assurance (18.75%; IQR: 100%), as well as funding and declaration of interests (12.5%; IQR: 32.82%). Future Directions: The evidence provided by CPGs for DFU self-management varied in strength, and some recommendations were inconsistent. The results adds to our knowledge and promotes the development of trustworthy CPGs on DFU. Further research is necessary to propose more evidence-based and high-quality recommendations.

Meta-epidemiology and reporting characteristics of mapping reviews: a scoping review

OBJECTIVES

To investigate the meta-epidemiology and reporting characteristics of mapping reviews.

STUDY DESIGN AND SETTING

We conducted a scoping review of a sample of recent mapping reviews (2022-2023) by searching nine electronic databases and eleven institutional websites up to January 2024. A 28-item reporting checklist, developed by our team and based on existing guidance and methodological studies of mapping reviews, was employed to assess reporting characteristics. The median (interquartile range [IQR]) was calculated based on the number of studies that reported each specified reporting item.

RESULTS

A total of 451 mapping reviews were included, with 197 published in 2022 and 254 in 2023. The USA published the most studies (80, 17.74%) and the University of London being the most active institution (23, 5.10%). Barbosa JLV from Universidade do Vale do Rio dos Sinos authored the highest number of studies, with significant collaborations primarily between Chinese and Canadian teams. The studies spanned 11 fields within health and social sciences, Environmental Evidence and Campbell Systematic Reviews published the most studies. A random sample of 200 studies was further assessed for reporting characteristics, where items such as title, author, abstract, background, conclusions, acknowledgments, contributions of authors, declarations of interest, and sources of support were reported by over 50% of the studies. Median number of studies reporting items related to methods, results, and discussion was 89.5 (IQR: 45.5, 165.25), 94.0 (IQR: 61.5, 183.5), and 164 (IQR: 124.0, 179.25), respectively. Items such as the definition of stakeholders, registration information, deviations from protocol, strategy for adequacy and priority setting, and plans for map updates were reported by less than 20% of the studies.

CONCLUSION

Mapping reviews receive contributions from authors across various countries and institutions. However, collaboration between teams is limited, and the reporting of included studies, especially in the methods and results sections, needs improvement to better emphasize their unique attributes and functions compared to other methods.

Exercise-Based Cardiac Rehabilitation for Patients After Heart Valve Surgery: A Systematic Review and Re-Evaluation With Evidence Mapping Study

OBJECTIVE

This systematic review and evidence mapping study aims to assess the effects of exercise-based cardiac rehabilitation on clinical outcomes in patients after heart valve surgery. By consolidating and visualizing existing evidence, the study seeks to identify gaps in knowledge, evaluate the quality and breadth of current research, and provide guidance for clinical practice and future research. The evidence mapping will highlight under-researched areas and inform healthcare providers on effective strategies to enhance postoperative recovery.

METHODS

A comprehensive search was performed across multiple databases, including PubMed, Embase, Cochrane CENTRAL, Web of Science, CNKI, and Wanfang, up to May 2024. Two reviewers independently screened the articles, extracted relevant data, and assessed study quality. Study characteristics and outcomes were visualized using bubble plots.

RESULTS

Ten systematic reviews/meta-analyses met the inclusion criteria. Based on AMSTAR-2, two were rated "high quality," two "low quality," and six "very low quality." Using the GRADE system, of the 48 pieces of evidence across 10 outcomes, 1 was "high quality," 8 "moderate," 19 "low," and 20 "very low."

CONCLUSION

Current evidence indicates that exercise-based cardiac rehabilitation can enhance physical capacity, left ventricular ejection fraction, peak oxygen uptake, and daily living activities in heart valve surgery patients. However, more large-scale, high-quality studies are needed to verify its effects on all-cause mortality, quality of life, adverse events, return to work, and emotional health.

Evidence map of liver surgery: study protocol of a living systematic review

INTRODUCTION

The amount of scientific data on liver surgery is exploding. There is a critical unmet need to develop tools that will facilitate navigating the literature and offer easy, fast and accurate access to data with a high level of evidence. Evidence maps (EM) combining living systematic reviews (SR) and user-friendly synthesis with graphs and figures were developed for this purpose in other medical fields and showed promising results but remain yet unavailable in liver surgery. The present study protocol aims to generate an EM in liver surgery, gathering randomised clinical trials (RCT) and SR.

METHODS AND ANALYSIS

A systematic search will be conducted in the Cochrane Central Register of Controlled Trials, Web of Science, Embase and Medline to identify all RCT and SR concerning liver surgery. RCT and SR will be classified in research topics. Selected endpoints will be extracted and meta-analysed. Results will be freely available for patients, clinicians and researchers via a web-based evidence map platform. EM and meta-analyses (MA) will be updated at regular intervals.

ETHICS AND DISSEMINATION

Including publicly available data, this type of study design did not require ethical committee approval. EM displays the required properties to facilitate literature search and to get a rapid overview of the current evidence, an unavailable tool in liver surgery, to date. Generating such an aid may considerably help patients, clinicians and researchers in many aspects: accessing accurate data, helping in decision-making and identifying gaps in the field. On completion of the project, results will be published, freely available via www.evidencemap.surgery and permanently updated.

PROSPERO REGISTRATION NUMBER

CRD42023489201 (https://www.crd.york.ac.uk/prospero/).

To scope or not to scope? The benefits and challenges of integrating scoping studies in rapid qualitative research and evaluation

Creating sustainable change and fostering collaborative relationships between researchers and stakeholders is a recognized challenge in the field of evaluation. Identifying programme purpose, cultural context, potential challenges, and engaging stakeholders before an evaluation can produce responsive and impactful evaluations. This paper discusses implementing a targeted scoping study within the framework of rapid qualitative research and evaluation. A scoping study enables collaborative decision-making on evaluation priorities, and functions as an evaluability assessment in time-sensitive contexts. In our experience, a scoping study can be carried out in as little as five days or as long as six weeks. It is timely to revisit the question of what factors influence evaluation outcomes, a scoping study can be used to support an evaluation, address access to data and research, and strengthen communication channels. The methodological approach was used to co-produce an evaluation with an NGO that accurately reflected their needs, recognizing possible challenges and solutions.

Systematic Review of Volume and Methodological Quality of Randomized Trials in Acute Pancreatitis

BACKGROUND

This systematic review assessed the volume and methodological quality of randomized controlled trials (RCTs) in relation to management of acute pancreatitis (AP).

MATERIALS AND METHODS

The PubMed, MEDLINE, and CENTRAL databases were systematically searched for RCTs published across 3 time periods: <1996 (P1), 1996-2008 (P2), and >2008 (P3). RCT quality was assessed using the Cochrane Risk of Bias (RoB) 2 tool and sample size recalculation, and for spin (interpretation of nonstatistically significant results as relevant, making the study appear to be positive).

RESULTS

Overall, 263 RCTs with 23,232 patients with AP were included. The average number of RCTs per year increased from 1.4, 6.0, to 10.6 in P1, P2, and P3, respectively. The RoB assessment showed low, some, and high concerns in overall RoB in 21%, 56%, and 24% of all RCTs. Selective reporting bias improved over time. Sample size calculation reporting significantly increased through the 3 time periods (17%, 38%, and 47%; P < 0.001). Spin was identified in 68 RCTs (26% of all RCTs).

CONCLUSION

The quantity and quality of published RCTs relating AP management has increased over time, however significant shortcomings of methodological quality persist. Significant improvements in the conduct and reporting of randomized trials in AP are required to improve the evidence base in this field.

Mindfulness-based interventions for improvement of lifestyle behaviors and body mass index in children with overweight or obesity: a systematic review and meta-analysis

This study aimed to synthesize evidence from primary studies on the acceptability and effectiveness of mindfulness-based interventions (MBIs) for improving lifestyle behaviors and body mass index (BMI) in children with overweight or obesity. We conducted a meta-analysis or followed the Synthesis Without Meta-analysis (SWiM) guidelines to synthesize study findings. The analysis included both mindfulness-only interventions and comprehensive behavioral interventions incorporating mindfulness components. Participants were overweight or obese children, with a mean age below 18 years. A total of 11 studies were included: 7 randomized controlled trials (RCTs), 1 non-randomized parallel-controlled study, and 3 single-group studies. Retention rates for MBIs ranged from 62 to 100%, and participants generally expressed positive attitudes toward the interventions. Regarding effectiveness, no significant improvement in BMI was observed overall (pooled mean difference 0.12 kg/m2 (95% CI - 0.38 to 0.62); I2 = 44%). Subgroup analysis revealed that comprehensive behavioral interventions integrating mindfulness were effective in influencing BMI, while only 11% of mindfulness-only interventions showed similar results. Moreover, 71% of the included studies reported improvements in diet or physical activity behaviors following MBIs.

CONCLUSION

Mindfulness-based interventions are generally acceptable and show potential for improving lifestyle behaviors. However, their impact on BMI remains inconsistent in children with overweight or obesity. Comprehensive behavioral interventions that combine mindfulness practices with conventional approaches may enhance effectiveness. Given the limited evidence, these findings should be interpreted with caution.PROSPERO registration number: CRD42023411790.

WHAT IS KNOWN

• Childhood obesity is a significant public health concern, and conventional interventions have achieved limited success. • Mindfulness-based interventions offer a promising alternative to conventional approaches. A systematic review is urgently needed to evaluate their acceptability and effectiveness in improving lifestyle behaviors and body mass index (BMI) in children with overweight or obesity.

WHAT IS NEW

• Mindfulness-based interventions are generally acceptable to children with overweight or obesity. • Mindfulness-based interventions show potential for improving lifestyle behaviors, but their effectiveness in reducing BMI remains inconsistent.

A Protocol for AI-Powered Tools to Enhance Mobility and Function in Older Adults: An Evidence and Gap Map

Introduction: Artificial intelligence (AI) is transforming healthcare by enhancing diagnostic accuracy, treatment, and patient monitoring, benefiting older adults by offering personalized care plans. AI-powered tools help manage chronic conditions and maintain independence, making them a valuable asset in addressing aging challenges. Objectives: The objectives are as follows: 1. To identify and describe AI-power-based exercise programs for older adults. 2. To highlight primary evidence gaps in AI interventions for functional improvement and mobility. 3. To evaluate the quality of existing reviews on this topic. Methods: The evidence gap map (EGM) will follow the five-step method, adhering to the Campbell Collaboration guidelines and, if available at the time of reporting, PRISMA-AI standards. Guided by the Metaverse Equitable Rehabilitation Therapy framework, this study will categorize findings across domains like equity, health service integration, interoperability, governance, and humanization. The study will include systematic reviews, randomized controlled trials, and pre-and post-intervention designs. Results will be reported following PRISMA-AI guidelines. We will use AMSTAR-2 Checklist for Analyzing Systematic Reviews on AI Interventions for Improving mobility and function in Older Adults to evaluate the reliability of systematic reviews and focus on internal validity. Conclusions: This comprehensive analysis will act as a critical resource for guiding future research, refining clinical interventions, and influencing policy decisions to enhance AI-driven solutions for aging populations. The EGM aims to bridge existing evidence gaps, fostering a more informed, equitable, and effective approach to AI solutions for older adults.

Mapping the Gaps: A Scoping Review of Virtual Care Solutions for Caregivers of Children with Chronic Illnesses

Background/Objectives: Caregivers of children with chronic illnesses, including chronic pain, experience high levels of distress, which impacts their own mental and physical health as well as child outcomes. Virtual care solutions offer opportunities to provide accessible support, yet most overlook caregivers' needs. We conducted a scoping review to create an interactive Evidence and Gap Map (EGM) of virtual care solutions across a stepped care continuum (i.e., from self-directed to specialized care) for caregivers of youth with chronic illnesses. Methods: The review methodology was co-designed with four caregivers. Data sources were the peer-reviewed scientific literature and a call for innovations. Records were independently coded and assessed for quality. Results: Overall, 73 studies were included. Most virtual care solutions targeted caregivers of children with cancer, neurological disorders, and complex chronic illnesses. Over half were noted at lower levels of stepped care (i.e., self-guided apps and websites), with psychological strategies being predominant (84%). However, very few addressed caregivers' physical health (15%) or provided family counseling (19%) or practical support (1%). Significant gaps were noted in interventions for managing caregiver chronic pain, despite its high prevalence and impact on child outcomes. Conclusions: Evidence and Gap Maps are innovative visual tools for knowledge synthesis, facilitating rapid, evidence-informed decision-making for patients, families, health professionals, and policymakers. This EGM highlighted high-quality virtual care solutions ready for immediate scaling and identified critical evidence gaps requiring prioritization. To address the complexities of pediatric chronic illnesses, including chronic pain, virtual care initiatives must prioritize family-centered, accessible, and equitable approaches. Engaging caregivers as partners is critical to ensure interventions align with their needs and priorities.

Management for children and adolescents with overweight and obesity: a recommendations mapping

BACKGROUND

Childhood obesity is a global public health issue, and the status of clinical practice guidelines (CPGs) as instruction manuals for the management of childhood obesity remains unclear. This study aims to identify and apprise the methodological and reporting quality of CPGs focused on childhood obesity and provide an overview of key recommendations.

METHODS

Databases and websites reporting guidelines were searched from January, 2018 to September, 2023. The methodological quality was graded using the AGREE II, and RIGHT was used to assess the reporting completeness.

RESULTS

Among the six included CPGs, two were rated as high quality and considered "Recommended" and three were reported no less than 80%. CPGs included 184 recommendations cover diagnosis, assessment and management of complications, interventions and prevention. The diagnostic criteria for children with obesity over 2 years of age are based on normative BMI percentiles, depending on sex and age. CPGs recommended the delivery of multi-component behavior-changed interventions included controlling diet and increasing physical activity. Pharmacological interventions and bariatric surgery are considered as complementary therapies.

CONCLUSION

CPGs for childhood obesity should emphasize the impact of psychological factors and consider the provision of interventions from multiple settings, and could consider the role of complementary alternative therapies.

IMPACT

Six guidelines have been published in the past 5 years focusing children obesity. Recommendations covered diagnosis, multiple intervention and prevention. Guidelines should focus on the role of complementary alternative therapies. Guidelines should emphasize the impact of psychological factors. Guidelines should consider the provision of interventions from multiple settings.

Strategies to Address Racial and Ethnic Disparities in Health and Health Care for Chronic Conditions : An Evidence Map of Research From 2017 to 2024

BACKGROUND

Racial and ethnic disparities in health and health care persist in the United States, adversely affecting outcomes in prevention and treatment of chronic conditions among adults.

PURPOSE

To map interventions aimed at reducing racial and ethnic disparities and improving health outcomes in the prevention and treatment of chronic conditions in adults.

DATA SOURCES

Searches of MEDLINE, CINAHL, and Scopus from January 2017 to April 2024, supplemented with gray literature.

STUDY SELECTION

U.S.-based studies of interventions targeting racial and ethnic disparities in adults with chronic conditions.

DATA EXTRACTION

Information on intervention types, targets, outcomes, study designs, study settings, chronic conditions, and delivery personnel was extracted and categorized.

DATA SYNTHESIS

Among 174 unique studies, 12 intervention types were identified, with self-management support and patient navigation the most common. Most interventions targeted patient behaviors; few studies addressed disparities directly or focused on underrepresented racial and ethnic marginalized groups.

LIMITATIONS

The lack of standardized terminology and the underrepresentation of certain racial and ethnic groups limit the evidence base. Although the literature search accurately reflects the current state of the literature, it also limits the body of evidence by excluding health disparities research conducted before January 2017, so significant findings from earlier studies may have been overlooked.

CONCLUSION

The literature highlights diverse interventions targeting health disparities, but few studies evaluated their effectiveness in reducing the health disparities gaps. There is an urgent need for research focused on underrepresented racial and ethnic groups, particularly in promising areas such as patient navigation for cancer and diabetes self-management. Future research should prioritize robust study designs to assess the long-term effect and broader applicability of interventions, thus helping organizations and stakeholders to tailor strategies to community-specific needs.

PRIMARY FUNDING SOURCE

Agency for Healthcare Research and Quality.

Timing, setting, and content of patient education prior to goal setting for cancer survivors: a scoping review

BACKGROUND

Because the concepts of goal setting and patient education are intertwined, it is important to understand the details of patient education content for cancer survivors. This study aimed to conduct a comprehensive review of the timing (during or after treatment), setting, and content of patient education provided to cancer survivors prior to setting goals.

METHODS

A systematic search was conducted across three databases to identify articles on rehabilitation that included patient education, conducted prior to goal setting for cancer survivors. The patient education was then mapped according to the survivors' treatment stage and the 13 elements outlined in the health decision model proposed by Eraker et al. RESULTS: A review of 21 studies revealed that only four (19.0%) were randomized controlled trials (RCTs). Additionally, education for patients, including goal setting, often considers survivors' feelings and provides adequate information through interactive and repeated communication. However, the satisfaction of survivors (an element of patient education) is not sufficiently reflected in the education provided. During treatment, education more includes personalized materials and evaluations of patient comprehension than after treatment. After treatment, other healthcare professionals are more involved, and social networks are more incorporated than during treatment.

CONCLUSION

Current patient education research evaluating comprehension by cancer survivors after treatment, multidisciplinary approaches during treatment, and active participation by family members in outpatient or home care, is lacking. Studies that address these gaps should be conducted as RCTs.

Mapping review of register-based cohort studies of bipolar disorder

OBJECTIVES

Register-based cohorts allow us to better understand bipolar disorder over a life course. They are inclusive and their long-term data collection provides a longer scope than most clinical trials. This mapping review provides an overview of register-based cohort studies of bipolar disorder to inform researchers of the strengths and limitations to this body of research and identify gaps for future research.

METHODS

A systematic search was performed of Medline, EMBASE, and PsycINFO databases. Cohort studies were included if they focused on bipolar disorder and had a minimum of 1 year of longitudinal data. Studies needed to be from databases that monitor the whole state or national population. A descriptive analysis of the studies' populations and methodology provides an overview of this field of study and identifies evidence gaps.

RESULTS

A hundred and forty-six studies were included. The majority were from databases in Taiwan (n = 63), Denmark (n = 38), Sweden (n = 23), and Finland (n = 11). Forty-eight studies focused on aetiological questions. Sixty prognostic studies identified cohorts with bipolar disorder and described the impact of the illness by considering comorbidity, prescribing patterns, social functioning, and mortality. Thirty-six treatment studies focused on the efficacy and adverse effects of pharmaceuticals and ECT. No studies focused on psychological treatments.

CONCLUSION

Bipolar disorder research should include register-based cohorts with greater geopolitical and cultural diversity. Custodians of health registers should consider how non-pharmaceutical interventions such as psychotherapy are captured. Register-based cohorts investigating treatments of bipolar disorder should consider long-term social outcomes alongside the usual clinical outcomes.

Examining self-described policy-relevant evidence base for policymaking: an evidence map of COVID-19 literature

Background

Evidence-based policymaking is a paradigm aimed at increasing the use of evidence by actors involved in policymaking processes. The COVID-19 pandemic highlighted a heavy reliance on emerging evidence for policymaking during emergencies.

Objective

This study describes the focus and types of evidence in journal articles self-described as relevant to policymaking using the COVID-19 pandemic as a case study, identifying gaps in evidence and highlighting author stated perceived biases specifically in evidence-based policy making.

Design

Evidence mapping.

Data sources

We systematically searched SCOPUS, PubMed and LexisNexis for literature identifying policy-relevant evidence available on the COVID-19 pandemic.

Eligibility criteria

The study included only peer-reviewed literature identified as 'article', 'book chapter', 'review' covering the period from January 2020 to December 2022. Inclusion criteria required that articles have an abstract, authorship attribution and are written in English.

Data extraction and synthesis

A minimum of two authors independently extracted and coded for every level and final outputs were compared for consistency.

Results

A total of 213 articles met the inclusion criteria and were reviewed in this study. Lead authorship affiliations were from 50 countries with 70% of the outputs from developed economies including USA (20.2%), UK (18.3%) and Australia (7.5%). The most common purpose of the articles was the presentation of research findings the authors considered of relevance to policy (60.1%), followed by work that examined the impact of policy (28.6%) or highlighted or supported a policy need (22.5%), while some papers had multiple stated purposes. The most common challenges in policymaking identified by the authors of the reviewed papers were process failures and poor evidence utilisation during policymaking.

Conclusions

The evidence map identified the need for an interdisciplinary policy approach involving relevant stakeholders and driven by quality research as a progressive step towards prevention of future public health crises/pandemics.

Interventions to improve mental health and well-being in care-experienced children and young people aged less than 25: the CHIMES systematic review

Background

Children and young people with experience of being in care (e.g. foster care, kinship care, residential care or at home with a supervision requirement order) are at higher risk of adverse mental health and well-being outcomes compared to the general population. Despite a range of policy recommendations and interventions, it is not clear what approaches are effective in the United Kingdom, or how context factors give rise to facilitators and inhibitors of implementation and acceptability.

Objectives

The CHIMES review is a complex-systems-informed mixed-method systematic review that aimed to synthesise the international evidence base for interventions addressing the mental health and well-being of care-experienced children and young people (age ≤ 25 years) and to assess the potential transportability of this evidence base to the United Kingdom context.

Data sources

We searched 16 electronic bibliographic databases and 22 websites from 1990 to May 2022. We conducted citation tracking, screened relevant systematic reviews and contacted international experts.

Method

We used a convergent synthesis design. We first constructed an evidence map to confirm review scope before undertaking method-level syntheses for outcome evaluations, process evaluations and economic evaluations. These elements were integrated into a review-level synthesis to identify potential evidence-based interventions that may progress to further development, adaptation and evaluation in the United Kingdom. We conducted stakeholder consultations to prioritise intervention theories, types and outcomes.

Results

We identified 64 interventions from 124 study reports. Interventions were primarily evaluated in the United States and targeted young people's competencies or carers' parenting practices. Meta-analysis reported limited evidence that interventions effectively improved mental health in the shorter term (0-6 months): total social, emotional and behavioural problems (d = -0.15, 95% confidence interval -0.28 to -0.02); internalising problem behaviours (d = -0.35, 95% confidence interval -0.61 to -0.08); externalising problem behaviours (d = -0.30, 95% confidence interval -0.53 to -0.08); depression and anxiety (d = -0.26, 95% confidence interval -0.40 to -0.13) and social-emotional functioning difficulties (d = -0.18, 95% confidence interval -0.31 to -0.05), but these impacts were not observed in the longer term (> 6 months). Five key context factors potentially explain challenges to implementation and acceptability: lack of system resources; the time, cognitive and emotional burden of delivery or participation; interprofessional tensions; the devaluing of young people, meaning that they felt unable to express dissatisfaction with interventions; and the devaluating of carers' expertise and needs. From the evidence, stakeholder consultation identified two priority interventions: (1) mentoring by individuals with knowledge and experience of care and (2) system and ethos change to create harmonisation between organisations and facilitate interprofessional relationships. Well-being and suicide-related behaviours are priority outcomes alongside mental health.

Limitations

The review was limited by a paucity of theory and economic evaluations, so it is unclear how interventions might function or their potential cost-effectiveness. Interventions were insufficiently described, making it challenging to map the evidence base. Outcome evaluations were poorly reported. Due to ongoing restrictions with COVID-19, stakeholder consultations were conducted later than intended with a smaller number of attendees.

Conclusions

The review identified some evidence for interventions impacting mental health in the short term. There is a lack of system-level interventions and approaches that target subjective well-being and suicide-related outcomes. Future intervention might prioritise mentoring and targeting system culture.

Study registration

This study is registered as PROSPERO CRD42020177478.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR129113) and is published in full in Public Health Research; Vol. 12, No. 14. See the NIHR Funding and Awards website for further award information.

Predictors of weaning failure in ventilated intensive care patients: a systematic evidence map

BACKGROUND

Ventilator weaning is of great importance for intensive care patients in order to avoid complications caused by prolonged ventilation. However, not all patients succeed in weaning immediately. Their spontaneous breathing may be insufficient, resulting in extubation failure and the subsequent need for reintubation. To identify patients at high risk for weaning failure, a variety of potential predictors has already been examined in individual studies and meta-analyses over the last decades. However, an overview of all the predictors investigated is missing.

AIM

To provide an overview of empirically investigated predictors for weaning failure.

METHODS

A systematic evidence map was developed. To this end, we conducted a systematic search in the Medline, Cochrane, and CINAHL databases in December 2023 and added a citation search and a manual search in June 2024. Studies on predictors for weaning failure in adults ventilated in the intensive care unit were included. Studies on children, outpatients, non-invasive ventilation, or explanatory factors of weaning failure were excluded. Two reviewers performed the screening and data extraction independently. Data synthesis followed an inductive approach in which the predictors were thematically analyzed, sorted, and clustered.

RESULTS

Of the 1388 records obtained, 140 studies were included in the analysis. The 112 prospective and 28 retrospective studies investigated a total of 145 predictors. These were assigned to the four central clusters 'Imaging procedures' (n = 22), 'Physiological parameters' (n = 61), 'Scores and indices' (n = 53), and 'Machine learning models' (n = 9). The most frequently investigated predictors are the rapid shallow breathing index, the diaphragm thickening fraction, the respiratory rate, the P/F ratio, and the diaphragm excursion.

CONCLUSION

Predictors for weaning failure are widely researched. To date, 145 predictors have been investigated with varying intensity in 140 studies that are in line with the current weaning definition. It is no longer just individual predictors that are investigated, but more comprehensive assessments, indices and machine learning models in the last decade. Future research should be conducted in line with international weaning definitions and further investigate poorly researched predictors. Registration, Protocol: https://doi.org/10.17605/OSF.IO/2KDYU.

A global systematic map of knowledge of inland commercial navigation effects on freshwater ecosystems

Inland navigation is one of the most sustainable transport alternatives to help decarbonise the world economy. However, the likely impacts of intensifying inland navigation on freshwater ecosystems are difficult to predict. A global map of knowledge that considers both abiotic and biotic responses to increasing shipping traffic and developing infrastructures is lacking. Deriving general evidence-based assessments is challenging, because most studies on inland navigation impacts are merely descriptive and either consist of local case studies, or address single navigation stressors or specific taxa only. We conducted a systematic mapping of the published literature (1908-2021) to provide a global synthesis of the effects of inland navigation on the biotic and abiotic components of freshwater ecosystems. We show that only half of the reported navigation-related impacts were statistically tested. Navigation itself (vessel operation) had mainly negative effects on native taxa (57%), followed by waterway management (40%), and navigation infrastructures (35%). Navigation has direct negative impacts caused by physical disturbances such as vessel-induced waves, and indirect impacts that facilitate the spread of aquatic invasive species, and altering the abiotic habitat conditions. Thirty percent of the tested relationships showed non-significant impacts on the biotic environment, while in 10% of cases impacts were context-dependent. We identified the main gaps of knowledge, namely (i) impacts of waterway management on communities, (ii) underlying processes of navigation impacts on river ecosystems; and (iii) interactions between multiple navigation factors and cascading effects on multi-taxa responses. These future research directions should improve the diagnosis, mitigate the negative impacts of navigation on rivers and provide guidelines for improving navigated river management.

Effectiveness and clinical relevance of kinesio taping in musculoskeletal disorders: a protocol for an overview of systematic reviews and evidence mapping

INTRODUCTION

Kinesio taping (KT) has been extensively applied in the management of musculoskeletal disorders (MSDs). Although plentiful systematic reviews (SRs) have evaluated its efficacy, there are no convincing conclusions due to dispersed and inconclusive results, and its clinical relevance remains unclear. Hence, there is a need to summarise all the SRs for comprehensive and consistent evidence. This overview aims to appraise the overall effectiveness of KT in MSDs and provide evidence maps to visualise the findings.

METHOD AND ANALYSIS

Electronic databases (Cochrane Database of Systematic Reviews, MEDLINE, Embase, Epistemonikos, PEDro, Scopus and ISI Web of Science) and reference lists will be searched from inception to September 2024 for the SRs of randomised controlled trials (RCTs). The SRs involving comparisons of the effectiveness between single or adjunctive KT and other interventions for patients with MSDs will be included. The primary and additional outcomes to be considered will be the core outcome set, and the patient-reported outcome measure and patient-important outcome, respectively. Two reviewers will independently screen and select studies, extract the data and evaluate the reporting and methodological quality of eligible SRs as well as the risk of bias of included RCTs. For the SRs without meta-analysis, we will collate the number of RCTs that showed any differences in outcomes. For the SRs with meta-analysis, we will provide the original summary of evidence (eg, pooled effects and heterogeneity) for outcomes with an evaluation of missing results and clinical relevance. The certainty of each outcome will be measured, and user-friendly maps of findings will be presented graphically.

ETHICS AND DISSEMINATION

Formal ethical approval for this study is not required since the data will be only collected from published literature in public databases. The results will be disseminated in the peer-reviewed academic journal, and relevant datasets will be preserved in the online repository.

PROSPERO REGISTRATION NUMBER

CRD42024517528.

Current evidence on patient precautions for reducing breast cancer-related lymphedema manifestation and progression risks

Risk management and self-management strategies for breast cancer-related lymphedema (BCRL) must balance best-evidence guidelines and associated risk factor knowledge. There is an evidence-based practice gap in the understanding of whether a change in education about risk factors and whether behavioral changes actually influence BCRL manifestation or progression. The purpose of this study was to (1) review if current evidence supports or refutes patient precautions to prevent the manifestation and/or progression of BCRL, (2) review if behavioral changes result in the prevention or reduction of BCRL, and (3) identify related gaps of knowledge for future research. Evidence map methodology was used to systematically review literature related to reducing the risk of BCRL. Literature searches were conducted in Medline, CINAHL, and Cochrane for the categories of trauma, blood pressure, temperature, air travel, and behavior change. One hundred and forty-eight articles were included for full-text review, of which 37 articles were included in this study. Within the confines of limb and trunk circumferential and/or volume enlargement, a 'just in case' approach to patient education on risk factors may not be appropriate for breast cancer survivors at risk of manifesting lymphedema. Patient education about precautionary risks for the onset of BCRL needs to align with research evidence. There is scant evidence about the risks of BCRL progression suggesting a need for future research.

The missing clinical guidance: a scoping review of care for autistic transgender and gender-diverse people

The co-occurrence of autism and gender diversity has been increasingly studied in the past decade. It is estimated that ∼11% of transgender and gender-diverse (TGD) individuals are diagnosed with autism. However, there is insufficient knowledge about appropriate gender-related clinical care for autistic TGD individuals. We performed a scoping review of current clinical guidance for the care of TGD individuals to identify what was said about autism. Clinical guidance documents were searched in PubMed, Web of Science, Google Scholar, Embase, Guidelines International Network, and TRIP medical database, as well as reference mining and expert recommendation. Evidence was synthesised by narrative synthesis, recommendation mapping, and reference frequency analysis. Out of the identified 31 clinical guidance documents, only eleven specifically mentioned the intersection between autism and TGD. Key concepts among the available recommendations included advocating for a multidisciplinary approach; emphasising the intersectionality of autism and gender-diverse experiences during assessments; and-importantly-recognising that autism, in itself, does not serve as an exclusion criterion for receiving gender-related care. However, detailed and practical clinical guidance is lacking due to a gap in evidence. Empirical research into the care experiences and outcomes of autistic TGD individuals using a developmental, lifespan, and strengths-based approach is needed to generate evidence-informed and tailored guidance.

Funding

This study was funded through a Canadian Institutes of Health Research Sex and Gender Science Chair program (GSB 171373) awarded to M-CL.

Interventions for people with perceptual disorders after stroke: the PIONEER scoping review, Cochrane systematic review and priority setting project

Background

Stroke often affects recognition and interpretation of information from our senses, resulting in perceptual disorders. Evidence to inform treatment is unclear.

Objective

To determine the breadth and effectiveness of interventions for stroke-related perceptual disorders and identify priority research questions.

Methods

We undertook a scoping review and then Cochrane systematic review. Definitions, outcome prioritisation, data interpretation and research prioritisation were coproduced with people who had perceptual disorders post stroke and healthcare professionals. We systematically searched electronic databases (including MEDLINE, EMBASE, inception to August 2021) and grey literature. We included studies (any design) of interventions for people with hearing, smell, somatosensation, taste, touch or visual perception disorders following stroke. Abstracts and full texts were independently dual reviewed. Data were tabulated, synthesised narratively and mapped by availability, sense and interventions. Research quality was not evaluated. Our Cochrane review synthesised the randomised controlled trial data, evaluated risk of bias (including randomisation, blinding, reporting) and meta-analysed intervention comparisons (vs. controls or no treatment) using RevMan 5.4. We judged certainty of evidence using grading of recommendations, assessment, development and evaluation. Activities of daily living after treatment was our primary outcome. Extended activities of daily living, quality of life, mental health and psychological well-being perceptual functional and adverse event data were also extracted.

Results

We included 80 studies (n = 893): case studies (36/80) and randomised controlled trials (22/80). No stroke survivor or family stakeholder involvement was reported. Studies addressed visual (42.5%, 34/80), somatosensation (35%, 28/80), auditory (8.7%, 7/80) and tactile (7.5%, 6/80) perceptual disorders; some studies focused on 'mixed perceptual disorders' (6.2%, 5/80 such as taste-smell disorders). We identified 93 pharmacological, non-invasive brain stimulation or rehabilitation (restitution, substitution, compensation or mixed) interventions. Details were limited. Studies commonly measured perceptual (75%, 60/80), motor-sensorimotor (40%, 32/80) activities of daily living (22.5%, 18/80) or sensory function (15%, 12/80) outcomes.

Cochrane systematic review

We included 18 randomised controlled trials (n = 541) addressing tactile (3 randomised controlled trials; n = 70), somatosensory (7 randomised controlled trials; n = 196), visual (7 randomised controlled trials; n = 225) and mixed tactile-somatosensory (1 randomised controlled trial; n = 50) disorders. None addressed hearing, taste or smell disorders. One non-invasive brain stimulation, one compensation, 25 restitution and 4 mixed interventions were described. Risk of bias was low for random sequence generation (13/18), attrition (14/18) and outcome reporting (16/18). Perception was the most commonly measured outcome (11 randomised controlled trials); only 7 randomised controlled trials measured activities of daily living. Limited data provided insufficient evidence to determine the effectiveness of any intervention. Confidence in the evidence was low-very low. Our clinical (n = 4) and lived experience (n = 5) experts contributed throughout the project, coproducing a list of clinical implications and research priorities. Top research priorities included exploring the impact of, assessment of, and interventions for post-stroke perceptual disorders.

Limitations

Results are limited by the small number of studies identified and the small sample sizes, with a high proportion of single-participant studies. There was limited description of the perceptual disorders and intervention(s) evaluated. Few studies measured outcomes relating to functional impacts. There was limited investigation of hearing, smell, taste and touch perception disorders.

Conclusion

Evidence informing interventions for perceptual disorders after stroke is limited for all senses.

Future work

Further research, including high-quality randomised controlled trials, to inform clinical practice are required.

Study registration

This study is registered as PROSPERO CRD42019160270.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR128829) and is published in full in Health Technology Assessment; Vol. 28, No. 69. See the NIHR Funding and Awards Website for further award information.

Complementary and Alternative Therapies for Genitourinary Syndrome of Menopause : An Evidence Map

BACKGROUND

Women seeking nonhormonal interventions for vulvovaginal, urinary, and sexual symptoms associated with genitourinary syndrome of menopause (GSM) may seek out complementary and alternative medicine or therapies (CAMs).

PURPOSE

To summarize published evidence of CAMs for GSM.

DATA SOURCES

Ovid MEDLINE, EMBASE, and CINAHL from inception through 11 December 2023.

STUDY SELECTION

Randomized controlled trials (RCTs) 8 weeks or more in duration that evaluated the effectiveness or harms of CAMs for postmenopausal women with GSM and reported 1 or more outcomes of interest, with sample sizes of 20 or more participants randomly assigned per group.

DATA EXTRACTION

Data were abstracted by 1 reviewer and verified by a second.

DATA SYNTHESIS

An evidence map approach was used to organize and describe trials. Studies were organized by type of intervention, with narrative summaries for population, study characteristics, interventions, and outcomes. Fifty-seven trials were identified that investigated 39 unique interventions. Studies were typically small (n < 200), and most were done in Iran (k = 24) or other parts of Asia (k = 9). Few trials evaluated similar combinations of populations, interventions, comparators, or outcomes. Most studies (k = 44) examined natural products (that is, herbal or botanical supplements and vitamins), whereas fewer reported on mind and body practices (k = 6) or educational programs (k = 7). Most studies reported 1 or 2 GSM symptoms, mainly sexual (k = 44) or vulvovaginal (k = 30). Tools used to measure outcomes varied widely. Most trials reported on adverse events (k = 33).

LIMITATIONS

Only English-language studies were used. Effect estimates, risk of bias, and certainty of evidence were not assessed.

CONCLUSION

There is a large and heterogeneous literature of CAM interventions for GSM. Trials were small, and few were done in North America. Standardized population, intervention, comparator, and outcomes reporting in future RCTs are needed.

PRIMARY FUNDING SOURCE

Agency for Healthcare Research and Quality and Patient-Centered Outcomes Research Institute. (PROSPERO: CRD42023400684).

What do we Know about Complex-Contrast Training? A Systematic Scoping Review

BACKGROUND

The complex-contrast training (CCT) method utilizes two exercises with different loads and movement velocities in a set-by-set fashion to induce multiple neuromuscular adaptations. The speculated primary mechanism involves the post-activation potentiation or post-activation performance enhancement (PAPE) of the muscles used during the heavy load (low velocity) exercise, thereby improving the performance of lower load (high velocity) exercise. However, no previous study has attempted to systematically synthesize the available evidence on CCT (e.g., if post-activation potentiation or PAPE was measured during the training sessions during the intervention period). This study aimed to synthesize the available evidence on CCT using a systematic scoping review approach. More specifically, we identified gaps in the literature using an evidence gap map (EGM), and provided future directions for research.

METHODS

Three electronic databases (PubMed, Scopus, and Web of Science) were searched up to 20th February 2024. Data were extracted under a PICO framework: (a) Participants-related data (e.g., age, sex, type of sport); (b) Intervention-related data (e.g., duration of training); (c) Comparators (when available); and (d) Outcomes (e.g., measures of physical fitness). Interactive EGMs were created using the EPPI mapper software.

RESULTS

From the 5,695 records screened, 68 studies were eligible for inclusion, involving 1,821 participants (only 145 females from 5 studies). All CCT interventions lasted ≤ 16 weeks. More than half of the studies assessed countermovement jump, sprint, and maximal strength performances. No studies were identified which examined upper-body CCT exercises alone, and no study assessed PAPE during the CCT sessions. Overall, the available evidence was rated with a low level of confidence.

CONCLUSIONS

In conclusion, whether CCT produces a PAPE that translates into longitudinal performance gains remains unclear. Moreover, the available evidence on the effects of CCT on various outcomes provides low confidence regarding the most effective way to implement this training method, particularly among females, and beyond long-term interventions.

Chiropractic and Spinal Manipulation: A Review of Research Trends, Evidence Gaps, and Guideline Recommendations

Chiropractors diagnose and manage musculoskeletal disorders, commonly using spinal manipulative therapy (SMT). Over the past half-century, the chiropractic profession has seen increased utilization in the United States following Medicare authorization for payment of chiropractic SMT in 1972. We reviewed chiropractic research trends since that year and recent clinical practice guideline (CPG) recommendations regarding SMT. We searched Scopus for articles associated with chiropractic (spanning 1972-2024), analyzing publication trends and keywords, and searched PubMed, Scopus, and Web of Science for CPGs addressing SMT use (spanning 2013-2024). We identified 6286 articles on chiropractic. The rate of publication trended upward. Keywords initially related to historical evolution, scope of practice, medicolegal, and regulatory aspects evolved to include randomized controlled trials and systematic reviews. We identified 33 CPGs, providing a total of 59 SMT-related recommendations. The recommendations primarily targeted low back pain (n = 21) and neck pain (n = 14); of these, 90% favored SMT for low back pain while 100% favored SMT for neck pain. Recent CPG recommendations favored SMT for tension-type and cervicogenic headaches. There has been substantial growth in the number and quality of chiropractic research articles over the past 50 years, resulting in multiple CPG recommendations favoring SMT. These findings reinforce the utility of SMT for spine-related disorders.

Evidence map of traditional Chinese exercises

Objective

This study aimed to assess and visually depict the clinical evidence landscape of traditional Chinese exercises and identify any research gaps and future research needs.

Methods

We comprehensively searched seven Chinese and English databases to identify randomized controlled trials (RCTs) and systematic reviews (SRs) evaluating the effects of traditional Chinese exercises from their inception until May 2023. The quality of evidence was assessed via the GRADE approach, and the research topics, intervention effects, and strength of evidence were graphically displayed.

Results

This evidence map includes 2,017 studies, comprising 1,822 RCTs and 195 SRs. These studies were conducted globally in various countries. Among the traditional Chinese exercises, Tai Chi and Baduanjin have received the most research attention, with a growing number of publications. When traditional Chinese exercises were compared with the control groups, 88.2% of the included SRs reported significantly positive effects, 4.1% reported unclear effects, and 7.7% reported no significant differences. The findings suggested that traditional Chinese exercises could benefit patients with osteoarthritis, osteoporosis, hypertension, coronary heart disease, diabetes, chronic obstructive pulmonary disease, stroke, Parkinson's disease, anxiety, and depression. However, the overall quality of the evidence was suboptimal, with 11.3% rated as moderate, 45.6% as low, and 43.1% as critically low.

Conclusion

This evidence map visually represents valuable information on traditional Chinese exercises. While most studies have reported significant benefits, the overall quality of evidence is low.

Investigating innovations in outpatient services: a mixed-methods rapid evaluation

Background

Within outpatient services, a broad range of innovations are being pursued to better manage care and reduce unnecessary appointments. One of the least-studied innovations is Patient-Initiated Follow-Up, which allows patients to book appointments if and when they need them, rather than follow a standard schedule.

Objectives

To use routine national hospital data to identify innovations in outpatient services implemented, in recent years, within the National Health Service in England. To carry out a rapid mixed-methods evaluation of the implementation and impact of Patient-Initiated Follow-Up.

Methods

The project was carried out in four sequential workstreams: (1) a rapid scoping review of outpatient innovations; (2) the application of indicator saturation methodology for scanning national patient-level data to identify potentially successful local interventions; (3) interviews with hospitals identified in workstream 2; and (4) a rapid mixed-methods evaluation of Patient-Initiated Follow-Up. The evaluation of Patient-Initiated Follow-Up comprised an evidence review, interviews with 36 clinical and operational staff at 5 National Health Service acute trusts, a workshop with staff from 13 National Health Service acute trusts, interviews with four patients, analysis of national and local data, and development of an evaluation guide.

Results

Using indicator saturation, we identified nine services with notable changes in follow-up to first attendance ratios. Of three sites interviewed, two queried the data findings and one attributed the change to a clinical assessment service. Models of Patient-Initiated Follow-Up varied widely between hospital and clinical specialty, with a significant degree of variation in the approach to patient selection, patient monitoring and discharge. The success of implementation was dependent on several factors, for example, clinical condition, staff capacity and information technology systems. From the analysis of national data, we found evidence of an association between greater use of Patient-Initiated Follow-Up and a lower frequency of outpatient attendance within 15 out of 29 specialties and higher frequency of outpatient attendance within 7 specialties. Four specialties had less frequent emergency department visits associated with increasing Patient-Initiated Follow-Up rates. Patient-Initiated Follow-Up was viewed by staff and the few patients we interviewed as a positive intervention, although there was varied impact on individual staff roles and workload. It is important that sites and services undertake their own evaluations of Patient-Initiated Follow-Up. To this end we have developed an evaluation guide to support trusts with data collection and methods.

Limitations

The Patient-Initiated Follow-Up evaluation was affected by a lack of patient-level data showing who is on a Patient-Initiated Follow-Up pathway. Engagement with local services was also challenging, given the pressures facing sites and staff. Patient recruitment was low, which affected the ability to understand experiences of patients directly.

Conclusions

The study provides useful insights into the evolving national outpatient transformation policy and for local practice. Patient-Initiated Follow-Up is often perceived as a positive intervention for staff and patients, but the impact on individual outcomes, health inequalities, wider patient experience, workload and capacity is still uncertain.

Future research

Further research should include patient-level analysis to determine clinical outcomes for individual patients on Patient-Initiated Follow-Up and health inequalities, and more extensive investigation of patient experiences.

Study registration

This study is registered with the Research Registry (UIN: researchregistry8864).

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 16/138/17) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 38. See the NIHR Funding and Awards website for further award information.

Evidence mapping and quality assessment of systematic reviews on exercise intervention for Alzheimer's disease

BACKGROUND

A significant body of literature suggests that exercise can reverse cognitive impairment and ameliorate somatic function in patients with Alzheimer's disease (AD). Systematic reviews (SRs), a common approach of evidence-based medicine, concentrate on a specific issue of a research area. The objective of this work is to provide an overview of existing evidence on the effects of exercise intervention in AD patients and report related health outcomes by reviewing SRs.

METHODS

SRs on exercise intervention in AD patients were retrieved from the PubMed, the Cochrane Library, CBMdisc, Scopus, Web of Science, Embase (via Ovid), China National Knowledge Infrastructure, and WanFang databases from the time of inception to February 2023. The quality of the SRs was evaluated utilizing the A Measurement Tool to Assess Systematic Review 2 (AMSTAR 2) checklist. The results were reported according to the population-intervention-comparison-outcome (PICO) framework and the corresponding evidence mapping was illustrated in tables and bubble plots.

RESULTS

A total of 26 SRs met the eligibility criteria. In terms of methodological quality, 10 SRs were rated as "critically low", 13 SRs were rated as "low", and 3 SRs were rated as "moderate". Exercise was found to exert a beneficial effect on cognitive function, functional independence, physical function, and neuropsychiatric symptoms in patients with AD.

CONCLUSION

Exercise intervention benefits AD patients mainly by improving cognitive function, physical function, functional independence, and neuropsychiatric symptoms. However, due to the low-to-moderate methodology of most SRs included in this analysis, further investigations are required to support our current findings.

Evidence Map of Non-Pharmacological Dementia Care Partner Interventions Implemented in the US: Gaps and Impact Opportunities

There are 200+ tested interventions for care partners (family, friends, and fictive kin) of people living with dementia (PLWD). But these interventions do not systematically cover relevant settings. Nor do these interventions affect all relevant outcomes that matter to people and healthcare systems. We present an evidence map of settings and outcomes from translated interventions to identify gaps. Of 190 studies identified, 31 unique interventions were retained in the evidence map. Identified setting gaps included studies set solely in hospitals/medical centers or set in multiple settings. Identified outcome gaps included interventions that improved care partner beliefs about providing care, care partner negative coping strategies, PLWD resources (e.g., social support), and PLWD coping strategies. Armed with an understanding of present gaps, we call on researchers to fill the identified gaps to ensure systematic coverage of settings and evaluation of outcomes that matter to people and healthcare systems.

Mapping the cited evidence of ductal carcinoma in situ from the 5th edition of the World Health Organisation classification of tumours of the breast

AIMS

Ductal carcinoma in situ (DCIS) is recognised by the World Health Organisation (WHO) Classification of Tumours (WCT) as a non-invasive neoplastic epithelial proliferation confined to the mammary ducts and lobules. This report categorises the references cited in the DCIS chapter of the 5th edition of the WCT (Breast Tumours) according to prevailing evidence levels for evidence-based medicine and the Hierarchy of Evidence for Tumour Pathology (HETP), identifying potential gaps that can inform subsequent editions of the WCT for this tumour.

METHODS AND RESULTS

We included all citations from the DCIS chapter of the WCT (Breast Tumours, 5th edition). Each citation was appraised according to its study design and evidence level. We developed our map of cited evidence, which is a graphical matrix of tumour type (column) and tumour descriptors (rows). Spheres were used to represent the evidence, with size and colour corresponding to their number and evidence level respectively. Thirty-six publications were retrieved. The cited literature in the DCIS chapter comprised mainly case series and were regarded as low-level. We found an unequal distribution of citations among tumour descriptors. 'Pathogenesis' and 'prognosis and prediction' contained the most references, while 'clinical features', 'aetiology' and 'diagnostic molecular pathology' had only a single citation each. 'Prognosis and prediction' had the greatest proportion of moderate- and high-levels of evidence.

CONCLUSION

Our findings align with the disposition for observational studies inherent in the field of pathology. Our map is a springboard for future efforts in mapping all available evidence on DCIS, potentially augmenting the editorial process and future editions of WCTs.

An evidence map on traditional medicine across health outcomes

Background

Traditional medicine (TM) plays a significant role in healthcare either as part of the primary healthcare system or as an adjunct to conventional medicine. This study aimed to map systematic reviews (SRs) of TM modalities across health conditions and identify gaps in the research literature to facilitate priority setting in future TM research.

Methods

We searched 17 databases from January 2018 to December 2022. Reviewers in pairs independently performed the database search, screened each record for inclusion, extracted data, and performed quality assessments using the AMSTAR 2 - A Measurement Tool to Assess systematic Reviews. To be included in this evidence map, the studies had to be SRs of clinical studies that evaluated the effectiveness of a TM modalities. The included SRs were analyzed according to TM modality, ICD-11 disease classification, and health outcomes, and visualized using graphical plots.

Results

We retrieved 241,509 records. After excluding duplicate records, 181,616 titles and abstracts were screened and 20,856 records were selected for full-text assessment, of which 18,137 records were further excluded. The final 2719 included SRs were primarily in adults (2591) with only 128 SRs in the pediatric population. The most commonly evaluated health conditions were diseases of the digestive system, circulatory system, and genitourinary system, with herbal medicine (n = 1867) and acupuncture (n = 471) being the most investigated TM modalities in treating these illnesses. Based on AMSTAR 2 criteria, the methodology quality of the included SRs is considerably low.

Conclusion

This evidence map provides a comprehensive overview of the extent and nature of the available research onTM modalities across health conditions. It provides an initial step towards characterizing the global evidence base and outlining gaps in the existing evidence. We regard this study as laying the basis for future research of TM modalities.

Registration

The protocol of this map is registered in PROSPERO (CRD42023416355).

Barriers and facilitators of cardiovascular disease prevention services for women with prior gestational diabetes or hypertensive disorders of pregnancy in low-income, middle-income and high-income settings: a scoping review protocol

INTRODUCTION

Women with previous pregnancy-related cardiovascular risk indicators, including gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP), have an increased risk of future cardiovascular disease (CVD). Although CVD screening and preventive care beginning in the early postpartum period are recommended, certain barriers limit access to such services. We plan to conduct a scoping review of the literature to explore and summarise evidence on the barriers and facilitators of postpartum CVD preventive services in women with a history of GDM and HDP.

METHODS AND ANALYSIS

This scoping review will be conducted in line with the Arksey and O'Malley's (2005) methodological framework and the Joanna Briggs Institute guidance for conducting a systematic scoping review and will follow the Evidence for Policy and Practice Information and the Coordinating Centre at the Institute of Education guidelines. The review results will be reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. We will search the following databases: Medline, Embase and CINAHL. We will conduct grey literature searches for registered dissertations and theses. Inclusion and exclusion criteria will be kept broad. Qualitative and quantitative studies published in English or French that investigated and reported percieved barriers or facilitators to postpartum CVD screening and preventive care among women with previous GDM and HDP will be included. Individual, interpersonal, organizational, and system level factors will be reported. Qualitative findings will be summarised narratively, and quantitative findings will be absorbed within the themes using the multisource synthesis method.

ETHICS AND DISSEMINATION

This review represents one objective of a larger project that was reviewed by the Ottawa Health Sciences Network Research Ethics Board (QI-184). We will disseminate knowledge emanating from this review through open-access publication, presentation/public forums on women's cardiovascular health, women's CVD prevention forums and social media. We will also present the findings of this review at the annual meeting of the Canadian Women's Heart Health Alliance.

Evaluation of quality and quantity of randomized controlled trials in hepatobiliary surgery: A scoping/mapping review

AIM

To evaluate the quantity and quality of randomized controlled trials (RCTs) in hepatobiliary surgery and for identifying gaps in current evidences.

METHODS

A systematic search was conducted in MEDLINE (via PubMed), Web of Science, and Cochrane Controlled Register of Trials (CENTRAL) for RCTs of hepatobiliary surgery published from inception until the end of 2023. The quality of each study was assessed using the Cochrane risk-of-bias (RoB) tool. The associations between risk of bias and the region and publication date were also assessed. Evidence mapping was performed to identify research gaps in the field.

RESULTS

The study included 1187 records. The number and proportion of published randomized controlled trials (RCTs) in hepatobiliary surgery increased over time, from 13 RCTs (.0005% of publications) in 1970-1979 to 201 RCTs (.003% of publications) in 2020-2023. There was a significant increase in the number of studies with a low risk of bias in RoB domains (p < .01). The proportion of RCTs with low risk of bias improved significantly after the introduction of CONSORT guidelines (p < .001). The evidence mapping revealed a significant research focus on major and minor hepatectomy and cholecystectomy. However, gaps were identified in liver cyst surgery and hepatobiliary vascular surgery. Additionally, there are gaps in the field of perioperative management and nutrition intervention.

CONCLUSION

The quantity and quality of RCTs in hepatobiliary surgery have increased over time, but there is still room for improvement. We have identified gaps in current research that can be addressed in future studies.

Effectiveness of exercise on pain intensity and physical function in patients with knee and hip osteoarthritis: an umbrella and mapping review with meta-meta-analysis

PURPOSE

The aim of this review was to provide a qualitative and quantitative overview of the effects of exercise on pain, physical function, and quality of life for patients with knee and hip osteoarthritis.

MATERIALS AND METHODS

This study was an umbrella and mapping review with meta-meta-analysis. Meta-analyses of randomized controlled trials were included. The methodological quality and risk of bias were evaluated using the Modified Quality Assessment Scale for Systematic Reviews and the Risk of Bias in Systematic Reviews tool. The quality of evidence was evaluated using the Physical Activity Guidelines Advisory Committee Grading Criteria.

RESULTS

41 meta-analyses were included, 43.9% of the studies had adequate methodological quality, and 56.1% of the studies had a low risk of bias. Moderate evidence was found that exercise decreases pain intensity (33 meta-analyses; SMD = -0.49; 95% CI -0.56 to -0.42), improves function (19 meta-analyses; SMD = -0.50; 95% CI -0.58 to -0.41), strength (6 meta-analyses; SMD = -0.57; 95% CI -0.70 to -0.44) and quality of life (SMD = -0.36; 95% CI -0.46 to -0.27) for patients with hip and knee osteoarthritis.

CONCLUSION

Exercise is an effective intervention to decrease pain intensity and improve function in patients with hip and knee osteoarthritis.(PROSPERO, CRD42020221987).

Solving the High-Intensity Multimodal Training Prescription Puzzle: A Systematic Mapping Review

BACKGROUND

High-Intensity Multimodal Training (HIMT) refers to all styles of high-intensity combined aerobic, resistance and/or bodyweight exercise. Previous heterogeneity in exercise prescription and reporting in HIMT reduces the understanding of which factors should be considered when prescribing HIMT (e.g., exercise volume, intensity, duration). Previous studies have demonstrated positive effects of HIMT on health and performance outcomes. However, methodological disparities limit comparisons between findings. The objective of this systematic mapping review was to examine which prescriptive considerations and health and performance outcomes have been reported on in HIMT. This review also examined the quantity and trends of research conducted on HIMT.

METHODS

A systematic literature search was conducted using Ovid Medline, SPORTDiscus and Cochrane Library databases and additional sources to identify studies up until February 2023. A total of 37,090 records were retrieved, of which 220 were included for review. 246 individual HIMT protocols were included for categorical analysis against the Consensus on Exercise Reporting Template (CERT) and Applied Research Model for the Sport Sciences (ARMSS).

RESULTS

A total of 85 unique terms were used to describe HIMT. Included studies most commonly prescribed HIMT using a consistent exercise selection and circuit format. Exercise intensity was inconsistently reported on and a large proportion of studies prescribed 'high-intensity' exercise at a level lower than the American College of Sports Medicine criteria for high-intensity (i.e., < 77% heart rate maximum). Participation location, supervision and participation format were the most commonly reported non-training variables. The most frequently reported outcomes were cardiovascular health, perceptual outcomes, body composition and biochemical outcomes. A large proportion of previous HIMT research was experimental in design.

CONCLUSIONS

Previous HIMT research demonstrates a lack of standardisation in reporting. Future studies should seek to follow guidelines (i.e., CERT) to improve reporting rigour. Additionally, forthcoming research should attempt to actively involve practitioners in implementation studies to improve ecological validity among interventions. Finally, future outcome measures should be accessible in practice and reflect common training goals of participants.

REGISTRATION

This review adhered to PRISMA-ScR guidelines.

PREREGISTRATION

osf.io/yknq4.

Parenting a High and Growing Population of Youth in the Arab Region: A Scoping Review for an Evidence-Informed Research Agenda

The Arab region is experiencing the largest youth cohort in its history. Parental influence is a clear factor in the well-being of this demographic. This scoping review serves as the first consolidated synthesis of existing research on parenting in the Arab world, aimed at identifying research gaps and informing future research agendas. Searches of 18 databases resulted in 4,758 records (1995-2018) in all languages. Using Arksey and O'Malley's methodological framework, eligible studies (n = 152) underwent duplicate data abstraction. An evidence gap map was developed using 3i.e.'s platform. Studies were mostly published in English (88%), and lead authors' affiliations were mostly from Arab institutions. Included studies were mostly cross-sectional (89%), quantitative (96%), conducted in a school/university (83%), and surveyed children and adolescents (70%). Most studies (79%) examined parenting influences on youth outcomes. Fewer examined parenting measurement (30%) or evaluated interventions (1%). Mental health and school performance were the most commonly investigated outcomes. The evidence gap map allows researchers who study youth in the Arab world to efficiently and visually delineate the gaps and strategically prioritize research needs. Future studies should employ robust mixed methods study designs, focus on evaluation and psychometric research, engage youth in the research process and explore a more diverse set of outcomes.

How much do we know about nursing care delivery models in a hospital setting? A mapping review

To deal with the upcoming challenges and complexity of the nursing profession, it is deemed important to reflect on our current organization of care. However, before starting to rethink the organization of nursing care, an overview of important elements concerning nursing care organization, more specifically nursing models, is necessary. The aim of this study was to conduct a mapping review, accompanied by an evidence map to map the existing literature, to map the field of knowledge on a meta-level and to identify current research gaps concerning nursing models in a hospital setting. Next to nursing models, two other organizational correlates seem to be of importance when looking at the organization of nursing care: nurse staffing and skill mix. Although it seems that in recent research, the theoretical focus on the organization of nursing care has been left behind, the increasingly complex healthcare environment might gain from the use of nursing theory, or in this case, care delivery models. As almost no fundamental studies have been done toward the combination of care delivery models, nurse staffing, and skill mix, those elements should be taken into account to fully capture the organization of nursing care in future research.

Use of Massage Therapy for Pain, 2018-2023: A Systematic Review

Importance

Massage therapy is a popular treatment that has been advocated for dozens of painful adult health conditions and has a large evidence base.

Objective

To map systematic reviews, conclusions, and certainty or quality of evidence for outcomes of massage therapy for painful adult health conditions.

Evidence Review

In this systematic review, a computerized search was conducted of PubMed, the Allied and Complementary Medicine Database, the Cumulated Index to Nursing and Allied Health Literature, the Cochrane Database of Systematic Reviews, and Web of Science from 2018 to 2023. Included studies were systematic reviews of massage therapy for pain in adult health conditions that formally rated the certainty, quality, or strength of evidence for conclusions. Studies of sports massage therapy, osteopathy, dry cupping or dry needling, and internal massage therapy (eg, for pelvic floor pain) were ineligible, as were self-administered massage therapy techniques, such as foam rolling. Reviews were categorized as those with at least 1 conclusion rated as high-certainty evidence, at least 1 conclusion rated as moderate-certainty evidence, and all conclusions rated as low- or very low-certainty evidence; a full list of conclusions and certainty of evidence was collected.

Findings

A total of 129 systematic reviews of massage therapy for painful adult health conditions were found; of these, 41 reviews used a formal method to rate certainty or quality of evidence of their conclusions and 17 reviews were mapped, covering 13 health conditions. Across these reviews, no conclusions were rated as high certainty of evidence. There were 7 conclusions that were rated as moderate-certainty evidence; all remaining conclusions were rated as low- or very low-certainty evidence. All conclusions rated as moderate certainty were that massage therapy had a beneficial associations with pain.

Conclusions and Relevance

This study found that despite a large number of randomized clinical trials, systematic reviews of massage therapy for painful adult health conditions rated a minority of conclusions as moderate-certainty evidence and that conclusions with moderate- or high-certainty evidence that massage therapy was superior to other active therapies were rare.

Scientific Committee guidance on appraising and integrating evidence from epidemiological studies for use in EFSA's scientific assessments

EFSA requested its Scientific Committee to prepare a guidance document on appraising and integrating evidence from epidemiological studies for use in EFSA's scientific assessments. The guidance document provides an introduction to epidemiological studies and illustrates the typical biases, which may be present in different epidemiological study designs. It then describes key epidemiological concepts relevant for evidence appraisal. This includes brief explanations for measures of association, exposure assessment, statistical inference, systematic error and effect modification. The guidance then describes the concept of external validity and the principles of appraising epidemiological studies. The customisation of the study appraisal process is explained including tailoring of tools for assessing the risk of bias (RoB). Several examples of appraising experimental and observational studies using a RoB tool are annexed to the document to illustrate the application of the approach. The latter part of this guidance focuses on different steps of evidence integration, first within and then across different streams of evidence. With respect to risk characterisation, the guidance considers how evidence from human epidemiological studies can be used in dose-response modelling with several different options being presented. Finally, the guidance addresses the application of uncertainty factors in risk characterisation when using evidence from human epidemiological studies.

A mapping review of Pacific Vascular Symposium 6 initiatives

OBJECTIVE

The 2010 Pacific Vascular Symposium 6 (PVS6) brought venous disease content experts together with a goal of addressing critical issues collated together in the next decade with concrete plans to achieve these goals. This mapping review aims to provide a broader representation of how progress in critical issues of chronic venous disease has been made by extrapolating scientific publications related to the PVS6 initiatives.

METHODS

We performed a mapping review identifying original or systematic review/meta-analysis articles related to PVS 6 initiatives (aims) that addressed one of the following key objectives: scales to measure chronic venous disease, effectiveness of interventional deep venous thrombus removal, development of a deep venous valve, and biomarkers related to venous disease. Searches were undertaken in PubMed, Ovid Medline, Cochrane Library, Embase (Elsevier), CINAHL (EBSCO), and Scopus. We extracted descriptive information about the studies and predefined variables for each specific aim, showing what and where research exists on the aims included.

RESULTS

A total of 2138 articles were screened from 3379 retrieved articles from six electronic databases. We mapped 186 included articles, finding that the total number of publications significantly increased after the 2010 PVS6 meeting. Aim results were visually summarized. The largest body of data addressed catheter-based thrombus removal strategies for acute iliofemoral deep venous thrombosis. Primary research on artificial venous valves and venous biomarkers remained limited. No new post-thrombotic syndrome (PTS) score has been developed.

CONCLUSIONS

This mapping review identified and characterized the available evidence and gaps in our knowledge of chronic venous disease that exist visually, which may guide where more significant investments for the future should be targeted.

Exploring the influence of weather variability and climate change on health outcomes in people living with dementia: A scoping review protocol

Environmental factors resulting from climate change and air pollution are risk factors for many chronic conditions including dementia. Although research has shown the impacts of air pollution in terms of cognitive status, less is known about the association between climate change and specific health-related outcomes of older people living with dementia. In response, we outline a scoping review protocol to systematically review the published literature regarding the evidence of climate change, including temperature and weather variability, on health-related quality of life, morbidity, mobility, falls, the utilization of health resources, and mortality among older adults living with dementia. This scoping review will be guided by the framework proposed by Arksey and O'Malley. Electronic search (Medline, Embase, PsycINFO, CINAHL, Scopus, Web of Science) using relevant subject headings and synonyms for two concepts (older people with dementia, weather/ climate change). No publication date or other restrictions will be applied to the search strategy. No language restriction will be applied in order to understand the impact of non-English studies in the literature. Eligible studies must include older adults (65+years) with dementia living in the community and investigate the impacts of climate change and/or weather on their health-related quality of life, morbidity, mobility, falls, use of health resources and mortality. Two independent reviewers will screen abstracts and select those for a full-text review, perform these reviews, select articles for retention, and extract data from them in a standardized manner. This data will then be synthesized and interpreted. OSF registration: DOI: 10.17605/OSF.IO/YRFM8.

Overview of Cochrane Systematic Reviews on Interventions for Rehabilitation in People with Ischemic Heart Disease: A Mapping Synthesis

Objectives: This overview of Cochrane Systematic Reviews (CSRs) reports on current evidence and its certainty of the effectiveness of interventions for the rehabilitation of people with ischemic heart disease (IHD), included in the World Health Organization Rehabilitation Programme Package of Interventions for Rehabilitation. Methods: We included all the CSRs relevant to people with IHD. We used a mapping synthesis to group outcomes and comparisons of included CSRs, indicating the effectiveness of interventions for rehabilitation and the certainty of evidence. Results: The evidence map included a total of 13 CSRs. The effect of the interventions varied across comparisons, and the certainty of evidence was inconsistent, ranging from high to very low. We found the best evidence for exercise-based cardiac rehabilitation in the reduction of fatal and non-fatal myocardial infarction and all-cause hospital admission up to 12 months follow-up. Also, combined interventions (work-directed interventions, physical conditioning interventions, and psychological interventions) reduce the days needed for returning to work. Conclusions: The current effect and certainty of evidence for several comparisons investigated support the role of exercise-based cardiac rehabilitation in the management of people with IHD, specifically reducing the risk of fatal and non-fatal myocardial infarction and hospitalisation. However, our findings highlight the lack of high-certainty evidence about hard endpoints, particularly total mortality. Future research should prioritise these primary endpoints to enhance the credibility of cardiac rehabilitation.

Physiological measures of operators' mental state in supervisory process control tasks: a scoping review

Physiological measures are often used to assess the mental state of human operators in supervisory process control tasks. However, the diversity of research approaches creates a heterogeneous landscape of empirical evidence. To map existing evidence and provide guidance to researchers and practitioners, this paper systematically reviews 109 empirical studies that report relationships between peripheral nervous system measures and mental state dimensions (e.g. mental workload, mental fatigue, stress, and vigilance) of interest. Ocular and electrocardiac measures were the most prominent measures across application fields. Most studies sought to validate such measures for reliable assessments of cognitive task demands and time on task, with measures of pupil size receiving the most empirical support. In comparison, less research examined the utility of physiological measures in predicting human task performance. This approach is discussed as an opportunity to focus on operators' individual response to cognitive task demands and to advance the state of research.

Ambulance service recognition of health inequalities and activities for reduction: An evidence and gap map of the published literature

Background

Emergency medical services (EMS) are often patients' first point of contact for urgent and emergency care needs. Patients are triaged over the phone and may receive an ambulance response, with potential conveyance to the hospital. A recent scoping review suggested disparities in EMS patient care in the United States. However, it is unknown how health inequalities impact EMS care in other developed countries and how inequalities are being addressed.

Objectives

This rapid evidence map of published literature aims to map known health inequalities in EMS patients and describe interventions reducing health inequalities in EMS patient care.

Methods

The search strategy consisted of EMS synonyms and health inequality synonyms. The MEDLINE/PubMed database was searched from 1 January 2010 to 26 July 2022. Studies were included if they described empirical research exploring health inequalities within ambulance service patient care. Studies were mapped on to the EMS care interventions framework and Core20PLUS5 framework. Studies evaluating interventions were synthesised using the United Kingdom Allied Health Professions Public Health Strategic Framework.

Results

The search strategy yielded 771 articles, excluding duplicates, with two more studies added from hand searches. One hundred studies met the inclusion criteria after full-text review. Inequalities in EMS patient care were predominantly situated in assessment, treatment and conveyance, although triage and response performance were also represented. Studies mostly explored EMS health inequalities within ethnic minority populations, populations with protected characteristics and the core issue of social deprivation. Studies evaluating interventions reducing health inequalities (n = 5) were from outside the United Kingdom and focused on older patients, ethnic minorities and those with limited English proficiency. Interventions included community paramedics, awareness campaigns, dedicated language lines and changes to EMS protocols.

Conclusions

Further UK-based research exploring health inequalities of EMS patients would support ambulance service policy and intervention development to reduce health inequality in urgent and emergency care delivery.