Publication Bias: The Elephant in the Review

The impact of feedback elements in serious games on nursing learning outcomes: A systematic review and meta-analysis

OBJECTIVE

This study evaluates the impact of different feedback elements in serious games (SGs) on nursing education outcomes.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

6546 English-language studies published between 2000 and 2023 were retrieved from seven electronic databases.

REVIEW METHODS

This systematic review and meta-analysis followed the PRISMA guidelines. The Cochrane Risk of Bias tool was used for quality assessment. Meta-analysis and subgroup analysis were conducted using RevMan 5.4, and the certainty of evidence for each outcome was assessed using the GRADE approach.

RESULTS

Eight studies were included in the meta-analysis. Findings showed that, compared to traditional learning methods, outcome feedback had a moderate effect size on knowledge (SMD = 0.51, 95 % CI [0.09, 0.92]), while comparative feedback had a small, non-significant effect size (SMD = 0.38, 95 % CI [-0.36, 1.12]). Immediate feedback had a large effect size on skills (SMD = 0.87, 95 % CI [0.61, 1.14]), and outcome feedback had a moderate effect size (SMD = 0.50, 95 % CI [0.21, 0.79]). Serious games with feedback had a large effect size on motivation (SMD = 1.31, 95 % CI [0.45, 2.17]). For confidence, outcome feedback had a moderately large effect size (SMD = 0.64, 95 % CI [-0.22, 1.51]), and comparative feedback had a small effect size (SMD = 0.24, 95 % CI [-0.44, 0.91]), but neither reached statistical significance. GRADE assessment showed high certainty for immediate feedback on skills, moderate certainty for outcome feedback on knowledge and skills, and very low certainty for comparative feedback on knowledge. Evidence certainty for motivation and confidence was low or very low.

CONCLUSION

Serious games incorporating feedback elements can enhance nursing students' motivation. Immediate feedback significantly improves nursing skills, while outcome feedback improves knowledge acquisition. However, further research is needed to validate these findings due to the limited number of studies and high heterogeneity.

Association between nailfold capillaroscopic findings and diabetes: a systematic review and meta-analysis

PURPOSE

People with diabetes often experience abnormal microcirculation, which can lead to various complications. This study aimed to investigate the relevance of nailfold capillaroscopy-a non-invasive imaging modality-in characterizing microvascular alterations specific to diabetes mellitus (DM).

METHODS

PubMed, Web of Science, and Baidu Academic were searched for relavant studies that investigated the associations between nailfold microcirculation abnormalities and DM. The quality of included studies was assessed using the National Institutes of Health (NIH) Quality Assessment tool for Observational Cohort and Cross-Sectional Studies. Meta-analysis was conducted to assess the relationship of various nailfold capillaroscopic findings with DM, and subgroup analysis was used to explore heterogeneity.

RESULTS

Ten studies with 1,423 participants were included. The quality of two studies was rated as Good, one as Poor, and the other seven were rated as Normal. The pooled analysis revealed significant correlations between various nailfold capillaroscopic findings and DM, including tortuosity (odds ratio [OR] 8.33, 95% confidence interval [CI]: 2.31-30.04), abnormal morphology (OR 5.00, 95% CI 3.03-8.26), ectasia (OR 4.86, 95% CI 2.56-9.20), bushy capillaries (OR 29.09, 95% CI 5.90-143.55), hemorrhage (OR 5.33, 95% CI 2.31-12.34), avascular areas (OR 6.14, 95% CI 1.40-26.86), bizarre capillaries (OR 10.33, 95% CI 2.79-38.31), and meander capillaries (OR: 2.84, 95% CI 1.25-6.45). Subgroup analysis showed strong associations between nailfold capillaroscopic findings and type 2 diabetes mellitus (T2DM).

CONCLUSION

Our findings demonstrated that distinct nailfold capillary abnormalities aresignificantly correlated with DM, particularly T2DM.

PROTOCOL REGISTRATION

Protocol registered in PROSPERO (registration number: CRD42024608214).

Efficacy of Olive Leaf Extract in Improving Blood Pressure in Pre-Hypertensive and Hypertensive Individuals: A Systematic Review and Meta-Analysis

Annually, approximately 10 million deaths are attributed to hypertension, highlighting the critical need for effective treatments beyond conventional medications due to their limitations. Therefore, the aim of this study was to evaluate the impact of Olea europaea L. on blood pressure in adults with prehypertension and hypertension. The search, conducted from November/2022-October/2024 was performed on EBSCO, CABI, CNKI, Cochrane Library, DOAJ, PUBMED, SCOPUS, and WEB OF SCIENCE databases using Hypertension AND Olea europaea L. Eligible studies included those evaluating the effect of Olea europaea L. on systolic/diastolic blood pressure in hypertensive or pre-hypertensive adults. Exclusion criteria were multi-preparation interventions. Data on reference, country, sample, intervention/control details, duration, and differences in systolic and diastolic blood pressure, adverse effects, and medication use were extracted manually. The mean differences, heterogeneity (I2) and quality of the studies were assessed using Review Manager (version 5.4). From 211 found studies, 3 met the eligibility criteria, considering 248 participants analysed. An antihypertensive effect was observed on systolic and diastolic blood pressure in the pre- vs. post-intervention in the global analysis (systolic -6.03 mmHg, 95% CI: [-11.60, -0.46], I2 = 82%, p = 0.03; diastolic -2.38 mmHg, 95% CI: [-4.96, 0.20], I2 = 50%, p = 0.07) and in the sub-analysis that included the studies with the highest dose (1000 mg/day) (systolic -11.45 mmHg, 95% CI:[-13.99, -8.91], I2 = 0%, p ≤ 0.001; diastolic -4.65 mmHg, 95% CI: [-6.56, -2.74], I2 = 0%, p ≤ 0.001). Olive leaf extract (1000 mg/day) may reduce systolic and diastolic blood pressure by -11.45 and -4.65 mmHg, respectively. However, limitations include variable trial quality and exclusion of studies not written in English. Additional comprehensive clinical studies are essential to confirm its efficacy and safety.

The use of gamified interventions to enhance social interaction and communication among people with autism spectrum disorder: A systematic review and meta-analysis

BACKGROUND

Traditional gamified interventions and serious games have been widely employed by therapists and researchers working with people with autism spectrum disorder. Recent studies have also indicated a trend towards technology-based gamification for training behavioral and social skills in autistic people. Nevertheless, the effectiveness of these gamified interventions in enhancing social interaction and communication outcomes among autistic people remains unclear.

OBJECTIVE

This systematic review and meta-analysis of existing gamified interventions focused on people with autism spectrum disorder aimed to provide an overview of commonly used gamification elements and features for enhancing their social interaction and communication outcomes.

METHODS

A total of 11 bibliographic databases were systematically searched from inception to April 2024. Experimental studies, including but not limited to randomized controlled trials, quasi-experimental studies (e.g., non-randomized studies, pre-post studies), and pilot studies. Medical Subject Heading terms, keywords, and free words such as 'ASD', 'gamification', and 'social interaction and communication' were used for the search. The extracted data were subjected to a narrative synthesis, and the study outcomes were subjected to a meta-analysis. Gamified elements were classified based on the most widely adopted gamification elements for learning purposes.

RESULTS

Twenty studies involving 349 participants were eligible. Of 297 participants included for descriptive synthesis, 246 (82.8 %) were male, with a mean age at study entry of 11.55 years. Children and adolescents with autism spectrum disorder were the most common target populations (k = 19, 95 %), followed by the general adult population (k = 1, 5 %). Two main themes related to the application of gamification interventions emerged from the included studies: the augmentation of engagement in the intervention and the amplification of the desired interventional outcomes. Commonly used gamification elements included feedback (k = 10, 50 %), rewards (k = 10, 50 %), custom learning (k = 9, 45 %), monitoring (k = 9, 45 %), and personalization (k = 8, 40 %). Four of the included studies applied 5-7 elements in their interventions. Five studies were included in the meta-analysis, showing a positive overall effect of gamified interventions on social interaction and communication (pooled standardized mean difference: 0.46; 95 % CI 0.08, 0.85; I2 0%).

CONCLUSION

This study offers a comprehensive review of gamification elements and gamified interventions currently used in social interaction and communication skills among people with autism spectrum disorder. The potential benefits of included studies targeting social interaction and communication skills highlight the need for further in-depth investigation in this group. Future randomized controlled trials with more comprehensive development and trials that apply game-related design are suggested.

A systematic review of the relationship between neighborhood stressors, discrimination, and cardiometabolic outcomes during pregnancy

Cardiometabolic outcomes during pregnancy, including hypertensive disorders of pregnancy (HDP) and gestational diabetes, disproportionately affect racial and/or ethnic minority groups in the United States. These disparities are not fully explained by traditional risk factors, but race-related psychosocial stressors such as perceived neighborhood stressors and discrimination (PNSD) may contribute to adverse health outcomes. This systematic review examined the literature on the impact of PNSD on HDP and gestational diabetes. A comprehensive search of PubMed, PsycINFO, Embase, Web of Science, and CINAHL identified 10 eligible studies: seven cohort and three cross-sectional studies. Five studies reported significant associations between PNSD and increased risk for cardiometabolic outcomes during pregnancy (HDP-1 study, gestational diabetes-3 studies, both hypertension and diabetes during pregnancy-1 study). The included studies demonstrated good methodological quality. These findings suggest that PNSD may be associated with cardiometabolic outcomes during pregnancy, but further research is needed, particularly on perceived neighborhood stressors.

Meta-Analysis Comparing Outcomes of Hinge Craniotomy to Decompressive Craniectomy in Patients Suffering from Elevated Intracranial Pressures

BACKGROUND AND OBJECTIVES

Traumatic brain injury (TBI) and stroke constitute 60% of the global neurosurgical case volume. Although decompressive craniectomy (DC) has been historically used for treating elevated intracranial pressures (ICP), it remains a controversial technique and is also associated with cranioplasty-related complications and additional costs. Hinge craniotomy (HC) may offer a potentially safer and, importantly, cheaper alternative to DC in low- and middle-income countries (LMICs), which bear the greatest burden of TBI cases. In this article, we aimed to provide a comprehensive meta-analysis comparing patients undergoing HC vs those undergoing DC for elevated ICP.

METHODS

The MEDLINE and Cochrane databases were systematically searched from inception to May 2024. We included all studies comparing outcomes in patients with elevated ICP undergoing HC vs those undergoing DC. Random effects models were used to pool dichotomous outcomes as risk ratios and continuous outcomes as mean differences.

RESULTS

Seven observational studies and one randomized controlled trial comprising 1335 patients were included in our meta-analysis. Both surgical techniques achieved comparable intracranial volume expansion (mean differences: -9.94 mm3) and had similar rates of postoperative hydrocephalus (risk ratio [RR]: 0.46), wound infections (RR: 0.61), and subdural hematoma (RR: 1.37). However, patients undergoing HC showed significant improvement in functional outcomes at discharge (RR: 3.32), although long-term outcomes in this respect were similar between the 2 arms (RR: 1.12).

CONCLUSION

Our meta-analysis, the first of its kind, depicts that HC offers an equally efficacious alternative to DC with the added benefit of achieving quicker functional recovery postoperatively. This is of particular clinical utility in LMICs which bear the greatest burden of TBI cases. However, in future, a cost-effectiveness analysis as well as adequately powered randomized controlled trials are needed to definitively delineate the optimal surgical approach needed to improve outcomes in our patient population.

Redefining pain management: investigating the efficacy and safety of erector spinae plane block and oblique subcostal transversus abdominis plane block in laparoscopic cholecystectomy - a meta analysis of randomized controlled trials

BACKGROUND

Pain following laparoscopic cholecystectomy plays a pivotal role in determining the quality of patient recovery. Considering the opioid crisis, exploration of alternative approaches, such as regional blocks, including erector spinae plane block (ESPB) and oblique subcostal transversus abdominis plane block (OSTAPB), has garnered considerable attention due to their promising outcomes in clinical trials.

OBJECTIVE

Our aim is to provide a robust analysis which reflects the most current evidence for the effectiveness and safety of ESPB by comparing it to OSTAPB in adult patients undergoing laparoscopic cholecystectomy.

METHODS

An extensive search was performed in the PubMed, Medline, and Cochrane Library databases from inception to June 1st 2023. Mean difference (SMD), and 95% confidence intervals (CIs) were calculated for continuous outcomes, Risk ratios (RR) were calculated for dichotomous outcomes. All statistical analyses were performed using R Statistical Software and meta package v4.17-0.

RESULTS

A total of 5 RCTs including 372 participants were included in this meta-analysis. Pooled analysis of overall postoperative pain scores at 12 and 24 h showed ESPB to be superior to OSTAPB [MD = -0.67; 95% CI: (-0.95 to -0.39); p < 0.001, I2 = 72%]. ESPB also showed significantly lesser opioid consumption at 24 h postoperatively [MD = -5.36; 95% CI: (-8.56 to -2.15); p < 0.001, I2 = 96%], while intraoperative opioid consumption {MD = -0.46; 95% CI: (-1.27 to -0.36); p = 0.27, I2 = 0%} and postoperative nausea and vomiting were not significantly different between the two groups {RR = 0.40, 95% CI (0.10 to 1.56), p = 0.19; I2 = 56%}.

CONCLUSION

In summary, the erector spinae plane block (ESPB) appears to be the preferred option for acute postoperative pain and opioid reduction in adults undergoing laparoscopic cholecystectomy.

Active group-based performing arts interventions in Parkinson's disease: an updated systematic review and meta-analysis

OBJECTIVES

To assess the evidence for active group-based performing arts interventions for people with Parkinson's disease (PD).

SETTING

Scholarly literature (published in English) from any country or countries (last search February 2025). This systematic review was not registered and received no funding.

DATA SOURCES

Five bibliographic databases: AMED (Ebsco), APA PsycINFO (Ovid), CINAHL (Ebsco), EMBASE (Ovid) and MEDLINE (Ovid), plus supplementary searches.

PRIMARY AND SECONDARY OUTCOME MEASURES

Eligible studies used a quantitative design to assess the benefit of active group-based performing arts interventions on quality of life, functional communication, speech, motor function and cognitive status in PD. The risk of bias was assessed using the SURE, University of York Centre for Reviews and Dissemination and Newcastle-Ottawa Scale checklists. Data were synthesised using narrative synthesis and random-effects meta-analysis.

RESULTS

A total of 94 studies were included: 2453 people with PD (mean age 68 years, 55% male) from 18 countries. Narrative synthesis supported nine combinations of performing arts modalities and outcome domains, including a benefit for dance on motor function (supported by 50 out of 54 studies), dance on quality of life (supported by 24 out of 37 studies) and singing on speech (supported by 17 out of 20 studies). Meta-analysis supported five combinations of performing art modalities, comparators and outcomes, including a clinically significant benefit for PD-specific dance versus usual care PDQ-39, MD -7.81, 95% CI -11.87 to -3.75 and tango-based dance versus usual care on UPDRS-III, MD -9.89, 95% CI -16.65 to -3.13.

CONCLUSIONS

Evidence from both the narrative synthesis and the meta-analysis supports a benefit for some combinations of performing arts modalities and outcomes. Limitations of the evidence base included differences in comparators and outcomes, heterogeneity, lack of control arms and male underrepresentation. Future studies should compare the effectiveness of different performing arts modalities, assess functional communication and consider clinical significance.

Clinical impact of radiotherapy quality assurance results in contemporary cancer trials: a systematic review and meta-analysis

BACKGROUND

Radiotherapy quality assurance (RTQA) is a critical aspect of randomized controlled trials (RCTs) and is associated with validity and reproducibility of the study findings. We conducted a systematic review and meta-analysis to assess the impact of RTQA results in contemporary RCTs on patient outcomes.

METHODS

We searched MEDLINE and CENTRAL from January 2010, to April 2024, for papers that report on the impact of RTQA on patient outcomes in contemporary RCTs. We conducted random-effects meta-analyses to examine the association of radiotherapy protocol deviations with overall survival (OS), progression free survival (PFS), and locoregional recurrence (LR).

RESULTS

Of 2,723 citations, 16 publications reporting on 13 RCTs were included across various disease sites. Of 7,170 total randomized patients across 1,076 institutions in over 25 countries, 5,560 patients had radiotherapy quality data and were included in RTQA analyses. Most included RCTs (7/12; 58 %) conducted exclusively retrospective RTQA after treatment completion. Our meta-analyses found that protocol deviations may be associated with worse OS [HR = 1.65 (95 % CI: 1.23-2.22; p < 0.001)] and PFS [HR = 1.79 (95 % CI: 1.00-3.21; p = 0.03)]. No significant association was demonstrated between protocol deviations and LR [HR = 2.09 (95 % CI: 0.85-5.15; p = 0.108)].

CONCLUSIONS

Quality of radiotherapy continues to have an important, measurable impact on patient outcomes in oncology RCTs, and rigorous, real-time RTQA procedures may diminish these effects by standardizing RT. Future trials should provide patient outcome data in relation to RTQA and continue to report on the effect of protocol deviations in the context of modern RT techniques.

P2Y12 Inhibitor-Based Single Antiplatelet Therapy Versus Conventional Dual Antiplatelet Therapy After Newer-Generation Drug-Eluting Stent Implantation in Chronic and Acute Coronary Syndromes: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

BACKGROUND

P2Y12 inhibitor-based single antiplatelet therapy (SAPT) after drug-eluting stent implantation reduces major bleeding without increasing the risk of major adverse cardiovascular and cerebral events compared with 12-month dual antiplatelet therapy (DAPT). The differential effects of P2Y12 inhibitor monotherapy compared with conventional DAPT in patients with chronic coronary syndromes versus acute coronary syndromes (ACS) remain uncertain.

METHODS AND RESULTS

PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched for randomized controlled trials comparing oral P2Y12 inhibitor-based SAPT after ≤3 months DAPT versus 12-month DAPT after newer-generation drug-eluting stent implantation. Patients were categorized based on baseline presentation (chronic coronary syndromes versus ACS). The co-primary end points were major bleeding and major adverse cardiovascular and cerebral events, a composite of all-cause death, myocardial infarction, or ischemic stroke. A total of 43 945 (ACS, 28 360, 65%) patients from 7 randomized controlled trials were included. At a median follow-up of 12 months, P2Y12 inhibitor-based SAPT was associated with a lower risk of major bleeding (risk ratio [RR], 0.63 [95% CI, 0.48-0.82]; P<0.001) compared with 12-month DAPT. The risk of major bleeding was significantly lower among patients with ACS (RR, 0.55 [95% CI, 0.40-0.75]; P<0.001). Compared with standard DAPT, P2Y12 inhibitor-based SAPT was associated with a similar risk of major adverse cardiovascular and cerebral events (RR, 0.98 [95%CI, 0.87-1.11]; P=0.74) among patients with chronic coronary syndromes and ACS. There was no significant interaction between treatment effect and baseline presentation.

CONCLUSIONS

Compared with 12-month DAPT, P2Y12 inhibitor-based SAPT after newer-generation drug-eluting stent implantation is associated with a lower risk of major bleeding without increasing the risk of major adverse cardiovascular and cerebral events, a difference primarily driven by patients with ACS.

REGISTRATION

URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42023239341.

Exploring the Needs of Stakeholders For Successful Patient Involvement in Mental Health Education

Objective

This scoping review aims to comprehensively map the existing literature on Patient Involvement (PI) in mental health education (MHE), identify the needs of mental health (MH) educators, students, and patients with lived experiences of MH challenges and develop a checklist for successful implementation of PI in MHE.

Methods

Conducted between November 2023-January 2024, this review followed PRISMA-ScR guidelines in databases PubMed, Scopus, ProQuest Dissertations and Theses, and WHO. Eligibility criteria adhered to PICOS guidelines, and screening was done via Covidence. Content analysis was carried out to develop a checklist.

Results

Eleven qualitative articles were found, revealing two superordinate stakeholder needs categories: Interpersonal and Course Needs. Interpersonal Needs included Self-determination, Communication and Collaboration, Recognition and Support, and Holistic approach. Course Needs comprised Content, Organisational, and Teaching. A checklist was developed to support PI in MHE.

Conclusion

Guidelines for successful PI in MHE should prioritize patient autonomy, foster collaboration, provide support, ensure inclusive course content, and promote patient involvement in educational processes. Study limitations, such as potential bias, underscore the need for future research to enhance evidence-based practices in MHE.

A Metric-Based, Meta-Analytic Appraisal of Environmental Enrichment Efficacy in Captive Primates

Non-human primates (hereafter 'primates') constitute a common group of animals in captivity but their captive maintenance involves ethical and husbandry issues, many of which can be addressed through environmental enrichment (hereafter 'enrichment'). Enrichment is often applied in a trial-and-error fashion or based on subjective assessments of efficacy. Thus, a predictive framework for enrichment is necessary to ensure it achieves the desired outcomes. As one of the initial steps towards the development of a predictive enrichment science, we aimed to identify the most effective enrichment approaches for captive primates. We conducted a comprehensive meta-analysis of the peer-reviewed literature and extracted information on methodological approaches, experimental design, species and environmental context. We developed and applied a novel efficacy index score to each study protocol as a comparable metric of enrichment efficacy in order to appraise current enrichment practices. Our findings suggest that captive primate enrichment approaches vary in their efficacy, with training-based enrichment being the most effective. Furthermore, the social context of subjects appears to influence efficacy, with primates housed alone deriving the most benefit from enrichment. A species' natural minimum group size may also influence enrichment efficacy but this relationship requires further investigation. Testing and reporting trends for captive primate enrichment are presented and discussed, highlighting important gaps in the literature and avenues of future research while identifying the beneficial effects of different enrichment practices.

Core beliefs in psychosis: a systematic review and meta-analysis

Increasing interest is growing for the identification of psychological mechanisms to account for the influence of trauma on psychosis, with core beliefs being proposed as a putative mediator to account for this relationship. A systematic review (n = 79 studies) was conducted to summarise the existing evidence base regarding the role of core beliefs/schemas in psychosis, Clinical High-Risk (CHR), and non-clinical samples with Psychotic-Like Experiences (PLEs). Compared to Healthy Controls (HCs), individuals with psychosis experiencing Auditory Hallucinations or Persecutory Delusions had significantly higher scores for negative self and negative other-beliefs and significantly lower scores for positive self and positive other-beliefs. This pattern of core beliefs was also observed for CHR individuals. In contrast, the core belief profile for grandiose delusions was in the opposite direction: higher positive self and positive other-beliefs and lower negative self-beliefs. In non-clinical samples, several factors mediated the relationship between Traumatic Life Events (TLEs) and PLEs, such as greater perceived stress, dissociation, external locus of control, and negative self and negative other-beliefs. Compared to HCs, meta-analyses revealed statistically significant large effects for negative self and negative other-beliefs in Schizophrenia. In CHR, statistically significant large and moderate effects were found for negative self and negative other-beliefs, respectively, along with a moderate negative effect for positive self-beliefs. Core beliefs were found to play a significant role in the development and maintenance of positive symptoms of psychosis. The development of psychosocial interventions that explicitly target negative self and other-beliefs, whilst also enhancing positive self-beliefs are warranted and would innovate CBTp practices.

The efficacy of abdominal binder in women undergoing cesarean delivery: A meta-analysis of randomized controlled trials

BACKGROUND

Abdominal binders are a prominent non-pharmacological intervention aimed at mitigating adverse outcomes following Cesarean delivery (CD), including pain and distress.

AIM

We conducted a meta-analysis to quantitatively evaluate the effects of abdominal binders on women undergoing CD.

METHODS

A systematic search was conducted using terms such as "abdominal binder," "clinical trials," and variations of "cesarean" across multiple electronic databases, including PubMed, Google Scholar, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Chinese National Knowledge Infrastructure (CNKI), and Wan-Fang database, up to November 2024. Study quality was assessed using the Cochrane Risk of Bias Tool 2.0. Statistical analysis was performed using Review Manager 5.4 and Comprehensive Meta-Analysis 4.0. Randomized controlled trials (RCTs) evaluating the use of abdominal binders compared to no binder usage following CD were included. The outcomes analyzed were postoperative pain, symptom distress, ambulatory function, and the occurrence of adverse effects.

RESULTS

Thirteen RCTs were included. Abdominal binders demonstrated a strong safety profile with no significant differences in postoperative complications between groups. Significant pain reductions were observed at 6, 12, 24, and 48 h postoperatively (weighted mean differences [WMD]: -1.13, 95 % confidence interval [CI]: -2.15 to -0.10, p = 0.03; WMD: -1.48, 95 % CI: -2.90 to -0.06, p = 0.04;WMD: -0.95, 95 % CI: -1.49 to -0.41, p = 0.0005; and WMD: -0.70, 95 % CI: -1.17 to -0.22, p = 0.004, respectively). Pain interference with breastfeeding was significantly lower in the binder group (WMD: -1.30, 95 % CI: -2.24 to -0.36, p = 0.006). Symptom Distress Scale scores were significantly reduced at 24 and 48 h (WMD: -1.22, 95 % CI: -2.05 to -0.39, p = 0.004; WMD: -1.63, 95 % CI: -2.67 to -0.60, p = 0.002). Improved ambulatory function was also observed at 8, 12, and 24 h (WMD: 20.57, 95 % CI: 16.91 to 24.23, p < 0.00001; WMD: 11.97, 95 % CI: 7.67 to 16.27, p < 0.00001; WMD: 10.14, 95 % CI: 1.89 to 18.40, p = 0.02, respectively).

CONCLUSIONS

This study uniquely demonstrates the temporal effects of abdominal binder use, with significant pain reductions noted at 6, 12, 24, and 48 h post-CD. These results provide actionable guidance for the timing of abdominal binder application, emphasizing their importance as an early intervention to optimize postoperative recovery. As a secure, cost-effective, and non-pharmacological solution, abdominal binders are strongly recommended as part of routine postpartum care for women following CD.

Prevalence and Determinants of Hookah Smoking Among the Youth: A Scoping Review

Hookah smoking is highly prevalent and has been rising in popularity among young people worldwide. Yet, no recent and comprehensive reviews have been published to assess the prevalence and identify the main predictors of hookah use. We have thus carried out a comprehensive scoping review to consolidate and review the existing evidence for the prevalence and main determinants of hookah smoking among youth. A comprehensive literature search was thus conducted utilizing various databases including ScienceDirect, Scopus, Embase, and MEDLINE to identify relevant studies. To be incorporated in this review, studies had to include individuals below the age of 25, measure the prevalence of hookah smoking, or examine the determinants of hookah smoking. The review showed that hookah is mostly prevalent among youth from the Middle Eastern region, USA, South Asia, and various European countries. It also identified the main determinants of hookah smoking, which include age, the male gender, socioeconomic status, geographic region, other forms of substance use, knowledge, beliefs, and attitudes toward hookah smoking, sensation seeking, having friends and/or family members who smoke hookah, social acceptability, intention, accessibility, and lack of enforcement of prohibiting laws. The main determinants of hookah use include having friends and/or family members who smoke hookah, social acceptability, attitude, accessibility, and lack of enforcement of prohibiting laws. Public health authorities, educators, and other stakeholders should implement educational interventions to enhance the knowledge level on hookah smoking's harm and addiction and should target not only the individuals but also the family and the social environment.

Resistance Exercise Training on Musculoskeletal, Metabolic and Psychological Health in Sedentary Office Workers - Systematic Review and Meta-analysis

PURPOSE

To consolidate the emerging evidence on the effectiveness of resistance training (RT) in reducing the health risks among sedentary office workers.

METHODS

Four electronic databases were searched for evidence from its inception till september 20, 2024. Studies were included if they examined any form of RT program targeting musculoskeletal, metabolic, or psychological health outcomes in office workers aged 18 years or older using PICOS criteria (Population - office workers, Intervention - RT program, Comparison - placebo or sham control and Outcomes - musculoskeletal, cardiometabolic and psychological health variables). Two reviewers independently screened the studies for risk of bias and assessed the certainty of the evidence.

RESULTS

Out of 60 identified studies, 17 studies were eligible for narrative synthesis, and 16 were included in the meta-analysis. Modest reductions in neck (SMD = -1.76, I2 = 88%, p < 0.00001) and shoulder discomfort (SMD = -13.29, I2 = 91%, p < 0.00001), while marginal improvement in shoulder (SMD = 4.13, I2 = 99%, p = 0.03) and neck extensor muscle strength (SMD = 9.07, I2 = 9%, p < 0.00001). The cardiometabolic and mental health risk markers remain unaltered. High uncertainty of evidence was observed due to high heterogeneity, risk of bias, inconsistency and publication bias.

CONCLUSION

Limited evidence demonstrate supervised RT programs of any dose has a potential to improve muscular strength and discomfort while potential cardiometabolic and mental health risk outcomes remain unaltered. However, more high-quality research trials are needed to understand the effects of RT on health benefits.

The alteration of gut microbiota composition in patients with epilepsy: A systematic review and meta-analysis

BACKGROUND

There is accumulating evidence suggesting a connection between epilepsy, a neurologic disease with recurrent seizures, and gut microbiota. This systematic review and meta-analysis explores the alterations of GM composition in patients with epilepsy.

METHODS

A systematic search was conducted up to June 26, 2024, across PubMed, Scopus, Web of Science, and Embase. The study outcomes were α- and β-diversity indexes, and relative abundance at different bacterial taxonomic levels, compared between epilepsy patients and healthy controls. Inverse variance-weighted meta-analysis was performed to estimate the standardized mean difference. We utilized the Newcastle-Ottawa Scale (NOS) to assess the quality of the included studies.

RESULTS

In this systematic review, we included 16 case-control studies encompassing 438 cases and 369 controls, and 12 studies were included in the meta-analyses. α-diversity was not significantly different between epilepsy and control group. Of the 11 studies measuring β-diversity, 8 studies showed that the microbiota compositions of the two groups differed significantly. Verrucomicrobia was significantly higher in the epilepsy group (SMD = 0.39 [0.05, 0.72], p = 0.022) than in the control group. At the genus level, Roseburia (SMD = -0.50 [-0.84, -0.17], p = 0.003), Blautia (SMD = -0.40 [-0.73, -0.06], p = 0.022), and Dialister (SMD = -0.40 [-0.74, -0.07], p = 0.018) were significantly less abundant in patients with epilepsy.

CONCLUSIONS

Our findings evince remarkable changes in gut microbiota composition in epilepsy. Bacterial genera that promote neuroinflammation are elevated in epilepsy. Our study revealed the interrelation between GM disruption and epileptogenesis, but the heterogeneity among the included results was high, and further investigation is encouraged.

"Does facial emotion recognition mediate the relationship between preterm birth and social skills? - A meta-analysis"

BACKGROUND

Preterm birth (PB) is prevalent and associated with structural and functional brain alterations which may affect cognitive and behavioural outcomes, including social development. Facial emotion recognition (FER) is one of the main components of social interaction. PB individuals face distinct FER challenges that may impact social skills. Furthermore, both FER and social skills have shown distinctive developmental trajectories in PB individuals compared to term born controls. This study investigates the association between FER and social skills in PB individuals compared to term-born controls.

OBJECTIVES

To systematically review and meta-analyse relevant literature on the association between FER and social skills and to summarize the reported differences in FER and social skills between PB individuals and term-born controls of similar age.

METHOD

a systematic search of peer-reviewed and English written studies was performed in MEDLINE, Web of Science and CINAHL, with an additional forward and backward citation search. Eligible studies included any observational study that had a term-born control sample of similar age with reported FER and social skills measures and/or correlations between them. Quality assessment and data extraction was carried out. Correlation coefficients and Hedges' g for FER and social skills were calculated as effect size indexes. Random effects model and subgroup analysis considering gestational age and age at assessment was performed. Results were summarized using forest plots. I2 statistics and Cochran's Q were used to test for heterogeneity.

RESULTS

8 studies were included (PB = 410, controls =337). Only 3 studies explored the correlation between FER and social skills. The review found a higher correlation between FER and social skills in the PB group (Z = 0.18, CI = -0.03, 0.39) compared to controls (Z = 0.11, CI = -0.03, 0.25). FER was significantly lower in PB individuals (overall g = -1.48; 95%IC = -2.46, -0-5), particularly in very preterm and adolescent subgroups.

DISCUSSION

FER might play a crucial role in the social development of PB individuals compared to those born at term, but existing research in this domain remains limited.

A Systematic Review and Meta-Analysis of Low Dose Radiation Therapy for COVID-19 Pneumonia: Learnings of 4 Years Since Pandemic

COVID-19 caused a worldwide pandemic resulting in break of demand-supply chain in all aspects of healthcare, high mortality rates, and a constant quest for effective treatment modalities. Based on historical and recent evidences of anti-inflammatory effects of low dose of ionizing radiation, several healthcare professionals proposed low-dose radiation therapy (LDRT) along with ongoing pharmacological treatment for COVID-19 pneumonia. A positive response in a few initial studies led to systematic trials by increasing the number of patients in the range of 0.5-1.5 Gy. However, the concerns of radiation-induced risks were also raised in parallel. In the present article, we have highlighted the basis of LDRT for COVID-19 therapy. We have reviewed the available literature, specifically for outcomes on various clinical trials carried out with LDRT. Meta-analysis was performed to identify if any survival benefits are offered by addition of LDRT over pharmacological treatment alone among COVID-19 pneumonia patients. Other clinical recovery parameters such as intubation rates, oxygenation status, anti-inflammatory response have also been compared. Overall data trends favored LDRT with standard pharmacological treatment against control cohort which received standard treatment alone at all the endpoints in majority studies. LDRT addition resulted in significantly higher odds of survival than control cohort. Among critical and/or mechanically ventilated patients, LDRT did not show any promising outcomes over the control group. In conclusion, LDRT may serve as a promising complementary treatment modality with a potential of better prognosis, provided the patient selection criteria are critically identified and implemented.

Quantitative Analysis of Propofol Dosage in Cannabis Users: A Systematic Review and Meta-Analysis

Background: Rising cannabis use poses significant challenges in the administration of general anesthetics, particularly propofol, due to potential alterations in pharmacodynamics caused by tetrahydrocannabinol and its interactions with central nervous system receptors. This systematic review and meta-analysis aims to consolidate the existing literature to quantify propofol requirements in cannabis users, highlighting the complex relationship between cannabis use and anesthetic management. Methods: A systematic search of English-language literature was conducted to identify studies with data on propofol dosing in adult cannabis users. Propofol requirements were defined as the total intraoperative dose needed to achieve and maintain adequate sedation or anesthesia, assessed using parameters like monitoring and procedural tolerance. A random-effects model was used with DerSimonian-Laird estimations for pooled effect sizes and 95% confidence intervals. Heterogeneity was assessed using I2 and Cochran's Q statistics, and sensitivity analysis was conducted by grouping publications by design, size, and quality. Results: Eight qualified studies were identified with 2268 patients included. Patients who used cannabis were typically younger and more likely to smoke tobacco than non-users. Propofol requirements were significantly higher in cannabis users, who required an average additional dose of 47.33 mg compared to non-users. Subgroup analyses revealed that cannabis users undergoing general anesthesia needed an additional 30.57 mg intraoperatively, while those undergoing sedation for endoscopic procedures required an additional 53.02 mg. Conclusions: These results underscore the need for personalized anesthetic plans to accommodate physiological variations in cannabis users. However, the lack of standardized definitions for propofol requirements and the heterogeneity across studies necessitate caution in interpretation. The observed increase in propofol requirements suggests altered central nervous system sensitivities and receptor changes in cannabis users, emphasizing the need for further research to establish clear definitions, elucidate underlying mechanisms, and refine clinical guidelines for anesthetic management in this population.

Impact of oncology pharmacy services on the management of chemotherapy-induced nausea and vomiting: A systematic review and meta-analysis

PURPOSE

To evaluate the effect of oncology services rendered by clinical pharmacists on reducing chemotherapy-induced nausea and vomiting (CINV) and improving overall treatment experiences.

METHODS

A systematic review and meta-analysis were conducted using studies retrieved from PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Research Information Sharing Service (RISS). The incidence and severity of CINV were evaluated as primary outcomes. Secondary outcomes were patient adherence, patient satisfaction, quality of life (QoL), emergency department (ED) visits, hospitalizations, and costs.

RESULTS

A total of 12 studies were selected for systematic review, with 8 studies eligible for meta-analysis. We found that clinical pharmacy services contributed to preventing and alleviating CINV as well as improving patient's medication adherence, treatment satisfaction, and QoL, reducing hospital visits, and achieving cost savings. In the meta-analysis, pharmacists' interventions were notably effective in reducing the incidence of nausea (odds ratio [OR], 1.917; 95% CI, 1.243-2.955; P = 0.003) and vomiting (OR, 2.491; 95% CI, 1.199-5.177; P = 0.014) during overall treatments periods relative to results in control groups. In addition, the impact of clinical pharmacy services on CINV control was greater during the delayed phase compared to the acute phase.

CONCLUSION

This study demonstrated the important role of clinical pharmacy services in controlling CINV and enhancing the overall treatment experience for patients with cancer. Further studies with standardized pharmacists' services and outcome measures are needed to validate our findings.

Interprofessional collaboration between pharmacists and community health workers: a scoping review

INTRODUCTION

Community health workers (CHWs) help bridge the cultural gap between health services and the communities they serve. CHWs work with physicians, nurses and social workers, but little is known about their collaboration with pharmacists. This scoping review aims to describe the interprofessional collaboration between CHWs and pharmacists, the types of interventions they deliver and CHWs' and pharmacists' specific roles within these interventions.

METHOD

The scientific literature published in PubMed, Embase, MEDLINE, Scopus, Web of Science, PsycInfo, CINAHL and the grey literature were searched. Inclusion criteria were that the research (i) involved pharmacists and CHWs working collaboratively and (ii) included an intervention, service or program. One researcher screened all articles, and two reviewers screened 6% of articles (20/340) assessed for eligibility, using the software Covidence. After the discrepancies were resolved, data from the included articles were extracted using a customized template for data extraction and synthesized narratively.

RESULTS

Eighteen studies met the inclusion criteria. Most were conducted in the USA (14/18) and were published since 2020 (12/18). Most interventions involved medication reviews, support for medication adherence, disease prevention or addressing the social determinants of health. Pharmacists had primarily clinical roles (i.e., medication reconciliation and patient education), while the CHWs' roles consisted of collecting patient information, supporting patient self-management, bridging the cultural gap by translating information in the patient's language and ensuring patient follow-up. The collaborative practice occurred via interprofessional referral, ranging from the CHW facilitating the link between the patient and the pharmacist, and information sharing between the CHW and the pharmacist, to an interprofessional collaborative practice where CHWs and pharmacists delivered the intervention together.

CONCLUSION

While CHWs and pharmacists had independent roles as part of the interventions, they also collaborated at various levels to deliver services to patients. CHWs have an important role to play in bridging the cultural gap between the patient and the pharmacist, in improving patient referral so that more patients can benefit from pharmaceutical services, and in identifying patients' social determinants of health. CHWs and pharmacists can work synergistically and collaboratively to tailor an intervention to the patient's needs, which can improve and optimize pharmaceutical services, and may ultimately positively impact health outcomes.

Effectiveness of virtual reality interventions in promoting healthy eating and physical activity among children: A systematic review

Background

Childhood obesity significantly impacts health, making the promotion of healthy behavior (HB) among children crucial to address this issue. Virtual reality (VR) has emerged as a promising tool for encouraging HB in children.

Objective

This systematic review aims to evaluate the literature on the application of VR in promoting healthy dietary habits and physical activity (PA) among children.

Method

A systematic search was conducted across Web of Science, PubMed, and Scopus databases in January 2024 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, focusing on English-language studies published between 2013 and 2023. The quality of the studies was assessed using the Cochrane Risk of Bias 2 and Risk of Bias in Nonrandomized Studies of Interventions tools. This review is registered at PROSPERO, CRD4202347801.

Result

A total of 25 studies involving participants aged 4-15 years were assessed. Sixteen studies focused on increasing PA through VR interventions, and six studies focused on healthy eating. Most studies utilized nonimmersive (n = 11) or semi-immersive (n = 10) VR technologies. Six theories were employed across the studies, and five design strategies were categorized. While most studies reported improvements in PA (n = 9) and healthy eating (n = 6), the short durations and small sample sizes limited the assessment of long-term impacts.

Conclusion

This review reveals the promising potential of VR as an effective tool to enhance PA and promote healthier eating among children. However, it also highlights the need for further rigorous research to explore the long-term effects of VR interventions on child HB change. These findings provide valuable input into the development of more effective VR interventions that can be applied in child health strategies.

Association of Strongyloides stercoralis infection with the development of diabetes mellitus: a meta-analysis

Previous studies have shown that helminth infection protects against the development of diabetes mellitus (DM), possibly related to the hygiene hypothesis. However, studies involving Stronglyoides stercoralis and its possible association with DM are scarce and have shown contradicting results, prompting us to perform this meta-analysis to obtain more precise estimates. Related studies were searched from PubMed, Google Scholar, Science Direct, and Cochrane Library until 1 August 2024. Data on the occurrence of DM in patients positive and negative for S. stercoralis were obtained. All analyses were done using Review Manager 5.4. The initial search yielded a total of 1725 studies, and after thorough screening and exclusion, only five articles involving 2106 participants (536 cases and 1570 controls) were included in the meta-analysis. Heterogeneity was assessed, and outlier studies were excluded using a funnel plot. Results showed a significant association of S. stercoralis infection with DM, suggesting that those with the infection are less likely to develop DM. Overall, the results suggest that S. stercoralis infection may decrease the likelihood of developing DM, potentially supporting the hygiene hypothesis.

Impact of levetiracetam use in glioblastoma: an individual patient-level meta-analysis assessing overall survival

BACKGROUND

Levetiracetam (Lev), an antiepileptic drug (AED), enhances alkylating chemotherapy sensitivity in glioblastoma (GB) by inhibiting MGMT expression. This meta-analysis evaluates Lev's impact on GB treatment by analyzing overall survival of individual patient data (IPD) from published studies.

METHODS

IPD was reconstructed using the R package IPDfromKM. Pooled IPD Kaplan-Meier charts of survival stratified by Lev therapy were created using the R package Survminer. One- and two-stage meta-analyses of Lev treatment regarding survival was performed.

RESULTS

Three articles covering 825 patients were included out of 3567 screened records. Lev usage prevalence was 0.36. IPD from 590 IDH wild-type glioblastomas, with a median follow-up of 16.1 months, were utilized. Pooled data revealed median survival times of 19.2 months (95%CI: 16.4-22.0) for Lev users versus 16.5 months (95%CI: 15.2-17.8) for partial/no use (p = 0.006). One-stage meta-analysis indicated a significant association between Lev use and survival in IDH wild-type GB (HR: 1.33, 95%CI: 1.08-1.64, p = 0.007). Two-stage meta-analysis confirmed these results.

CONCLUSIONS

This meta-analysis highlights that Lev use may prolong survival in IDH wild-type GB patients. Further randomized trials are needed to confirm these findings and identify subgroups benefiting most from Lev treatment.

Impact of Obstructive Sleep Apnea and Continuous Positive Airway Pressure Treatment on Dry Eye Disease: A Systematic Review and Meta-Analysis

Obstructive sleep apnea (OSA) has been reported to influence the ocular surface and may lead to dry eye disease (DED). Continuous positive airway pressure (CPAP) is the first-line conservative treatment for OSA. However, CPAP might also have mask-related side effects that could deteriorate DED simultaneously. This study investigated the impact of OSA on DED (Aim 1), and CPAP on DED (Aim 2). Five databases were searched for articles published up to May, 2024. OSA severity, CPAP usage, and DED parameters, including tear breakup time (TBUT), Schirmer test, Ocular Surface Disease Index (OSDI), and Corneal Fluorescence Staining Score (CFS), were analyzed. For Aim 1, the random-effects model was used for meta-analysis, and the leave-one-out method was used for sensitivity analysis. For Aim 2, a narrative synthesis with critical appraisal of the literature was performed. Eleven studies with 1,526 patients for Aim 1 and three studies with 180 patients for Aim 2 were included. For Aim 1, OSA patients had poorer dry eye profiles of TBUT, Schirmer test, and OSDI when compared to non-OSA patients. For Aim 2, it seemed that those wearing CPAP for less than half a year did not have enough improvement in dry eye status. Instead, those wearing CPAP for at least a year reached greater therapeutic effects for OSA and DED. We concluded that OSA patients may suffer from poorer dry eye condition compared to non-OSA patients. Besides, wearing CPAP for long enough duration (at least 1 year) seemed to have better improvement in DED.

Spatiotemporal, kinematic and kinetic gait characteristics in Parkinson's disease compared to healthy individuals: A systematic review with meta-analysis

BACKGROUND

Gait disorders are frequently reported in individuals with Parkinson's disease (PD). Despite extensive research, the specific gait features affected by PD remain inadequately defined. Therefore, this study aimed to investigate kinematic, kinetic, and spatiotemporal parameters of gait in individuals with PD compared to healthy controls.

METHODS

We conducted a systematic review in PubMed, CINAHL, and EMBASE up to March 2024 to retrieve studies assessing adults with PD, which examined gait compared to healthy controls. Two reviewers independently performed the screening process, extrapolation data and quality assessment. Studies were meta-analyzed using original units of measurement (mean difference, MD) to enhance the clinical understanding of the gait characteristics. The level of evidence was provided.

FINDINGS

Thirty-four studies were included (n = 1533 participants with PD and n = 1093 healthy controls). Moderate-to-strong evidence was found for reduced speed (MD:-0.21 m/s, 95 %CI: -0.27; -0.15), stride length (MD:-0.17 m, 95 %CI: -0.25; -0.09), swing time (MD:-1.16 % of gait cycle, 95 %CI: -2.30; -0.02), and sagittal range of motion of the lower limb joints in individuals with PD (hip: MD:-5.39°, 95 %CI: -10.42; -0.37; knee: MD:-11.05°, 95 %CI: -21.88; -0.22; ankle: MD:-4.03°, 95 %CI: -6.37; -1.69). An increase in double support time (MD:0.07 s, 95 %CI: 0.05; 0.10) and a decrease in cadence (MD: -4.93 steps/min, 95 %CI: -7.89; -1.98) were observed. Kinetic data showed diverse outcomes, making a meta-analysis not possible.

INTERPRETATION

PD is associated with changes in gait kinematics and spatiotemporal parameters, while kinetic aspects remain under investigated. Future research should focus on kinetics, joint angular velocity, and push-off parameters. PROSPERO registration: CRD42022347368.

Interactions between Polygenic Risk of Obesity and Dietary Factors on Anthropometric Outcomes: A Systematic Review and Meta-Analysis of Observational Studies

BACKGROUND

Diet is an important determinant of health and may moderate genetic susceptibility to obesity, but meta-analyses of available evidence are lacking.

OBJECTIVES

This study aimed to systematically review and meta-analyze evidence on the moderating effect of diet on genetic susceptibility to obesity, assessed with polygenic risk scores (PRS).

METHODS

A systematic search was conducted using MEDLINE, EMBASE, Web of Science, and the Cochrane Library to retrieve observational studies that examined PRS-diet interactions on obesity-related outcomes. Dietary exposures of interest included diet quality/dietary patterns and consumption of specific food and beverage groups. Random-effects meta-analyses were performed for pooled PRS- healthy eating index (HEI) interaction coefficients on body mass index (BMI) (on the basis of data from 4 cohort studies) and waist circumference (WC) (on the basis of data from 3 cohort studies).

RESULTS

Out of 36 retrieved studies, 78% were conducted among European samples. Twelve out of 21 articles examining dietary indices/patterns, and 16 out of 21 articles examining food/beverage groups observed some significant PRS-diet interactions. However, within many articles, findings are inconsistent when testing different combinations of obesity PRS-dietary factors and outcomes. Nevertheless, higher HEI scores and adherence to plant-based dietary patterns emerged as the more prominent diet quality/patterns that moderated genetic susceptibility to obesity, whereas higher consumption of fruits and vegetables, and lower consumption of fried foods and sugar-sweetened beverages emerged as individual food/beverage moderators. Results from the meta-analysis suggest that a higher HEI attenuates genetic susceptibility on BMI (pooled PRS∗HEI coefficient: -0.08; 95% confidence interval (CI): -0.15, 0.00; P = 0.0392) and WC (-0.37; 95% CI: -0.60, -0.15; P = 0.0013).

CONCLUSIONS

Current observational evidence suggests a moderating role of overall diet quality in polygenic risk of obesity. Future research should aim to identify genetic loci that interact with dietary exposures on anthropometric outcomes and conduct analyses among diverse ethnic groups.

TRIAL REGISTRATION NUMBER

This study was registered at the International Prospective Register of Systematic Reviews as CRD42022312289.

Effects of mindfulness-based interventions (MBIs) on psychotic symptoms and psychological outcomes in patients with schizophrenia spectrum disorders: A systematic review and meta-analysis

OBJECTIVE

Mindfulness refers to the practice of consciously attending to the present moment without judgement. Although mindfulness-based intervention have been extensively researched. Less is known about the effect of this intervention on psychotic symptoms in patients with schizophrenia spectrum disorders. Thus, we synthesized the effects of mindfulness-based interventions (MBIs) on psychotic symptoms, global functioning, insight, and mindfulness in patients with schizophrenia spectrum disorders.

METHOD

Nine electronic databases were searched from inception to March 2024 including Academic Search Complete, CINAHL, Cochrane, Ovid APA InFo, ProQuest, PubMed, Scopus, Mindfulness Journal and Web of Science. We reviewed studies on outcomes for patients with schizophrenia spectrum disorders receiving mindfulness-based interventions. We only reviewed all experimental and quasi-trials studies written in English. A random-effects model was used to compute the effect size. We used Funnel plot, Q statistics, and I2 to test the heterogeneity across studies. Also, we examined moderators to explore sources of heterogeneity.

RESULTS

Across 24 included studies (N = 1,632), 796 schizophrenia patients participated in mindfulness interventions; 836 served as controls. Most schizophrenia patients were males (69 %, s = 7). Mean age ranged from 24.4 to 59.5 years. Overall, mindfulness-based interventions showed reduced psychotic symptoms (g = 0.70, 95 %CI 0.04, 1.36, I2 = 96 %), increased global functioning (g = 1.28, 95 %CI 0.50, 2.05), insight (g = 1.21, 95 %CI 0.88, 1.55) and mindfulness (g = 0.56, 95 %CI 0.15, 0.97) compared to control groups, but with substantial heterogeneity. With subgroup analysis, every one-year of mean age of patients with schizophrenia increased, psychotic symptom worsened (slope = -0.071, tau2 = 0.77, Qbetween = 166.3, p = .016). Additionally, for every day of MBIs practice increased, psychotic symptoms improved (Slope = 0.012, tau2 = 1.37, Qbetween = 251.6, p = .033), patients' functioning improved (slope = 0.013, tau2 = 0.69, Qbetween = 142.1, p = .017) and patients' insight improved (slope = 0.001, tau2 = 0.012, Qbetween = 8.6, p = .043). Providing MBIs as a mixed format (individual plus group intervention) had a greater effect (g = 1.538) on improving patients' insight than providing MBIs only to individuals (g = 0.889). Also, providing MBIs with a home assignment had a greater effect (g = 1.517) on improving patients' insight than providing MBIs without a home assignment (g = 0.787). No primary studies reported the adverse effects.

CONCLUSION

MBIs significantly improved psychotic symptoms, global functioning, insight, and mindfulness among patients with schizophrenia spectrum disorders, especially MBIs with home assignment. Clinicians and health providers should consider using MBIs as alternative complementary treatment for improving psychotic symptoms and increasing global functioning, insight and mindfulness.

Use of stool DNA for colorectal cancer screening: a meta-analysis and systematic review

Colorectal cancer is the third most common malignancy in the USA and accounts for more than 1 million deaths worldwide with screening shown to reduce CRC mortality. This meta-analysis analyzed the use of stool DNA for screening average risk, asymptomatic subjects for colorectal cancer and advanced precancerous lesions and compared sDNA to FOBT tests (gFOBT and FIT). Eight studies were included from four different countries with a total of 39 665 subjects. Pooled sensitivity and specificity for sDNA for detecting CRC was 83.3% (95% CI: 60.8-94.2) and 92.4% (95% CI: 90.1-94.1), respectively, compared with FOBT, which had a lower sensitivity at 70.2% (95% CI: 45.5-86.9) but higher specificity 95.7% (95% CI: 95.1-96.2). Further analysis showed improved sensitivity of sDNA to 92.6% when only the studies employing sDNA tests that incorporate hemoglobin immunochemical test were used. Both sDNA and FOBT tests had low sensitivity for detecting advanced precancerous lesions. sDNA tests are sensitive and specific for the detection of CRC but show low sensitivity compared with colonoscopy for the detection of advanced precancerous lesions.

A Scoping Review and Meta-Analysis of the Relations Between Cognition and Cochlear Implant Outcomes and the Effect of Quiet Versus Noise Testing Conditions

OBJECTIVES

Evidence continues to emerge of associations between cochlear implant (CI) outcomes and cognitive functions in postlingually deafened adults. While there are multiple factors that appear to affect these associations, the impact of speech recognition background testing conditions (i.e., in quiet versus noise) has not been systematically explored. The two aims of this study were to (1) identify associations between speech recognition following cochlear implantation and performance on cognitive tasks, and to (2) investigate the impact of speech testing in quiet versus noise on these associations. Ultimately, we want to understand the conditions that impact this complex relationship between CI outcomes and cognition.

DESIGN

A scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed on published literature evaluating the relation between outcomes of cochlear implantation and cognition. The current review evaluates 39 papers that reported associations between over 30 cognitive assessments and speech recognition tests in adult patients with CIs. Six cognitive domains were evaluated: Global Cognition, Inhibition-Concentration, Memory and Learning, Controlled Fluency, Verbal Fluency, and Visuospatial Organization. Meta-analysis was conducted on three cognitive assessments among 12 studies to evaluate relations with speech recognition outcomes. Subgroup analyses were performed to identify whether speech recognition testing in quiet versus in background noise impacted its association with cognitive performance.

RESULTS

Significant associations between cognition and speech recognition in a background of quiet or noise were found in 69% of studies. Tests of Global Cognition and Inhibition-Concentration skills resulted in the highest overall frequency of significant associations with speech recognition (45% and 57%, respectively). Despite the modest proportion of significant associations reported, pooling effect sizes across samples through meta-analysis revealed a moderate positive correlation between tests of Global Cognition ( r = +0.37, p < 0.01) as well as Verbal Fluency ( r = +0.44, p < 0.01) and postoperative speech recognition skills. Tests of Memory and Learning are most frequently utilized in the setting of CI (in 26 of 39 included studies), yet meta-analysis revealed nonsignificant associations with speech recognition performance in a background of quiet ( r = +0.30, p = 0.18), and noise ( r = -0.06, p = 0.78).

CONCLUSIONS

Background conditions of speech recognition testing may influence the relation between speech recognition outcomes and cognition. The magnitude of this effect of testing conditions on this relationship appears to vary depending on the cognitive construct being assessed. Overall, Global Cognition and Inhibition-Concentration skills are potentially useful in explaining speech recognition skills following cochlear implantation. Future work should continue to evaluate these relations to appropriately unify cognitive testing opportunities in the setting of cochlear implantation.

Comparison of rhythm versus rate control of atrial fibrillation in heart failure subgroups: Systematic review and meta-analysis of randomized controlled trials

Patients with concurrent heart failure (HF) and atrial fibrillation (AF) have poor outcomes. Randomized clinical trials comparing rhythm control approaches to rate control of AF have yielded conflicting results and there is a paucity of updated and comprehensive evidence summaries to inform best practice in HF patients. We therefore conducted a systematic review and meta-analysis to compare outcomes with rhythm versus rate control of AF in various subgroups of HF patients. In HF patients overall, we found high certainty evidence that rhythm control decreased all-cause and cardiovascular mortality (hazard ratio [HR, 95 % confidence interval] 0.64 [0.43-0.94]) and HR 0.50 [0.34-0.74] respectively). Rhythm control was associated with decreased HF hospitalization (risk ratio [RR] 0.79 [0.63-0.99], moderate certainty), but did not significantly decrease thromboembolic events (RR 0.67 [0.32-1.39], low certainty). The mean difference in left ventricular ejection fraction [LVEF] from baseline to last follow-up was greater in rhythm control group by 6.01 % [2.73-9.28 %] compared with rate control. Subgroup analyses by age, HF etiology (ischemic or non-ischemic), LVEF, presence of diabetes and hypertension did not reveal any significant differences in treatment effect. The survival and hospitalization reduction benefit of rhythm control of AF in HF patients likely reflects the success of catheter ablation especially in HF with reduced ejection fraction. These data are important to guide shared decision-making when managing AF in HF patients.

Are combined conservative interventions effective in reducing pain, disability and/or global rating of pain in people with sciatica with known neuropathic pain mechanisms?

PURPOSE

National Clinical Guidelines recommend an integrated combination of conservative management strategies for sciatica. However, the efficacy of such combinations have not been established. The purpose of this systemic review with meta-analysis was to determine the efficacy of combined conservative (non-pharmacological) compared to single interventions for people with sciatica with a confirmed neuropathic mechanism.

METHODS

The systematic review was registered on PROSPERO CRD42023464011. The databases included were the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL (EBSCO), Embase, PubMed, Scopus, APA PsycINFO, and grey literature sources from inception until January 2024. Inclusion criteria were randomized controlled trials that assessed the effectiveness of combined non-pharmacological interventions in comparison to a control intervention among individuals with sciatica of a neuropathic origin identified using diagnostic or clinical tests. Primary outcomes were back pain, leg pain, and disability. The secondary outcome was global rating of change. Study selection, data extraction and risk of bias assessment (using Cochrane ROB2) were assessed by two reviewers. Meta-analysis was performed with a random effects model with inverse variance weighting used for the metanalysis using SPSS v 29.

RESULTS

3,370 articles were identified, of which 6 were included. Risk of bias was high in one study and had some concerns in the remaining 5 studies for each outcome measure. There was evidence of efficacy for combined interventions for back pain in the short-and long-term (SMD - 0.56 (95% CI -0.91, -0.22, p = 0.01, I2 = 0.2; SMD - 0.44 (95% CI -0.79, -0.1, p = 0.03, I2 = 0.00), and for disability in the short term (SMD - 0.48 (95% CI -0.92, -0.04, p = 0.04, I2 = 0.72). There was no evidence of efficacy for leg pain at any time point (( short term SMD - 0.45 (95% CI -0.91, 0.02, p = 0.06, I2 = 0.65), medium term (SMD - 0.29 (95% CI -1.12, 0.54, p = 0.35, I2 = 0.82), long term (SMD - 0.40 (95% CI -1.23, 0.44, p = 0.18, I2 = 0.57).Certainty of evidence ranged from very low to moderate.

CONCLUSION

There are few studies that have combined conservative (non-pharmacological) interventions for the management of sciatica with a neuropathic component pain mechanism, as recommended by National Clinical Guidelines. This review indicates that combining conservative (no-pharmacological) management strategies appeared more effective than single interventions for the outcomes of low back pain in the short and long term, and for disability in the short term, but not for leg pain at any time point. The overall low certainty of evidence, suggests that future studies with more robust methodologies are needed.

N-acetylcysteine as a treatment for substance use cravings: A meta-analysis

N-acetylcysteine (NAC) may serve as a novel pharmacotherapy for substance use and substance craving in individuals with substance use disorders (SUDs), possibly through its potential to regulate glutamate. Though prior meta-analyses generally support NAC's efficacy in reducing symptoms of craving, individual trials have found mixed results. The aims of this updated meta-analysis were to (1) examine the efficacy of NAC in treating symptoms of craving in individuals with SUD and (2) explore subgroup differences, risk of bias and publication bias across trials. Database searches of PubMed, Cochrane Library and ClinicalTrials.gov were conducted in June and July of 2023 to identify relevant randomized control trials (RCTs). The meta-analysis consisted of 9 trials which analysed data from a total of 623 participants. The most targeted substance in the clinical trials was alcohol (3/9; 33.3%), followed by tobacco (2/9; 22.2%) and multiple substances (2/9; 22.2%). Meta-analysis, subgroup analyses and leave-one-out analyses were conducted to examine the treatment effect on craving symptoms and adverse events (AEs). Risk of bias assessments, Egger's tests and funnel plot tests were conducted to examine the risk of bias and publication bias. NAC did not significantly outperform placebo in reducing symptoms of craving in the meta-analysis (SMD = 0.189, 95% CI = -0.015-0.393). Heterogeneity was very high in the meta-analysis (99.26%), indicating that findings may have been influenced by clinical or methodological differences in the study protocols. Additionally, results indicate that there may be publication bias present. Overall, our findings are contrary to those of prior meta-analyses, suggesting a limited impact of NAC on substance craving. However, the high heterogeneity and presence of publication bias identified warrants cautious interpretation of the meta-analytic outcomes.

In-Person Healthcare Simulation: An Umbrella Review of the Literature

SUMMARY STATEMENT

Given the large accumulation of research focused on the effectiveness of in-person simulation-based education (SBE), this umbrella review-or systematic review of systematic reviews-was conducted using Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines to analyze collective findings and close identified literature gaps. This study presents a descriptive analysis of the most effective modalities, methods, and measurements of in-person SBE, as well as major themes that emerged during analysis as it relates to SBE outcomes.The major patterns or themes that emerged confirm for the first time a longstanding sentiment in the literature, specifically the following: a need to produce higher-quality research with greater rigor, larger sample sizes, more randomized controlled trials, mixed methods, and longitudinal studies. These findings suggest a need to redirect scientific efforts in SBE. Despite the nearly ubiquitous issues noted across the systematic reviews' findings, results of this umbrella review seem to support the notion that in-person simulation-based education improves learning outcomes including technical and nontechnical skills and behavioral and attitudinal change. Analyses highlighted the need to improve overall research approaches and reduce redundancy, as well as the need to standardize terminology, broaden global diversity, and push for further research funding opportunities to support these efforts.

Journal recommended guidelines for systematic review and meta-analyses

Systematic reviews and meta-analyses aggregate research findings across studies and populations, making them a valuable form of research evidence. Over the past decade, studies in medical education using these methods have increased by 630%. However, many manuscripts are not publication-ready due to inadequate planning and insufficient analyses. These guidelines aim to improve the clarity and comprehensiveness of reporting methodologies and outcomes, ensuring high quality and comparability. They align with existing standards like PRISMA, providing examples and best practices. Adhering to these guidelines is crucial for publication consideration in Anatomical Sciences Education.

Does the pararectus approach have better outcomes and fewer complications than the modified Stoppa approach for the fixation of acetabular fractures in adults: A systematic review and meta-analysis?

BACKGROUND

The pararectus approach is a minimally invasive surgical approach for anterior acetabulum fracture, with an advantage of the medial window of the modified Stoppa approach (MSA). However, it is unclear whether the pararectus approach is superior to MSA. We aimed this systematic review and meta-analysis to compare the outcomes and complications of pararectus and MSA.

METHODS

We performed a data search by conducting an electronic search across databases of PubMed, Embase, Scopus, Cinahl, CNKI, and Cochrane Library and included seven comparative studies for analysis. Statistical analysis was performed using the RevMan software 5.4.1. The risk of bias was evaluated using the Cochrane Collaboration's risk of bias tool for RCTs and the MINORS tool for non-RCTs.

RESULTS

Two randomized control trials (RCTs), one prospective study, and four retrospective studies were included. Meta-analysis revealed a better Matta's reduction quality [OR 1.58, 95% CI 1.06, 2.37; p = 0.03] and radiological outcome [OR 2.18, 95% CI 1.03, 4.60; p = 0.04] in MSA than in pararectus approach. However, the pararectus approach has less intraoperative blood loss [MD - 9.79 (95% CI - 176.75, - 6.83; p = 0.03)] and a shorter hospital stay [MD - 2.61 (95% CI - 5.03, - .18; p = 0.04)] than MSA. Both approaches have failed to show a difference concerning overall complication rates [OR 0.66 (95% CI 0.28, 1.55; p = 0.34)], postoperative infection, DVT, duration of surgery [MD - 15.09 (95% CI - 35.38, 5.20; p = 0.15)], functional outcome, and incision length.

CONCLUSION

The pararectus approach offers an advantage with lesser operative blood loss and shorter hospital stay, whilst MSA stands out with better reduction quality and radiological outcomes. Nevertheless, both approaches exhibit no difference in complication rates, duration of surgery, incision length, and functional outcome. Hence, the pararectus approach can be considered an alternative to MSA; however, the existing literature fails to demonstrate a distinct advantage over MSA.

Current evidence on the effectiveness and safety of oral anticoagulants in superficial venous thrombosis: a systematic review and meta-analysis

INTRODUCTION

Previous studies suggest fondaparinux as an effective regimen for superficial venous thrombosis (SVT), but the inconvenience of prolonged parenteral injections has prompted investigations into oral anticoagulants (OACs). This study aims to evaluate the current evidence on the effectiveness and safety of OACs in the treatment of SVT.

EVIDENCE ACQUISITION

Following the PRISMA 2020 guidelines, we conducted a systematic review and meta-analysis registered in PROSPERO (CRD42024535625). A comprehensive literature search was performed across multiple databases up to April 2024. Studies were included if they involved adult patients diagnosed with SVT, treated with OACs, and reported relevant efficacy and safety outcomes. Both randomized controlled trials (RCTs) and observational studies were considered. Data extraction and risk of bias assessments were independently performed by two authors.

EVIDENCE SYNTHESIS

The search identified 1531 studies, with six studies (three RCTs and three prospective cohort studies) meeting inclusion criteria. Meta-analysis for Rivaroxaban-treated group showed DVT occurrence was 1.30% (95% CI 0.17-3.07%), SVT extension was 0.32% (95% CI: 0.00-1.58%), SVT recurrence was 0.75% (95% CI: 0.00-3.30%), clinically relevant non-major bleeding was 1.95% (95% CI: 0.46-4.11%), minor bleeding was 5.68% (95% CI: 3.02-9.01%). These estimates were for patients treated with rivaroxaban 10-20 mg once daily over 42 days to 37 months. No major bleeding was reported with rivaroxaban 10 mg once daily.

CONCLUSIONS

This systematic review and meta-analysis demonstrate that OACs, especially rivaroxaban, are effective and safe for the treatment of SVT. They offer a convenient alternative to parenteral anticoagulants, potentially improving patient compliance and outcomes. However, further large-scale studies are warranted to confirm these findings.

Complement Inhibitors for Geographic Atrophy in Age-Related Macular Degeneration-A Systematic Review

BACKGROUND/OBJECTIVES

Age-related macular degeneration (AMD) is one of the main causes of blindness and visual impairment worldwide. Intravitreal complement inhibitors are an emergent approach in the treatment of AMD, which have had encouraging results. This systematic review analyzes the outcomes and safety of complement inhibitor therapies for GA in AMD cases.

METHODS

A comprehensive search on the PubMed and Web of Science databases returned 18 studies involving various complement inhibitor agents, with a total of 4272 patients and a mean follow-up of 68.2 ± 20.4 weeks.

RESULTS

Most treated patients were white (96.8%) and female (55.8%), with a mean age of 78.3 ± 7.8 years and a mean GA area of 8.0 ± 3.9 mm2. There were no differences in visual function change between treated and control participants. The mean GA area change was 2.4 ± 0.7 mm2 in treated participants vs. 2.7 ± 0.8 mm2 in control groups (p < 0.001). The ocular and systemic side effects were similar to those of intravitreal anti-VEGF. A less-understood effect was that of the onset of choroidal neovascularization (CNV) in 1.1-13% of patients; this effect was found to be more frequent in patients with neovascular AMD in the fellow eye or nonexudative CNV in the study eye at baseline.

CONCLUSIONS

Complement inhibitors may represent a useful therapy for GA in AMD, but a personalized approach to patient selection is necessary to optimize the outcomes.

Hearing preservation and quality of life in small to medium sized vestibular schwannomas after a wait and scan approach or stereotactic radiosurgery: a systematic review and meta-analysis

BACKGROUND

The management of vestibular schwannomas (VS) encompasses a choice between conservative "wait-and-scan" (WAS) approach, stereotactic radiosurgery (SRS) or open microsurgical resection. Currently, there is no consensus on the optimal management approach for small to medium sized VS. This study aims to compared outcomes related to hearing in patients with small and medium sized VS who underwent initial treatment with WAS versus SRS.

METHODS

A systematic review of the available literature was conducted using PubMed/MEDLINE, Embase, and Cochrane up December 08, 2023. Meta-analysis was performed using a random-effect model to calculate mean difference (MD) and relative risk (RR). A leave-one-out analysis was conducted. The risk of bias was assessed via the Risk of Bias in Non-randomized Studies-Interventions (ROBINS-I) and Cochrane Risk of Bias assessment tool (RoB-2). Ultimately, the certainty of evidence was evaluated using the GRADE assessment. The primary outcomes were serviceable hearing, and pure-tone average (PTA). The secondary outcome was the Penn Acoustic Neuroma Quality of Life Scale (PANQOL) total score.

RESULTS

Nine studies were eligible for inclusion, comprising a total of 1,275 patients. Among these, 674 (52.86%) underwent WAS, while 601 patients (47.14%) received SRS. Follow-up duration ranged from two to eight years. The meta-analysis indicated that WAS had a better outcome for serviceable hearing (0.47; 95% CI: 0.32 - 0.68; p < 0.001), as well as for postoperative functional measures including PTA score (MD 13.48; 95% CI 3.83 - 23.13; p < 0.01), and PANQOL total score (MD 3.83; 95% CI 0.42 - 7.25; p = 0.03). The overall certainty of evidence ranged from "very low" to "moderate".

CONCLUSIONS

Treating small to medium sized VS with WAS increases the likelihood of preserving serviceable hearing and optimized PANQOL overall postoperative score compared to SRS. Nevertheless, the limited availability of literature and the methodological weakness observed in existing studies outline the need for higher-quality studies.

Effect of nitrate supplementation on oxygen saturation levels for acute mountain sickness prevention: A systematic review and meta-analysis

PURPOSE

This study aimed to systematically review the effect of nitrate supplementation on blood oxygen saturation.

METHODS

We searched PubMed, Scopus, and Cochrane Library databases from their inception up to October 2022. Two reviewers independently conducted two stages of the screening process to include a randomized controlled trial with nitrate supplementation versus placebo intervention assessing oxygen saturation among lowlanders going to either real or simulated high altitude environments. We used the Cochrane Risk of Bias 2.0 tool to assess the risk of bias in the included studies. Fixed-effect model meta-analyses were conducted for laboratory-based studies. Random-effect meta-analyses were conducted for real-world studies.

RESULTS

We found 7 trials that met the eligibility criteria. A meta-analysis of studies with some bias concerns showed an increase of 1.26 % in the SpO2 with 44 % I2 during submaximal exercise at simulated high altitudes (GRADE: low). On the contrary, a meta-analysis of studies without heterogeneity showed that nitrate supplementation aggravated oxygen saturation decline (-2.64 %, p = 0.03, GRADE: high) during rest in real high-altitude environments. A meta-analysis also showed that nitrate supplementation did not affect Acute Mountain Sickness (AMS) symptoms (GRADE: high).

CONCLUSION

Our results suggest that nitrate supplementation did not provide benefits for AMS prevention during rest at high altitudes. The low-quality evidence showing small beneficial effects of nitrate supplementation during exercise calls for further studies.

Efficacy evaluation of standardized Boswellia serrata extract (AflapinⓇ) in osteoarthritis: A systematic review and sub-group meta-analysis study

BACKGROUND AND PURPOSE

Osteoarthritis (OA) is a joint disease characterized by pain, inflammation, and physical disability. Boswellia serrata (BS) is widely studied for its effectiveness in OA condition. Our systematic review and meta-analysis study was aimed to evaluate BS extract efficacy in OA. A sub-group analysis was performed to compare the efficacy of a standardized BS extract (AflapinⓇ) with other BS extracts.

METHODS

Randomized controlled trials, identified from three online databases, evaluating the effect of BS extracts in OA were included. Quality of studies was assessed using PEDro scale and risk of bias was assessed using Cochrane Risk of Bias tool. Pooled effect was reported as mean difference (MD) and 95% confidence interval. Study was conducted as per the Cochrane guidelines (PROSPERO registration ID: CRD42023411356).

RESULTS

Nine RCTs with 712 participants were included. All studies (except one) were good quality studies. BS supplementation significantly reduced VAS (MD: -10.71; p<0.00001), LFI (MD: -2.99; p<0.00001), WOMAC-pain (MD: -10.69; p<0.0001), WOMAC-stiffness (MD: -5.49; p<0.00001), and WOMAC-function (MD: -10.69; p<0.00001) scores compared to control therapy. By sub-group analysis, AflapinⓇ supplementation showed greater reduction in VAS (MD: -16.09 vs -4.68), LFI (MD: -3.81 vs -2.01), WOMAC-pain (MD: -18.68 vs -7.07), WOMAC-stiffness (MD: -14.25 vs -3.78), and WOMAC-function (MD: -14.99 vs -8.41) scores as compared to other BS therapies.

CONCLUSIONS

BS supplementation is effective OA symptomatic management. Sub-group analysis revealed that AflapinⓇ supplementation may be better in improving the symptoms of OA which needs to be confirmed by more comparative clinical studies.

Stem Cell-Based Tissue Engineering for Cleft Defects: Systematic Review and Meta-Analysis

This study aimed to analyze the efficacy of stem cell-based tissue engineering for the treatment of alveolar cleft (AC) and cleft palate (CP) defects in animal models.

Systematic review and meta-analysis.

Preclinical studies on alveolar cleft repair in maxillofacial practice.

Electronic search was performed using PubMed, Embase, and Cochrane databases. Pre-clinical studies, where stem cell-based tissue engineering was used in the reconstruction of AC and CP in animal models were included. Quality of the selected articles was evaluated using SYRCLE (SYstematic Review Centre for Laboratory animal Experimentation).

Review of alveolar cleft bone augmentation interventions in preclinical models.

Outcome parameters registered were new bone formation (NBF) and/or bone mineral density (BMD).

Thirteen large and twelve small animal studies on AC (21) and CP (4) reconstructions were included. Studies had an unclear-to-high risk of bias. Bone marrow mesenchymal stem cells were the most widely used cell source. Meta-analyses for AC indicated non-significant benefits in favor of: (1) scaffold + cells over scaffold-only (NBF P = .13); and (2) scaffold + cells over empty control (NBF P = .66; BMD P = .31). Interestingly, dog studies using regenerative grafts showed similar to superior bone formation compared to autografts. Meta analysis for the CP group was not possible.

AC and CP reconstructions are enhanced by addition of osteogenic cells to biomaterials. Directions and estimates of treatment effect are useful to predict therapeutic efficacy and guide future clinical trials of bone tissue engineering.

The effectiveness of evidence-based healthcare educational interventions on healthcare professionals' knowledge, skills, attitudes, professional practice and healthcare outcomes: Systematic review and meta-analysis

OBJECTIVE

The primary aim of this systematic review is to assess the effectiveness of evidence-based healthcare (EBHC) educational interventions on healthcare professionals' knowledge, skills, attitudes, behaviour of EBHC, clinical process and care outcomes. A secondary aim of the review is to assess the effects of important pedagogical moderating factors for EBHC educational interventions.

METHOD

This systematic review used a forward and backward citation search strategy on the Web of Science platform (date of inception to 28 April 2023). Only randomised controlled trials (RCTs) and cluster RCTs which compared EBHC educational interventions for healthcare professionals were included. A random effects meta-analysis was undertaken for EBHC compared with an active and nonactive control for all outcomes.

RESULTS

Sixty-one RCTs were identified which included a total of 5208 healthcare professionals. There was a large effect for EBHC educational interventions compared with waiting list/no treatment/sham control on knowledge (SMD, 2.69; 95% CI, 1.26-4.14, GRADE Low), skills (SMD, 0.88; 95% CI, 0.25-1.73, Very Low Certainty), attitude (SMD, 0.81; 95% CI, 0.16-1.47, Very Low Certainty) and behaviour of EBHC (SMD, 0.82; 95% CI, 0.25-1.40, Very Low Certainty). Over time the effect of EBHC educational interventions substantially decreased with no evidence of effect at 6 months for any outcome except behaviour (SMD,1.72; 95% CI, 0.74-2.71, Low Certainty). There was some evidence that blended learning, active learning and consistency in the individual delivering the intervention may be important positive moderating factors.

CONCLUSION

These findings suggest that EBHC educational interventions may have a large short-term effect on improving healthcare professionals' knowledge, skills, attitude and behaviour of EBHC. These effects may be longer-lasting regarding EBHC behaviour. In terms of pedagogy, blended learning, active learning, and consistency of the individual delivering the intervention may be important positive moderating factors.

Machine learning-derived phenotypic trajectories of asthma and allergy in children and adolescents: protocol for a systematic review

INTRODUCTION

Development of asthma and allergies in childhood/adolescence commonly follows a sequential progression termed the 'atopic march'. Recent reports indicate, however, that these diseases are composed of multiple distinct phenotypes, with possibly differential trajectories. We aim to synthesise the current literature in the field of machine learning-based trajectory studies of asthma/allergies in children and adolescents, summarising the frequency, characteristics and associated risk factors and outcomes of identified trajectories and indicating potential directions for subsequent research in replicability, pathophysiology, risk stratification and personalised management. Furthermore, methodological approaches and quality will be critically appraised, highlighting trends, limitations and future perspectives.

METHODS AND ANALYSES

10 databases (CAB Direct, CINAHL, Embase, Google Scholar, PsycInfo, PubMed, Scopus, Web of Science, WHO Global Index Medicus and WorldCat Dissertations and Theses) will be searched for observational studies (including conference abstracts and grey literature) from the last 10 years (2013-2023) without restriction by language. Screening, data extraction and assessment of quality and risk of bias (using a custom-developed tool) will be performed independently in pairs. The characteristics of the derived trajectories will be narratively synthesised, tabulated and visualised in figures. Risk factors and outcomes associated with the trajectories will be summarised and pooled estimates from comparable numerical data produced through random-effects meta-analysis. Methodological approaches will be narratively synthesised and presented in tabulated form and figure to visualise trends.

ETHICS AND DISSEMINATION

Ethical approval is not warranted as no patient-level data will be used. The findings will be published in an international peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42023441691.

Intraoperative tranexamic acid administration in cranial meningioma surgery: a meta-analysis of prospective randomized, double-blinded, and placebo-controlled trials

Objective

Cranial meningioma surgeries often involve significant blood loss and transfusions. Tranexamic acid (TXA) has been used to reduce blood loss in various surgeries. This meta-analysis of randomized placebo-controlled trials (RCTs) evaluates the impact of TXA in cranial meningioma surgery.

Methods

Pubmed, Web of Science, and Cochrane Library were searched for RCTs. Studies were compared for: Blood loss, operative time, hospital stay, reoperation rates, allogeneic and autologous transfusion, and incidence of complications.

Results

Seven RCTs with 490 patients receiving TXA and 491 receiving placebos were included. TXA significantly shortened operative time (Mean Difference (MD): -20.95; 95%CI: -39.94 to -1.95; p=0.03). Blood loss was lower with TXA (MD: -262.7 ml; 95%CI: -397.6 to -127.8; p=0.0001). Odds of reoperation were not significantly different (OR: 0.44; 95%CI: 0.13-1.45; p=0.18). TXA significantly reduced the need for RBC transfusions (OR: 0.47; 95%CI: 0.22-0.99; p<0.05). No significant differences were observed regarding postoperative seizures (OR: 1.06; 95%CI: 0.56-2.03; p=0.85), hydrocephalus (OR: 0.25; 95%CI: 0.03-2.29; p=0.22), or hematoma (OR: 0.52; 95%CI: 0.22-1.28; p=0.16). Hospital stay was shortened in the TXA group (MD: -1.23; 95%CI: -2.41 to -0.05; p=0.04).

Conclusion

This meta-analysis suggests that a single intraoperative dose of TXA reduces blood loss, allogeneic blood transfusions and shortens surgery time.

N-acetylcysteine as a treatment for substance use cravings: A meta-analysis

N-acetylcysteine (NAC) may serve as a novel pharmacotherapy for substance use and substance craving in individuals with substance use disorders (SUDs), possibly through its potential to regulate glutamate. Though prior meta-analyses generally support NAC's efficacy in reducing symptoms of craving, individual trials have found mixed results. The aims of the this updated meta-analysis were to (1) examine the efficacy of NAC in treating symptoms of craving in individuals with a SUD and (2) explore subgroup differences, risk of bias, and publication bias across trials. Database searches of PubMed, Cochrane Library, and ClinicalTrials.gov were conducted in June and July of 2023 to identify relevant randomized control trials (RCTs). The meta-analysis consisted of 9 trials which analyzed data from a total of 623 participants. The most targeted substance in the clinical trials was alcohol (3/9; 33.3%), followed by tobacco (2/9; 22.2%) and multiple substances (2/9; 22.2%). Meta-analysis, subgroup analyses, and leave-one-out analyses were conducted to examine treatment effect on craving symptoms and adverse events (AEs). Risk of bias assessments, Egger's tests, and funnel plot tests were conducted to examine risk of bias and publication bias. NAC did not significantly outperform placebo in reducing symptoms of craving in the meta-analysis (SMD = 0.189, 95% CI = -0.015 - 0.393). Heterogeneity was very high in the meta-analysis (99.26%), indicating that findings may have been influenced by clinical or methodological differences in the study protocols. Additionally, results indicate that there may be publication bias present. Overall, our findings are contrary to those of prior meta-analyses, suggesting limited impact of NAC on substance craving. However, the high heterogeneity and presence of publication bias identified warrants cautious interpretation of the meta-analytic outcomes.

Impact of the ketogenic diet as a dietary approach on cardiovascular disease risk factors: a meta-analysis of randomized clinical trials

BACKGROUND

Cardiovascular diseases (CVD) remain the leading cause of mortality globally, and the scarcity of scientific evidence regarding the impact of ketogenic diets on CVD risk factors necessitates urgent attention and redress.

OBJECTIVES

This meta-analysis evaluates the impact of the ketogenic diet on CVD risk factors compared with control diets through randomized controlled trials (RCTs).

METHODS

The study was registered in advance in the PROSPERO database (CRD42023491853). A systematic search was conducted across PubMed, Web of Science, EMBASE, and Cochrane Library to identify relevant RCTs. Fixed and random effects were employed to calculate the mean differences and 95% confidence intervals (CIs) for changes in CVD risk factors pre- and postketogenic diet intervention.

RESULTS

A total of 27 RCTs with 1278 participants were analyzed. The ketogenic diet intervention presented increase in total cholesterol (mean differences: 0.36 mmol/L; 95% CI: 0.15, 0.57; I2: 85.1%), low-density lipoprotein cholesterol (mean differences: 0.35 mmol/L; 95% CI: 0.20, 0.50; I2: 73.9%) and high-density lipoprotein cholesterol (mean differences: 0.16 mmol/L; 95% CI: 0.09, 0.23; I2: 86.7%) concentrations. Reductions were observed in the triglyceride (mean differences: -0.20 mmol/L; 95% CI: -0.29, -0.11; I2: 72.2%), blood glucose (mean differences: -0.18 mmol/L; 95% CI: -0.33, -0.02; I2: 76.4%), blood insulin (mean differences: -8.32 pmol/L; 95% CI: -14.52, -2.12; I2: 81.5%), diastolic blood pressure (mean differences: -1.41 mmHg; 95% CI: -2.57, -0.26; I2: 49.1%), weight (mean differences: -2.59 kg; 95% CI: -3.90, -1.28; I2: 87.4%), and body mass index (mean differences: -1.59 kg/m2; 95% CI: -2.32, -0.86; I2: 84.5%) concentrations after implementing ketogenic diets.

CONCLUSIONS

Although the ketogenic diet demonstrates benefits in terms of triglyceride, blood pressure, weight, and glycemic control, its impact on CVD risk factors, especially the elevated total cholesterol and low-density lipoprotein cholesterol concentrations, warrants a cautious approach.