AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both

First Evidence-Based Guideline for Interventions in FASD

Prenatal alcohol exposure causes disruptions in brain development. The resulting disorder, fetal alcohol spectrum disorder (FASD), cannot be cured, but interventions can help improve the daily functioning of affected children and adolescents and the quality of life for the entire family.The aim of the German guideline version 2024 is to provide validated and evidence-based recommendations on interventions for children and adolescents with FASD.We searched for international guidelines and performed a systematic literature review and a hand search to identify literature (published 2012-2022) on interventions for children (0-18 years) with FASD. The quality of the literature was assessed for predefined outcomes using the GRADE method (grading of recommendations, assessment, development, and evaluation). We established a multidisciplinary guideline group, consisting of 15 professional societies, a patient support group, and 10 additional experts in the field. The group agreed on recommendations for interventions based on the systematic review of the literature and formulated additional recommendations, based on clinical experience/expert evidence in a formal consensus process.No international guideline focusing on interventions for patients with FASD was found. Thirty-two publications (4 systematic reviews and 28 original articles) were evaluated. The analysis resulted in 21 evidence-based recommendations and 26 expert consensus, covering the following topics: neuropsychological functioning, adverse effects of therapy, complications/secondary conditions, quality of life, caregiver burden, knowledge of FASD, and coping and self-efficacy.The German guideline is the first internationally to provide evidence-based recommendations for interventions in children and adolescents with FASD.

Dietitian-Provided Interventions for Adults with Cancer: An Umbrella Review of Systematic Reviews

Malnutrition is common in adults with cancer and is associated with lower quality of life and higher risk of mortality. A comprehensive picture of dietitian efficacy in cancer care is needed to inform payers and policymakers about effective care options. The objective of this umbrella review of systematic reviews (SRs) is to examine the impact of dietitian interventions, compared to no intervention or usual care, on nutrition-related outcomes in adults with all types and stages of cancer. MEDLINE, CINAHL, Cochrane Database of SRs, Food Science Source, and SPORTSDiscus databases were searched for SRs and meta-analyses published from 2018 to September 2024. The GRADE method was used to rate evidence certainty. There were 2,087 articles identified in the search, 125 full texts were examined for eligibility, and seven SRs were included in this umbrella review, representing 25 randomized controlled trials and six observational studies. Interventions provided by dietitians may improve nutrition status, protein and energy intake, length of stay, and quality of life, but evidence certainty was low, primarily due to the risk of bias in primary studies, heterogeneity, and lack of precise effect size. Providing dietitian-led interventions for adults with cancer may improve a wide range of nutrition-related outcomes.

Risk factors for metachronous periprosthetic joint infection in patients with multiple prosthetic joints: a systematic review and meta-analysis

OBJECT

Although periprosthetic joint infection (PJI) can affect multiple joints simultaneously, most individuals with multiple joint involvement exhibit PJI in only one joint. Data regarding the metachronous PJI management for these patients are limited. This study aimed to explore the risk factors for metachronous PJI in patients with multiple prosthetic joints, thereby guiding and optimizing clinical practice.

METHODS

The MEDLINE, Web of Science, Cochrane Library, and EMBASE were searched for all clinical studies of metachronous PJI from inception until May 2024. The clinical studies on risk factors for metachronous PJI in patients with multiple prosthetic joints after experiencing a periprosthetic infection were collected, with two authors independently screening the literatures. Newcastle Ottawa scale was used as a quality assessment tool for the included studies, and the meta-analysis was conducted to evaluate the potential risk factors of metachronous PJI.

RESULTS

A total of 1,544 patients with PJI after multiple joint arthroplasties were reported in 9 studies, including 189 with metachronous PJI. The meta-analysis showed that methicillin-resistant staphylococcus aureus (MRSA; OR, 3.43; 95%CI, 1.71-6.88; p = 0.0005), rheumatoid arthritis (RA; OR, 2.38; 95%CI, 1.06-5.38; p = 0.04), history of steroid use (OR, 2.93; 95%CI, 1.58-5.43; p = 0.0007), and previous or ongoing non-periprosthetic infection (OR, 4.47; 95%CI, 1.45-13.82; p = 0.009) were identified as significant risk factors for metachronous PJI in patients with multiple prosthetic joints. However, there was no significant difference between the metachronous PJI group and non-metachronous group in terms of revision, age, diabetes, and gender.

CONCLUSION

Patients with MRSA, RA, history of steroid use, previous or ongoing non-periprosthetic infection are at significantly higher risk for metachronous PJI. Further research is needed to optimize management strategies for preventing metachronous PJI in patients with multiple prostheses after a single joint PJI.

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

BACKGROUND

Migraine is common, affecting 15% of Americans.

PURPOSE

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

DATA SOURCES

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

STUDY SELECTION

Two investigators independently selected English-language randomized trials.

DATA EXTRACTION

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

DATA SYNTHESIS

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

LIMITATIONS

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

CONCLUSION

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

PRIMARY FUNDING SOURCE

American College of Physicians. (PROSPERO: CRD42023441146).

Clinical Significance of Extracellular Volume of Myocardium (ECV) Assessed by Computed Tomography: A Systematic Review and Meta-Analysis

Background/Objectives: Extracellular volume (ECV) of the myocardium, a biomarker of interstitial space and fibrosis, plays a critical role in cardiac disease diagnosis and prognosis. Although cardiac magnetic resonance imaging (MRI) is the gold standard for ECV assessment, computed tomography (CT) offers a viable alternative, particularly in patients with contraindications to MRI. This study aimed to assess whether CT-derived ECV is systematically elevated in cardiac diseases associated with myocardial fibrosis. Methods: A systematic search of PubMed and Web of Science up to January 2023 identified 364 studies, including 16 from registers and 4 from manual searches. After exclusions, 73 studies were included in the systematic review. Of these, 15 provided quantitative data on group sizes, mean ECV values, standard deviations, and imaging modalities (CTA, DECT, LIE-DECT) and were analyzed in the meta-analysis. Standardized mean differences (SMD) were calculated using Cochrane Handbook formulas. Statistical analyses employed random-effects models (R version 4.4.2). Results: The pooled analysis showed that ECV was significantly higher in pathological groups compared to controls (SMD 1.60; 95% CI: 1.23-1.96; I2 = 84.6%). Elevated ECV correlated with worse clinical outcomes, including higher mortality in heart failure and advanced myocardial fibrosis in amyloidosis and cardiomyopathies. Subgroup analyses demonstrated that advanced CT techniques (DECT, LIE-DECT) and CTA provided comparable diagnostic accuracy. Conclusions: CT-derived ECV is a reliable, non-invasive marker of myocardial fibrosis, offering diagnostic and prognostic value similar to MRI. Standardizing CT protocols and conducting multicenter studies are essential to validate its broader clinical application.

Boosting recovery before surgery: The impact of prehabilitation on upper gastrointestinal cancer patients - A quantitative comparative analysis

BACKGROUND

Emerging research presents divergent perspectives on the efficacy of prehabilitation for patients scheduled for surgery due to upper gastrointestinal (GI) cancers, capturing the attention of both the scientific community and surgical professionals. This quantitative comparative analysis seeks to assess the association of prehabilitation to ameliorate postoperative outcomes in individuals with upper GI cancers, thereby providing a comprehensive evaluation of its potential benefits within a surgical context.

MATERIALS AND METHODS

Medline, Embase, Cochrane Library and Web of Science were searched up to February 2024. Studies reporting the association between prehabilitation, and postoperative complications, readmissions or other outcomes of interest were included. Fixed or random effect models were used, and forest plots were applied to show the results of the quantitative comparative analysis.

RESULTS

A total of 198 studies were initially screened based on titles and abstracts, with 129 studies subsequently excluded. Overall, 69 full-text studies were identified, of which 12 studies were finally included for qualitative analysis in the quantitative comparative analysis after determining whether the inclusion and exclusion criteria were met. The pooled results indicated that prehabilitation significantly reduced the overall postoperative complication rates in patients with upper GI cancer undergoing surgical therapy with the pooled OR of 0.59 (95%CI: 0.39-0.88). Moreover, prehabilitation was also shown to be a protective factor of pulmonary complications (OR: 0.54, 95%CI: 0.36-0.80) and ICU readmissions (OR: 0.23, 95%CI: 0.06-0.89).

CONCLUSION

The correlation between prehabilitation and a reduction in overall postoperative complications, pulmonary complications, and ICU readmissions among patients with upper GI cancer is substantiated by significant data. This pivotal finding necessitates further empirical investigation to validate these initial results and ascertain the clinical efficacy of prehabilitation protocols, thereby informing future surgical practice strategies.

Digital Physical Activity and Sedentary Behavior Interventions for Community-Living Adults: Umbrella Review

BACKGROUND

Digital interventions hold significant potential for improving physical activity (PA) and reducing sedentary behavior (SB) in adults. Despite increasing interest, there remain surprising gaps in the current knowledge of how best to deliver these interventions, including incorporating appropriate theoretical frameworks and behavior change techniques. Following numerous systematic reviews, there is now significant potential for umbrella reviews to provide an overview of the current evidence.

OBJECTIVE

This umbrella review aimed to explore digital PA and SB interventions for community-living adults across effectiveness, key components, and methodological quality.

METHODS

This review followed the Joanna Briggs Institute framework for umbrella reviews. Key search terms were developed iteratively, incorporating physical and sedentary activity alongside digital interventions. We searched 7 online databases (Web of Science Core Collection, CINAHL, APA PsycINFO, Inspec, the Cochrane Library, MEDLINE [Ovid], and PROSPERO) alongside gray literature databases. Information was extracted and tabulated from each included article on intervention effectiveness, key components, and content acknowledging both the digital and human elements. The study quality was appraised using A Measurement Tool to Assess systematic Reviews 2 (AMSTAR 2). The corrected covered area method was used to assess the overlap of primary studies included in the systematic reviews. All relevant research findings were extracted and reported.

RESULTS

Search terms identified 330 articles, of which 5 (1.5%) met the inclusion criteria. The most common PA outcomes identified were daily steps, moderate-to-vigorous PA, total PA, and PA change. Reviews with meta-analysis reported that digital interventions improved multiple PA outcomes (daily steps, moderate-to-vigorous PA time, and total PA time). However, findings from the remaining systematic reviews were mixed. Similarly, the findings for SB were contrasting. Regarding intervention components, monitor- and sensor-only intervention delivery methods were most frequently implemented. Eleven theoretical frameworks were identified, with social cognitive theory being the most prominent theory. In total, 28 different behavior change techniques were reported, with goal setting, self-monitoring, feedback, and social support being the most frequently used. All 5 systematic reviews were of low or critically low quality, each incorporating unique primary studies (corrected covered area=0%).

CONCLUSIONS

This umbrella review highlights the potential of digital interventions to increase PA and reduce SB among community-living adults. However, the disparate nature of current academic knowledge means potentially efficacious research may not realistically translate to real work impact. Our review identified a lack of consensus around outcomes and components at both individual (eg, difficult to collate and compare findings) and multiple study (poor reported quality of systematic reviews) levels. Collective, concerted action is required to standardize outcomes and improve systematic review reporting to optimize future learning around digital interventions to increase PA and reduce SB in community-living adults, including traditionally overlooked populations, like informal carers.

TRIAL REGISTRATION

PROSPERO CRD42023450773; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023450773.

The mechanisms of manual therapy: A living review of systematic, narrative, and scoping reviews

INTRODUCTION

Treatment mechanisms are the underlying process or pathway through which a treatment influences the body. This includes molecular, cellular and physiological processes or pathways contributing to treatment effect. Manual therapy (MT) evokes complex mechanistic responses across body systems, interacting with the individual patient and context to promote a treatment response. Challenges arise as mechanistic studies are spread across multiple professions, settings and populations. The purpose of this review is to summarize treatment mechanisms that have been reported to occur with MT application.

METHODS

Four electronic databases were searched (Medline, CINAHL, Cochrane Library, and PEDro) for reviews investigating mechanistic responses which occur during/post application of MT. This review was registered a priori with PROSPERO (CRD42023444839). Methodological quality (AMSTAR-2) and risk of bias (ROBIS) were assessed for systematic and scoping reviews. Data were synthesized by mechanistic domain.

RESULTS

Sixty-two reviews were included. Systematic reviews (n = 35), narrative reviews (n = 24), and scoping reviews (n = 4) of asymptomatic (n = 37), symptomatic (n = 43), non-specified human subjects (n = 7) and animals (n = 7) were included. Reviews of moderate quality supported neurovascular, neurological, and neurotransmitter/neuropeptide changes. Reviews of low quality supported neuroimmunce, neuromuscular, and neuroendocrine changes. Reviews of critically low quality support biomechanical changes.

CONCLUSIONS

Findings support critically low to moderate quality evidence of complex multisystem mechanistic responses occurring with the application of MT. Results support peripheral, segmental spinal, and supraspinal mechanisms occurring with the application of MT, which can be measured directly or indirectly. The clinical value of these findings has not been well established. While MT has proven to be an effective intervention to treat conditions such as pain, the current body of literature leaves uncertainty as to 'why' MT interventions work, and future research should look to better define which mechanisms (or combinations of mechanisms) are mediators of clinical response.

What is the impact of perineural invasion on the prognosis of cervical cancer: a systematic review and meta-analysis

BACKGROUND

Perineural Invasion (PNI) is a marker of a highly invasive tumor with poor prognosis, but the real influence on the prognosis of cervical cancer is still debated. We aimed to systematically investigate the prognostic impact of PNI in cervical cancer.

METHODS

We searched PubMed, Embase, Cochrane databases, and ClinicalTrials.gov from inception to 20 April 2024. Cohort, case-control, and randomized controlled studies reporting the PNI status and survival outcomes of women with cervical cancer were included. Two reviewers extracted data independently and appraised study quality following the PRISMA guideline. The quality of the studies was assessed with Newcastle-Ottawa Scale. Random effect model was used if the heterogeneity was significant (P ≤ 0.1, I2 ≥ 50%).

RESULTS

We included seven retrospective cohort studies (1561 women) in the analysis. PNI was remarkably associated with a worse survival (risk ratio [95% CI]: 2.79 [1.67- 4.66], I2 = 78% for 5-year overall survival (OS); 2.16 [1.30-3.59], I2 = 84% for 5-year disease-free survival (DFS)). After multivariate cox regression adjustment, the hazard ratio [95% CI] of PNI was 3.25 [1.09, 9.74] (I2 = 85%) for OS, and 2.50 [0.66, 9.46] (I2 = 89%) for DFS. PNI showed positive correlation with higher stage, larger tumor size, lymph node metastasis, deep stromal invasion, lymphovascular invasion, resection margin involvement, and parametrial invasion (P < 0.05). Besides, PNI was associated with higher possibility of adjuvant therapy (risk difference [95% CI]: 0.28 [0.04-0.52], I2 = 92%), especially for chemoradiation (0.25 [-0.02-0.53], I2 = 76%). Subgroup analysis showed patients with PNI had poorer prognosis than those without PNI in patients with LNM or large tumor size (P < 0.05).

CONCLUSIONS

PNI demonstrated a significant association with reduced overall survival in cervical cancer patients and emerged as a potential independent prognostic indicator, which provided a foundation for future investigations to evaluate the clinical utility of PNI status in guiding therapeutic strategies.

TRAIL REGISTRATION

The protocol for this study was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) under identifying number CRD42022315970.

Evidence Summary of Early Enteral Nutrition Support for Adult Patients with Extracorporeal Membrane Oxygenation (ECMO)

Objective

This study aims to systematically review and summarize the evidence on early enteral nutrition (EEN)support for Extracorporeal Membrane Oxygenation (ECMO)patients, Offer evidence-based guidance to healthcare professionals, including doctors and nurses, to inform their clinical practices.

Methods

Using the "6S"evidence-based model, we searched multiple databases including UpToDate, Best Practice, Guideline International Network (GIN), National Guideline Clearinghouse (NGC),Registered Nurses' Association of Ontario (RNAO), Joanna Briggs Institute (JBI), Evidence-Based Healthcare Center database, the Cochrane Library, PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI),Wanfang Database, and Chinese Biomedical Literature Database (CBM). Aiming to find evidence on early enteral nutrition support for adult patients with extracorporeal membrane oxygenation. The search included clinical decisions, guidelines, systematic reviews, evidence summaries, and expert consensus. The time frame for the search was from the inception of the databases to September 10, 2024.Two researchers evaluated the quality of the collected literature and extracted data and summarized evidence from publications that met the quality criteria.

Results

We retrieved 13 relevant documents, consisting of 6 guidelines, 3 expert consensus papers, 2 clinical decision-making articles, and 2 cohort studies. Through summarization and induction, a total of 26 best evidence pieces were obtained across five aspects: the establishment of nutritional support plans; strategies and risk assessment for enteral nutrition; the implementation of early enteral nutrition supplementation strategies; the amount and composition of nutrients reaching standard intake; and prevention of enteral nutrition-related complications.

Conclusion

This study has summarized the evidence regarding early enteral nutrition support for adult patients with extracorporeal membrane oxygenation (ECMO). It provides an evidence-based foundation for the practice of nursing and assists medical staff in developing personalized nutrition management plans for enteral nutrition support in ECMO patients.

Evidence on non-pharmacological interventions for preventing or reversing physical frailty in community-dwelling older adults aged over 50 years: overview of systematic reviews

BACKGROUND

A large proportion of older adults are pre-frail. Interventions aimed at this group provide opportunity to reduce progression of physical frailty. The aim of this overview of reviews is to evaluate evidence for non-pharmacological interventions for the prevention/reversal of physical frailty in community-dwelling adults aged ≥ 50 years.

METHODS

Medline, Embase, CINAHL, Cochrane Database of Systematic Reviews, Google Scholar and Social Science Citation Index were searched for non-pharmacological interventions that used a validated frailty measurement tool. Review quality was assessed using AMSTAR-2 and a Synthesis Without Meta-analysis (SWiM) approach was adopted.

RESULTS

Twenty-three reviews were included, six of which were of high quality. This included 18,768 unique participants from 98 unique primary studies. Physical activity containing an aspect of resistance training, for a minimum of twice per week, was evidenced as being beneficial for reversing frailty (28 primary studies and 3,246 unique participants). However, one randomised controlled trial (RCT) showed resistance training by pre-frail adults (n = 66) for eight weeks was not effective at reversing frailty status. Nutrition interventions combined with physical activity that include resistance training (9 studies, 1,812 participants) were effective at reversing/preventing frailty.

CONCLUSION

The evidence synthesised in this overview of reviews suggests physical activity containing an aspect of resistance training is beneficial at reversing frailty status and preventing frailty progression. Nutrition interventions alone were inconclusive. It is recommended that future studies include a validated tool to assess frailty status, report samples by frailty status and make recommendations based on dose (frequency/duration of minutes per session) and adherence to dose.

Impact of opium on bladder cancer incidence: A systematic review and meta-analysis

INTRODUCTION

Opium is used recreationally and for pain relief in certain regions and has been classified as a human carcinogen by the IARC. While its use is rare in Europe and Oceania, it remains a major public health issue in other parts of the world. This study evaluates the risk of bladder cancer (BCa) among opium users compared to non-users.

METHODS

A comprehensive search of MEDLINE, Scopus, and Web of Science was conducted up to July 2024 to identify studies examining the link between opium use and BCa. A meta-analysis was performed to calculate the pooled risk ratio (RR) with 95% confidence intervals (CIs) (PROSPERO: CRD42024562623).

RESULTS

A total of 15 studies (n=60,149) were included. The analysis showed that opium users had a significantly higher risk of developing BCa than non-users (RR: 2.36; 95% CI: 1.92-2.90; P<.001). The risk increased with the amount of opium consumed, regardless of type or method of use.

CONCLUSIONS

Opium consumption increase the risk of developing BCa by more than twofold among users. Awareness of its carcinogenic potential and public health implications is crucial. Our findings underscore the need for global prevention strategies and further research into opium-related BCa risks.

Outdoor air pollution exposure and the risk of type 2 diabetes mellitus: A systematic umbrella review and meta-analysis

The association between different air pollutants and Type 2 Diabetes Mellitus (T2DM) is a growing topic of interest in public health research. This umbrella review and meta-analysis aimed to consolidate current literature on the association between various outdoor air pollutants and T2DM. Subgroups and dose-response relationships were also analyzed to further quantify the association, especially by the factors such as the type of pollutants, duration of exposure, and geographical variation, etc. A thorough literature search of three databases revealed a total of 71 records for umbrella review and 1524 records for meta-analysis where 8 studies were included in the final review of umbrella review and 46 studies for meta-analysis. The evaluation of the study's quality in umbrella review and meta-analysis were conducted using the AMSTAR 2 criteria and the Newcastle-Ottawa Scale (NOS), respectively. Exposure to Particulate Matter (PM) 2.5, PM10, Nitrogen dioxides (NO2) and Ozone (O3) were significantly associated with the risk of T2DM [OR = 1.12 (95% Confidence Interval (CI): 1.09, 1.15), 1.12 (95% CI: 1.06, 1.18), 1.09 (95%CI: 1.07, 1.12), 1.05 (95%CI: 1.03, 1.08), respectively] and subgroup analysis further revealed that PM2.5, PM10, and NO2 associations were confounded by factors such as ages, study design, regions of exposure and air pollution concentration levels. Lastly, only exposure to PM10 had a significant dose-response relationship with the risk of T2DM (p-value = 0.000). These findings further emphasized the need for standardized methods in conducting air pollution research and additional research on other air pollutants to further explore the relationships between these air pollutants and T2DM.

Improving medication adherence in the community: a purposive umbrella review of effective patient-directed interventions that are readily implementable in the United Kingdom National Health Service

BACKGROUND

Suboptimal medication adherence is a major determinant of treatment outcome. Between a third and a half of prescribed medicines for long-term conditions are not taken as intended, the reasons for which are numerous and multifaceted. Improving medication adherence should optimise therapeutic outcomes.

AIM

To identify effective and readily implementable patient-focused interventions for improving medicines adherence that can inform best practice to improve health outcomes.

METHOD

Medline, CINAHL and EMBASE were searched on 11 May 2022 for publications added since 11 January 2013, along with citation searches linked to Nieuwlaat's 2014 Cochrane review. An umbrella review was undertaken of meta-analyses and systematic reviews of empirical research to identify and describe interventions that improve medication adherence. Effective interventions were assessed for their implementation potential.

RESULTS

Strategies to improve medication adherence follow common themes. Fifteen reviews and meta-analyses were identified, and interventions were grouped into eight types. These included using pharmacists to provide interventions; providing face to face interventions; using combination formulations; providing reminders and prompting mechanisms; giving feedback on individual adherence rates; promoting positive habits; using strategies to enhance self-management and positive behaviours; and using interventions in parallel.

CONCLUSION

There are several readily implementable intervention approaches with demonstrable effectiveness based on systematic review or meta-analysis evidence. However, owing to the diverse evidence base in this field, and the significant risk of bias in many studies, further work is needed to understand the comparative value of different interventions and their impact on patient-oriented outcomes.

Dietary Nitrate Supplementation and Exercise Performance: An Umbrella Review of 20 Published Systematic Reviews with Meta-analyses

BACKGROUND

Dietary nitrate (NO3-) supplementation is purported to benefit exercise performance. However, previous studies have evaluated this nutritional strategy with various performance outcomes, exercise tasks, and dosing regimens, often yielding inconsistent results that limit the generalizability of the findings.

OBJECTIVE

We aimed to synthesize the available evidence regarding the effect of NO3- supplementation on 11 domains of exercise performance.

METHODS

An umbrella review was reported in accordance with the Preferred Reporting Items for Overviews of Reviews guideline. Seven databases (MEDLINE, EMBASE, Cochrane Database, CINAHL, Scopus, SPORTDiscus, and Web of Science) were searched from inception until July 2024. Systematic reviews with meta-analyses comparing NO3- supplementation and placebo-controlled conditions were included. Literature search, data extraction, and methodological quality assessment (A Measurement Tool to Assess Systematic Reviews Assessing the Methodological quality of SysTemAtic Review [AMSTAR-2]) were conducted independently by two reviewers.

RESULTS

Twenty systematic reviews with meta-analyses, representing 180 primary studies and 2672 unique participants, met the inclusion criteria. Our meta-analyses revealed mixed effects of NO3- supplementation. It improved time-to-exhaustion tasks [standardized mean difference (SMD): 0.33; 95% confidence interval (CI) 0.19-0.47] with subgroup analyses indicating more pronounced improvements when a minimum dose of 6 mmoL/day (372 mg/day) and chronic (> 3 days) supplementation protocol was implemented. Additionally, ergogenic effects of NO3- supplementation were observed for total distance covered (SMD: 0.42; 95% CI 0.09-0.76), muscular endurance (SMD: 0.48; 95% CI 0.23-0.74), peak power output (PPO; SMD: 0.25; 95% CI 0.10 to 0.39), and time to PPO (SMD: - 0.76; 95% CI - 1.18, - 0.33). However, no significant improvements were found for other performance outcomes (all p > 0.05). The AMSTAR-2 ratings of most included reviews ranged from low to critically low.

CONCLUSIONS

This novel umbrella review with a large-scale meta-analysis provides an updated synthesis of evidence on the effects of NO3- supplementation across various aspects of exercise performance. Our review also highlights significant methodological quality issues that future systematic reviews in this field should address to enhance the reliability of evidence.

CLINICAL TRIAL REGISTRATION

This study was registered in the International Prospective Register of Systematic Review (PROSPERO) database (registration number: CRD42024577461).

Development of venous thromboembolism and its impact on hospitalized adults with covid-19: rapid systematic review

The association between COVID-19 and coagulation disorders has been discussed since the onset of the pandemic. Four years into the pandemic, it is crucial to organize the findings and evidence accumulated thus far. The objective of this study was to review and synthesize the available scientific evidence regarding the relationship between COVID-19 and development of venous thromboembolism (VTE). A rapid systematic review was conducted by searching two electronic databases, selecting systematic review articles that assessed the association between COVID-19 and development of VTE, such as deep vein thrombosis (DVT) or pulmonary embolism (PE). The studies indicated that hospitalized COVID-19 patients are at greater risk of developing VTE, especially those admitted to intensive care units (ICUs). Elevated D-dimer levels and male gender were also associated with increased risks.

Association of red and processed meat consumption with cancer incidence and mortality: An umbrella review protocol

BACKGROUND

Many meta-analyses have reported the associations between red and processed meat consumption and cancer outcomes, but few have assessed the credibility of the evidence. In addition, the results of dose-effect analyses of the association between red and processed meat consumption and cancer outcomes were inconsistently reported in different articles. Here we propose a protocol for an umbrella review (UR) that be designed to assess these associations and explore the potential dose-response relationships.

METHODS

We will independently search five electronic databases and two registers from inception to July 2024 for systematic reviews with meta-analysis concerning the associations of red and processed meat consumption with cancer incidence and mortality. We will conduct the statistical analysis between August 2024 and December 2024. Also, an up-to-date search for additional primary studies of cancer outcomes that were not included in previously published meta-analyses will be conducted. The main outcomes will include the incidence and mortality of any cancer related to red and processed meat exposure. A series of unique associations will be created based on the cancer outcome, exposure, and clinical or population setting. For each association, we will update the meta-analysis by combining studies included in prior meta-analyses and new studies that were not included in prior meta-analyses, and re-perform the meta-analysis using the random-effects models. According to the credibility of the evidence assessment, all associations with a P value of ≤  0.05 will be categorized as convincing, highly suggestive, suggestive, or weak evidence. All analyses will be performed in R (version 4.2.3).

RESULTS

The results of this UR are planned to be submitted to a peer-reviewed journal.

CONCLUSION

The main aim of protocol publication is to get feed back from the reviewers to develop a standard protocol before its publication and after publication, it should guide this protocol to take up similar research by any researcher(s) by following meticulously this standard protocol.

REGISTRATION

PROSPERO CRD42023414550.

Artificial Intelligence-Assisted Capsule Endoscopy Versus Conventional Capsule Endoscopy for Detection of Small Bowel Lesions: A Systematic Review and Meta-Analysis

BACKGROUND

Capsule endoscopy (CE) is a valuable tool used in the diagnosis of small intestinal lesions. The study aims to systematically review the literature and provide a meta-analysis of the diagnostic accuracy, specificity, sensitivity, and negative and positive predictive values of AI-assisted CE in the diagnosis of small bowel lesions in comparison to CE.

METHODS

Literature searches were performed through PubMed, SCOPUS, and EMBASE to identify studies eligible for inclusion. All publications up to 24 November 2024 were included. Original articles (including observational studies and randomized control trials), systematic reviews, meta-analyses, and case series reporting outcomes on AI-assisted CE in the diagnosis of small bowel lesions were included. The extracted data were pooled, and a meta-analysis was performed for the appropriate variables, considering the clinical and methodological heterogeneity among the included studies. Comprehensive Meta-Analysis v4.0 (Biostat Inc.) was used for the analysis of the data.

RESULTS

A total of 14 studies were included in the present study. The mean age of participants across the studies was 54.3 years (SD 17.7), with 55.4% men and 44.6% women. The pooled accuracy for conventional CE was 0.966 (95% CI: 0.925-0.988), whereas for AI-assisted CE, it was 0.9185 (95% CI: 0.9138-0.9233). Conventional CE exhibited a pooled sensitivity of 0.860 (95% CI: 0.786-0.934) compared with AI-assisted CE at 0.9239 (95% CI: 0.8648-0.9870). The positive predictive value for conventional CE was 0.982 (95% CI: 0.976-0.987), whereas AI-assisted CE had a PPV of 0.8928 (95% CI: 0.7554-0.999). The pooled specificity for conventional CE was 0.998 (95% CI: 0.996-0.999) compared with 0.5367 (95% CI: 0.5244-0.5492) for AI-assisted CE. Negative predictive values were higher in AI-assisted CE at 0.9425 (95% CI: 0.9389-0.9462) versus 0.760 (95% CI: 0.577-0.943) for conventional CE.

CONCLUSION

AI-assisted CE displays superior diagnostic accuracy, sensitivity, and positive predictive values albeit the lower pooled specificity in comparison with conventional CE. Its use would ensure accurate detection of small bowel lesions and further enhance their management.

Dietary and circulating omega-6 fatty acids and their impact on cardiovascular disease, cancer risk, and mortality: a global meta-analysis of 150 cohorts and meta-regression

BACKGROUND

Despite the significant increase in omega-6 fatty acid consumption, evidence regarding their health impacts remains inconsistent. This study performs an umbrella review and updated meta-analysis to evaluate the association between dietary and circulating omega-6 levels and the risks of cardiovascular diseases (CVDs), cancer, and mortality.

METHODS

A systematic search was conducted in PubMed, Scopus, and Web of Science until January 2024 to identify eligible meta-analyses of prospective observational studies. The Cochrane risk of bias and GRADE tools were used to assess the risk of bias and certainty of the evidence, respectively.

RESULTS

Analysis of 150 publications revealed that higher dietary intake and circulating levels of omega-6 were associated with lower risks of CVDs, cancer incidence, and all-cause mortality in the general population, particularly for coronary heart disease and stroke. While omega-6 intake was linked to lower risks of lung and prostate cancers, it was associated with higher risks of ovarian and endometrial cancers. Subgroup analyses revealed that these protective associations were more pronounced in cohort studies and absent in populations with pre-existing health conditions.

CONCLUSIONS

Higher dietary intake and circulating levels of omega-6 fatty acids were associated with lower risks of CVDs, cancers, and all-cause mortality. However, the associations vary by cancer type and are less evident in individuals with pre-existing health conditions. These findings highlight the potential benefits of omega-6 fatty acids for public health while underscoring the need for further research to address specific risks and underlying mechanisms.

TRIAL REGISTRATION

Registration number (PROSPERO): CRD42024522842.

Effects of transcranial direct current stimulation (tDCS) on motor function among people with stroke: evidence mapping

OBJECTIVE

To present, organize, and assess the methodological quality of the current research related to tDCS on motor function after a stroke and to identify gaps and clinical implications using an evidence mapping approach.

METHODS

Six electronic databases (PubMed, Embase, Cochrane Library, Web of Science, CINAHL, PEDro), gray literature, and reference lists of articles were searched from inception until October 2023. The Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) checklist and PEDro scale were used to assess the methodology quality of systematic reviews (SRs) and randomized controlled trials (RCTs).

RESULTS

A total of 172 articles met the inclusion criteria from 5759 records, including 46 SRs and 126 RCTs. Related studies came from 29 countries around the world, and China has performed the most, with 12 SRs and 21 RCTs. More than half of SRs (65.22%) were evaluated with low or critically low quality, while 78.58% of RCTs have shown excellent or good quality. A total of 26 SRs and 93 RCTs have reported outcomes on upper limb motor function with kinds of tDCS, and 15 SRs and 44 RCTs have focused on lower extremity function. Studies with safety concerns have reported no or mild adverse events.

CONCLUSIONS

This study systematically identified gaps and indicated that tDCS is a kind of potential and safe intervention. Given potential concerns on the clinical application, more high-quality research with large sample size and kinds of objectives is needed in the future.

Patterns of Use of e-Cigarettes and Their Respiratory Effects: A Critical Umbrella Review

E-cigarettes (ECs) are a well-established consumer product. To study their respiratory health effects, there is the issue of heterogenous patterns of use: concurrently with cigarette smoking (dual use), exclusive use after smoking cessation (exclusive use), or use initiated without any prior or current use of cigarettes (naïve use). Our primary goal was to synthesize the evidence on the respiratory effects of ECs use in adults, categorized by their pattern of use. Additionally, we identified the highest quality systematic reviews and critically evaluated the current literature on this topic. The review was developed with published umbrella review guidelines. The database searches were Medline, Scopus, Cochrane, Epistemonikos, LILACS, and grey literature databases. The criterion for inclusion of systematic reviews was analyses of respiratory tests from randomized controlled trials or cohort studies. Quality assessments were performed with AMSTAR2 and a checklist of reporting biases. A narrative analysis was synthesized by test method: spirometry, impulse oscillometry, breath gasses, biomarkers, and clinical serious adverse events. Twelve systematic reviews were included. The findings on respiratory functioning were statistically non-significant across all patterns of use. Reporting bias was frequently observed. Based on the current research, there is no evidence of significant change in the short or medium term in respiratory function with any pattern of ECs use. We attribute the null findings to the weaknesses of acute studies, the participants' smoking history masking testing, and the inclusion of participants with a low frequency of use.

Improving peer review of systematic reviews and related review types by involving librarians and information specialists as methodological peer reviewers: a randomised controlled trial

OBJECTIVE

To evaluate the impact of adding librarians and information specialists (LIS) as methodological peer reviewers to the formal journal peer review process on the quality of search reporting and risk of bias in systematic review searches in the medical literature.

DESIGN

Pragmatic two-group parallel randomised controlled trial.

SETTING

Three biomedical journals.

PARTICIPANTS

Systematic reviews and related evidence synthesis manuscripts submitted to The BMJ, BMJ Open and BMJ Medicine and sent out for peer review from 3 January 2023 to 1 September 2023. Randomisation (allocation ratio, 1:1) was stratified by journal and used permuted blocks (block size=4). Of 2670 manuscripts sent to peer review during study enrollment, 400 met inclusion criteria and were randomised (62 The BMJ, 334 BMJ Open, 4 BMJ Medicine). 76 manuscripts were revised and resubmitted in the intervention group and 90 in the control group by 2 January 2024.

INTERVENTIONS

All manuscripts followed usual journal practice for peer review, but those in the intervention group had an additional (LIS) peer reviewer invited.

MAIN OUTCOME MEASURES

The primary outcomes are the differences in first revision manuscripts between intervention and control groups in the quality of reporting and risk of bias. Quality of reporting was measured using four prespecified PRISMA-S items. Risk of bias was measured using ROBIS Domain 2. Assessments were done in duplicate and assessors were blinded to group allocation. Secondary outcomes included differences between groups for each individual PRISMA-S and ROBIS Domain 2 item. The difference in the proportion of manuscripts rejected as the first decision post-peer review between the intervention and control groups was an additional outcome.

RESULTS

Differences in the proportion of adequately reported searches (4.4% difference, 95% CI: -2.0% to 10.7%) and risk of bias in searches (0.5% difference, 95% CI: -13.7% to 14.6%) showed no statistically significant differences between groups. By 4 months post-study, 98 intervention and 70 control group manuscripts had been rejected after peer review (13.8% difference, 95% CI: 3.9% to 23.8%).

CONCLUSIONS

Inviting LIS peer reviewers did not impact adequate reporting or risk of bias of searches in first revision manuscripts of biomedical systematic reviews and related review types, though LIS peer reviewers may have contributed to a higher rate of rejection after peer review.

TRIAL REGISTRATION NUMBER

Open Science Framework: https://doi.org/10.17605/OSF.IO/W4CK2.

Circulating Tumor DNA as a Real-Time Biomarker for Minimal Residual Disease and Recurrence Prediction in Stage II Colorectal Cancer: A Systematic Review and Meta-Analysis

The role of adjuvant chemotherapy (adj-CT) in stage II colon cancer remains controversial. Circulating tumor DNA (ctDNA) is a promising biomarker for detecting minimal residual disease (MRD) and predicting recurrence. This systematic review and meta-analysis evaluated the prognostic value of ctDNA in stage II colorectal cancer (CRC), focusing on postoperative detection, post adj-CT outcomes, and dynamic surveillance. A literature search identified studies correlating ctDNA positivity in stage II CRC with recurrence risk, recurrence-free survival (RFS), and disease-free survival (DFS). Seven studies met the inclusion criteria. Postoperative ctDNA positivity significantly increased the risk of recurrence (pooled risk ratio [RR:] 3.66; 95% confidence interval [CI]: 1.25-10.72; p = 0.002). CtDNA positivity after adj-CT was strongly associated with poor survival, while dynamic ctDNA monitoring detected recurrence earlier than conventional methods, including carcinoembryonic antigen (CEA) and imaging. CtDNA is a robust prognostic biomarker in stage II CRC, enabling personalized treatment. High-risk ctDNA-positive patients may benefit from intensified therapy, while ctDNA-negative patients could avoid unnecessary treatments. However, the standardization of detection methods and large-scale validation studies are needed before integrating ctDNA into routine clinical practice as a non-invasive, dynamic tool for personalized care.

The Role of Artificial Intelligence in Nursing Education, and Practice: An Umbrella Review

BACKGROUND

Artificial intelligence (AI) is rapidly transforming healthcare, offering significant advancements in patient care, clinical workflows, and nursing education. While AI has the potential to enhance health outcomes and operational efficiency, its integration into nursing practice and education raises critical ethical, social, and educational challenges that must be addressed to ensure responsible and equitable adoption.

OBJECTIVE

This umbrella review aims to evaluate the integration of AI into nursing practice and education, with a focus on ethical and social implications, and to propose evidence-based recommendations to support the responsible and effective adoption of AI technologies in nursing.

METHODS

A comprehensive literature search was conducted in PubMed, CINAHL, Web of Science, Embase, and IEEE Xplore to identify relevant review articles (systematic, scoping, narrative, etc.) on AI integration in nursing, published up to October 2024 (with an updated search in January 2025). Eligibility was determined using the SPIDER framework to include reviews addressing AI in any nursing context (practice or education). Two reviewers independently screened studies, extracted data, and assessed the quality of each review using ROBIS and an adapted AMSTAR 2 tool. The findings were synthesized using thematic analysis to identify key recurring themes across the included studies.

RESULTS

Eighteen reviews met the inclusion criteria, encompassing diverse nursing domains (clinical practice, education, and research). Three overarching themes emerged: (1) Ethical and Social Implications - widespread concerns about data privacy, algorithmic bias, transparency in AI decision-making, accountability, and equitable access; (2) Transformation of Nursing Education - the need for curriculum reform to integrate AI literacy, the use of AI-driven educational tools, and training to address ethical and interpersonal skills in an AI-enabled environment; and (3) Strategies for Integration - the importance of scalable implementation plans, development of ethical governance frameworks, promoting equity in AI access, and fostering interdisciplinary collaboration. Critical barriers identified across studies include algorithmic bias, data privacy concerns, resistance to AI adoption among nursing professionals, lack of standardized AI education (highlighting the need for curriculum updates), and disparities in access to AI technologies.

CONCLUSIONS

AI offers significant promise to transform nursing practice and education, but realizing these benefits requires proactive strategies to address the identified challenges. This review recommends implementing robust ethical AI governance frameworks and regulatory guidelines, integrating AI literacy and ethics into nursing curricula, and encouraging interdisciplinary collaboration between healthcare and technology professionals. Such measures will help ensure that AI technologies are adopted in nursing practice in an ethical and equitable manner. Further research is needed to develop standardized implementation strategies and to evaluate the long-term impacts of AI integration on patient care and professional nursing practice.

Prehospital Use of Medication-Assisted Treatment for Opioid Use Disorder: A Rapid Review of Implementation Approaches and Outcomes

This study aimed to evaluate the use of prehospital medication-assisted treatment (MAT) administration by Emergency Medical Services for opioid use disorder (OUD) through a review of literature published between 2014-2024. A search of the NCBI repository using selected keywords returned N=28 results; articles meeting the inclusion criteria (n=13) were reviewed and analyzed. Heterogeneity among studies was assessed using the Chi-squared test and I² statistic. Studies were categorized into two primary domains: implementation and protocols or patient outcomes. Findings suggest that while MAT administration extends on-scene time, it significantly improves patient retention in OUD treatment. However, operational challenges, including geographical disparities in access and racial inequities in retention, limit widespread implementation. This review underscores the consistent safety of prehospital MAT administration, specifically by EMS personnel outside of an emergency department, yet highlights the need for addressing these barriers to optimize its effectiveness as a critical intervention in managing OUD in the prehospital setting.

Comparison of the Hinotori surgical robot with the da Vinci robotic system in urologic surgery: a systematic review and meta-analysis

The objective is to investigate the outcomes of the Hinotori Surgical Robotic System (HSRS) for urological surgery and to analyze the variation in perioperative performance between the HSRS and the da Vinci surgical robot. Multiple databases including PubMed, Cochrane Library, Embase and Web of Science were comprehensibly retrieved to screen studies that applied HSRS to urologic surgery and compared it with the da Vinci system. The results were combined and analyzed using estimated ratio of ratios (OR) and weighted mean difference (WMD). Eight studies with 740 patients were included. Among the baseline characteristics of patients in both groups, all outcomes showed similarity. In urologic surgery, the HSRS cohort experienced a longer operative time (WMD = 8.85, 95% Cl (1.73, 15.97), p < 0.05) and a relatively longer use of the robotic system (WMD = 10.77, 95% Cl [1.09, 20.44], p < 0.05), as well as a notable increase in console time (WMD = 20.99, 95% Cl 95% Cl [8.24, 33.75], p < 0.05). However, estimated blood loss, length of hospitalization, rate of severe complications, and rate of positive margins did not show statistical differences. In urologic surgery, HSRS has a longer operative time, robot system usage time, and console time, but its perioperative results are similar to the Da Vinci system. HSRS shows good clinical promise, however, further long-term data studies are needed to prove it.

Ginkgo biloba leaf extract EGb 761® for the treatment of various diseases: Overview of systematic reviews

BACKGROUND

Ginkgo biloba leaf extract EGb 761® might have diverse therapeutic effects.

OBJECTIVE

We conducted an overview of systematic reviews (SRs) to compile the efficacy and safety of EGb 761®.

METHODS

The Cochrane Database of Systematic Reviews, MEDLINE (via PubMed), Embase (via OVID) and PROSPERO were searched from inception until July 25th, 2023 with an update on January 30th, 2025. SRs were included if they evaluated the efficacy and safety of oral treatment with EGb 761® under any clinical condition or in healthy subjects for clinical reasons, such as prevention, or for health promotion. Two authors carried out screening, selection, data extraction and risk of bias assessment (AMSTAR 2). The degree of overlap was quantified. The overview was registered a priori (PROSPERO: CRD42023423789).

RESULTS

We screened 126 articles and included reviews on neurocognitive disorders (n = 13), tinnitus, macular degeneration and schizophrenia (all n = 1). For neurocognitive disorders, most SRs were in favor of EGb 761® regarding cognition and behavioral and/or psychological symptoms, while the results for functional activities of daily living varied. EGb 761® might have positive effects on tinnitus, macular degeneration or schizophrenia: however, more evidence is needed. In general, EGb 761® appears to be safe. Methodological quality was poor in all SRs. The overall overlap of the primary studies on neurocognitive disorders was very high, and pairwise overlap varied.

CONCLUSION

EGb 761® has been studied in various reviews, particularly regarding neurocognitive disorders and has been reported to be safe in many SRs. The results must be treated with caution due to the poor quality of the SRs.

Move your body, stay away from depression: a systematic review and meta-analysis of exercise-based prevention of depression in middle-aged and older adults

Objective

This study aimed to systematically assess the efficacy of exercise interventions in preventing depression among middle-aged and older adults. It further sought to dissect the impact of various intervention factors on the exercise-depression nexus within this demographic.

Methods

We conducted a comprehensive search across multiple databases including PubMed, Embase, Web of Science, and the Cochrane Library, spanning from their inception through April 2024. The initial search yielded several studies, from which 11 papers involving a total of 792 subjects were selected based on predetermined inclusion criteria.

Results

Our meta-analysis revealed a significant overall effect size (SMD = -3.64) with a 95% confidence interval of [-4.81, -2.48] and a p-value of <0.00001, underscoring the potent preventative impact of exercise on depressive symptoms in the target population. However, the studies exhibited substantial heterogeneity (I 2 = 87%).

Conclusion

Exercise interventions, particularly balance and gentle training as well as functional training, significantly reduce the risk of depression among middle-aged and older adults. The most pronounced effects were observed in group exercise settings and with exercise sessions lasting 30-40 min. Interventions of medium duration generally outperformed shorter-term interventions. Despite these promising results, the observed heterogeneity and other potential study limitations suggest a need for further research involving larger samples and more comprehensive study designs to refine and optimize exercise protocols for depression prevention in this population.

Equality, Diversity and Inclusion characteristics measured or reported in randomised trials of intrapartum interventions: A Scoping Review

Background

Equality, diversity and inclusion (EDI) has gained discursive momentum across multiple arenas, including in maternal health research. As a preliminary exploration for future discussion and development, we undertook a scoping review to identify the types, frequency, and extent of EDI characteristics that were measured and reported in randomised controlled trials (RCTs) of intrapartum interventions specifically.

Methods

Joanna Briggs Institute methodological guidance for scoping reviews guided the conduct of the review. The population were women of any parity and risk category who were enrolled in intrapartum RCTs in any birth setting or geographical location. The concept was measured and reported EDI characteristics. CINAHL, MEDLINE, PsycINFO, EMBASE, and CENTRAL were searched from January 2019 to March 2024. Data were extracted using a pre-designed form. The findings were summarised and narratively reported supported by illustrative tables and graphs.

Results

Two-hundred and forty-seven RCTs from 49 countries were included. Eleven EDI characteristics were measured or reported in at least one RCT, although frequency varied. Religion, for example, featured in three RCTs only, whereas Age featured in 222 RCTs. How the EDI characteristics featured also varied. Race/Ethnicity, for example, was described in 21 different ways in 25 RCTs. Similarly, Education was reported in 62 different ways across 96 RCTs. Ninety RCTs limited inclusion to nulliparous participants only, six RCTs required participants to have a minimum educational level, 127 RCTs had inclusion age cut-offs although 23 different variations of this were noted and 15 RCTs excluded participants on the grounds of disability.

Conclusions

This scoping review highlights EDI characteristic measurement and reporting deficits in intrapartum RCTs. There is a critical need for improvements in designing, conducting, and reporting RCTs to incorporate EDI. By adopting more extensive EDI practices a greater understanding of healthcare treatments and innovations leading to enhanced maternal health equity could be achieved.

The Impact of Sodium-Glucose Cotransporter-2 Inhibitors on Atrial Fibrillation Burden in Diabetic Patients

Atrial Fibrillation (AF) and Type 2 Diabetes Mellitus (T2DM) are comorbid conditions associated with increased adverse outcomes. Recent evidence suggests that antidiabetic therapies such as sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 agonists (GLP1a) may influence the risk of AF and stroke differently. This study aims to compare the risk of new-onset AF and stroke in T2DM patients treated with SGLT2i versus GLP1a. A systematic literature review was performed on Pubmed and Embase, including studies comparing the effect of SGLT2i or GLP1a on new-onset AF and stroke incidence in T2DM patients. A random effects model was used to pool relative risk and 95% confidence intervals to assess the study outcomes. Univariate metaregression analysis was performed for selected demographics and comorbidities. Six observational studies were included in the analysis comprising 847,028 patients. Our meta-analysis found a significantly lower risk of new-onset AF in patients with T2DM treated with SGLT2i compared to those receiving GLP1a (RR = 0.76, 95% CI: 0.65 to 0.89). There was no statistically significant difference in the risk of stroke between SGLT2i and GLP1a (RR = 1.09, 95% CI = 0.98 to 1.21). Univariate meta-regression indicated male sex was a significant negative effect modifier for new-onset AF (coefficient = -0.0191, p-value = 0.0158). In conclusion, SGLT2i may reduce AF risk in T2DM patients, while GLP1a may provide a modest, nonsignificant protective effect against stroke. Further research is needed to confirm these results and guide cardiovascular risk management in patients with T2DM.

The impact of probiotics on oxidative stress and inflammatory markers in patients with diabetes: a meta-research of meta-analysis studies

Objective

Probiotic supplementation has gained attention for its potential to modulate inflammatory and oxidative stress biomarkers, particularly in metabolic disorders. This meta-analysis evaluates the effects of probiotics on C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), malondialdehyde (MDA), total antioxidant capacity (TAC), glutathione (GSH), and nitric oxide (NO) in patients with diabetes.

Methods

A Meta-Research was conducted on 15 meta-analyses of unique 33 randomized controlled trials (RCTs) published between 2015 and 2022, involving 26 to 136 participants aged 26 to 66 years. Data were synthesized using standardized mean differences (SMD), with sensitivity analysis using a random-effect model.

Results

Probiotic supplementation significantly reduced CRP (SMD = -0.79, 95% CI: -1.19, -0.38), TNF-α (SMD = -1.35, 95% CI: -2.05, -0.66), and MDA levels (WMD: -0.82, 95% CI: -1.16, -0.47). Probiotics increased GSH (SMD = 1.00, 95% CI: 0.41, 1.59), TAC (SMD = 0.48, 95% CI: 0.27, 0.69), and NO (SMD = 0.60, 95% CI: 0.30, 0.91). Result on IL-6 was not significant (SMD = -0.29, 95% CI: -0.66, 0.09). Sensitivity analyses confirmed robustness.

Conclusion

Probiotics significantly improved inflammatory and oxidative stress biomarkers in patients with diabetes, with variations influenced by population and dosage. Future studies should explore novel probiotic strains and longer interventions.

Efficacy and safety of brain-computer interface for stroke rehabilitation: an overview of systematic review

Background

Stroke is a major global health challenge that significantly influences public health. In stroke rehabilitation, brain-computer interfaces (BCI) offer distinct advantages over traditional training programs, including improved motor recovery and greater neuroplasticity. Here, we provide a first re-evaluation of systematic reviews and meta-analyses to further explore the safety and clinical efficacy of BCI in stroke rehabilitation.

Methods

A standardized search was conducted in major databases up to October 2024. We assessed the quality of the literature based on the following aspects: AMSTAR-2, PRISMA, publication year, study design, homogeneity, and publication bias. The data were subsequently visualized as radar plots, enabling a comprehensive and rigorous evaluation of the literature.

Results

We initially identified 908 articles and, after removing duplicates, we screened titles and abstracts of 407 articles. A total of 18 studies satisfied inclusion criteria were included. The re-evaluation showed that the quality of systematic reviews and meta-analyses concerning stroke BCI training is moderate, which can provide relatively good evidence.

Conclusion

It has been proven that BCI-combined treatment can improve upper limb motor function and the quality of daily life for stroke patients, especially those in the subacute phase, demonstrating good safety. However, its effects on improving speech function, lower limb motor function, and long-term outcomes require further evidence. Multicenter, long-term follow-up studies are needed to increase the reliability of the results.

Clinical Trial Registration

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024562114, CRD42023407720.

Interventions for suicidal and self-injurious related behaviors in adolescents with psychiatric disorders: a systematic review and meta-analysis

As a leading cause of adolescent death, suicidal and self-injurious related behaviors (SSIRBs) is a devastating global health problem, particularly among patients with psychiatric disorders (PDs). Previous studies have shown that multiple interventions can alleviate symptoms and reduce risks. This review aimed to provide a systematic summary of interventions (i.e., medication, physical therapy, psychosocial therapy) for the treatment of SSIRBs among Chinese adolescents with PDs. From inception to September 17, 2023, twelve databases (PubMed, CINAHL, ScienceDirect, PsycINFO, EMBASE, Cochrane Library, Clinical Trial, Web of Science, CEPS, SinoMed, Wanfang and CNKI) were searched. We qualitatively and quantitatively synthesized the included studies. Standardized mean differences (SMDs), risk ratios and their 95% confidence intervals (CIs) used the Der Simonian and Laird random-effects model. Fifty-two studies covering 3709 eligible participants were included. Overall, the commonly used interventions targeting SSIRBs and negative feelings in PDs adolescents with SSIRBs included psychosocial therapy (e.g., cognitive behavioral therapy), medication (e.g., antidepressants), and physiotherapy (e.g., repetitive transcranial magnetic stimulation). Importantly, quetiapine fumarate in combination with sodium valproate (SV) had positive effects on reducing self-injury behaviors score [SMD: -2.466 (95% CI: -3.305, -1.628), I2 = 88.36%], depression [SMD: -1.587 (95% CI: -2.505, -0.670), I2 = 90.45%], anxiety [SMD: -1.925 (95% CI: -2.700, -1.150), I2 = 85.23%], impulsivity [SMD: -2.439 (95% CI: -2.748, -2.094), I2 = 0%], as well as its safety in comparison with SV alone. No significant difference of adverse reactions was found by low-dose QF (P > 0.05). This review systematically outlined the primary characteristics, safety and effectiveness of interventions for Chinese PDs adolescents with SSIRBs, which could serve as valuable evidence for guidelines aiming to formulate recommendations.

Comparative efficacy and safety of bicompartmental versus total knee arthroplasty: a systematic review and update meta-analysis

BACKGROUND

This study was aimed at comparing the efficacy and safety of bicompartmental knee arthroplasty (BKA) and total knee arthroplasty (TKA) in treating bicompartmental knee osteoarthritis through a systematic evaluation and meta-analysis.

METHODS

A comprehensive systematic literature search of the Pub Med, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov databases was performed to identify the relevant scientific literature published until 1st March 2024. The eligible studies were evaluated for quality assessment and data extraction, and meta-analysis was performed using Review Manager 4.1 software.

RESULTS

A total of 1378 studies were identified. Based on strict inclusion criteria, 12 studies were finally included in this meta-analysis. The results of the analysis revealed that BKA yielded better postoperative outcomes than TKA, in terms of Knee Society Score (KSS) Knee Score, Function Score, and range of knee flexion (P = 0.02; P < 0.0001; P = 0.0005, respectively). Intraoperative bleeding in the BKA group was significantly lower than that in the TKA group (P = 0.02), although postoperative complications (P < 0.05) were higher and operative time (P = 0.04) was longer in the BKA group. However, the two groups did not show any significant difference in terms of Oxford knee score and WOMAC pain score (P = 0.53 and P = 0.96, respectively).

DISCUSSION

Our present results indicate that while BKA affords better improvement in knee function and quality of life in bicompartmental knee osteoarthritis than TKA, it also increases complications and operative time. Therefore, further studies are warranted to confirm these results and assess long-term outcomes and cost-effectiveness.

OTHER

Systematic review registration PROSPERO CRD420-24551418.

Effects of calcium supplementation on the prevention of preeclampsia: an umbrella review of systematic reviews and meta-analyses

Background

Preeclampsia is the leading cause of maternal and fetal morbidity and mortality. Calcium supplementation has been considered a potential intervention to reduce the risk of preeclampsia. This umbrella review aims to summarize the effects of calcium supplementation in the prevention of preeclampsia based on existing systematic reviews and meta-analyses studies.

Methods

A systematic search of electronic databases, such as MEDLINE, Web of Science, SCOPUS, and the Cochrane Library, was conducted from inception to 30 December 2023. The methodological quality of the included studies was assessed using the revised version of the Assessing the Methodological Quality of Systematic Reviews (AMSTAR 2) tool. A random-effects model was used to estimate the effect of calcium supplementation on preeclampsia. Heterogeneity among included studies and publication bias were assessed using the I2 statistic and the Egger's test, respectively.

Results

Calcium supplementation reduced the risk of preeclampsia by 47% (RR: 0.53, 95% CI: 0.42, 0.68) with a considerable level of heterogeneity (I2 = 84.39%). Our subgroup analyses revealed that the risk of preeclampsia was significantly lower in high-risk pregnancies that received calcium supplementation (RR: 0.35, 95% CI: 0.26, 0.47), indicating a 65% risk reduction. In comparison, low-risk pregnant women who received calcium supplementation experienced a 33% risk reduction (RR: 0.67, 95% CI: 0.59, 0.77). Furthermore, the effects of calcium supplementation were more pronounced in women from developing countries compared to those from developed countries.

Conclusion

This umbrella review provides a summary of the evidence supporting the use of calcium supplementation to reduce preeclampsia. Incorporating calcium supplementation into antenatal care interventions may help to reduce the burden of preeclampsia and improve maternal and fetal outcomes. Further studies are needed to explore the impact of baseline calcium levels, optimal dosage, timing, and routes of supplementation to effectively decrease the incidence of preeclampsia.

Efficacy and safety of arthroscopy in femoroacetabular impingement syndrome: a systematic review and meta-analysis of randomized clinical trials

This study aimed to compare the efficacy and safety of arthroscopy with physiotherapy or joint lavage in patients with femoroacetabular impingement (FAI). A meta-analysis using PubMed, Embase, Scopus, and the Cochrane Collaboration Library databases was performed in September 2022. We included studies focusing on patients with FAI who underwent arthroscopic surgery versus those who underwent physiotherapy or arthroscopic lavage. The outcomes were functional scores (iHOT-33 and HOS ADL) and adverse events. Randomized clinical trials were included in the study. The risk of bias in each study was assessed according to Cochrane guidelines for clinical trials. The data were combined using Review Manager version 5.4. (PROSPERO CRD42022375273). Six RCTs were included, from a pool of 839 patients (407 females). There were no significant differences between groups at 6 months regarding iHOT-33 (MD 4.68, 95% CI -0.07 to 9.44) and HOS ADL (MD 5.09, 95% CI -0.07 to 10.24). The iHOT-33 and HOS ADL scales showed significant differences at 12 months in favor of the arthroscopy group (MD 10.65, 95% CI 6.54 to 14.76) and (MD 8.06, 95% CI 1.05 to 15.07). MCID was not achieved through arthroscopy in functional variables. The rate of numbness was significantly higher in the arthroscopy group. Although the arthroscopy group demonstrated statistical superiority, the clinical significance based on the MCID remains controversial, and arthroscopy did not demonstrate clinical superiority.

Is the oral pathogen, Porphyromona gingivalis, associated to colorectal cancer?: a systematic review

BACKGROUND

The association between the oral pathogen Porphyromonas gingivalis (PG) and the gut microbiota in colorectal cancer (CRC) patients has been explored with inconsistent results. This study aims to systematically assess this potential association.

MATERIALS AND METHODS

A systematic review was conducted across three databases (Pubmed, Embase and Web of Science) from inception up to January 2023 and updated until November 2024. Inclusion criteria were observational studies examining PG in the microbiota of adults with CRC compared to healthy controls. Exclusion criteria were studies without control group of healthy individuals, other designs or without full-text access. Two reviewers independently selected and extracted data following a pre-registered protocol. Disagreements were resolved by consensus or with a third reviewer. Risk of bias (RoB) was assessed using the Newcastle-Ottawa Scale (NOS). Results were summarized with a flow diagram, tables, and narrative descriptions. Meta-analysis was not feasible, so Fisher's method for combining p-values and the sign test were used as alternative integration methods.

RESULTS

Finally, 18 studies, with 23 analysis units were included, providing a total sample of 4,373 participants (48.0% cases and 52.0%controls), 38.2% men and 61.8% women, with a similar distribution among cases and controls. The mean (SD) age of cases was 63.3 (4.382) years old and 57.0 (7.753) years for controls. Most of the studies analyzed the presence of PG in feces (70.0%) collected before colonoscopy (55.0%) and were classified with good quality (70.0%) in the RoB assessment. Results suggested an effect (Fisher's test, p = .000006) with some evidence towards a positive association of PG in CRC patients compared to healthy controls (Sign test, p = .039).

CONCLUSIONS

Results of the systematic review suggest that PG is associated with the microbiota of CRC patients. Lack of information to calculate the effect size prevented the performance of a meta-analysis. Future research should aim for standardized protocols and statistical approaches.

FUNDING

No funding was received for this work.

SYSTEMATIC REVIEW REGISTRATION

The research protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 2023 (registration number: CRD42023399382).

Food-based indexes and their association with dietary inflammation

Chronic inflammation is associated with an increased risk of noncommunicable diseases, prompting an intensified interest in the diet-disease relationship for modulating inflammation. Diet quality indexes are widely used to quantify dietary patterns. However, the optimal tool for assessing dietary quality in relation to chronic inflammation remains unclear. The objective of this study was to synthesize the literature on food-based diet quality indexes and their association with chronic inflammation. A systematic scoping review of scientific databases was conducted from inception to March 2024. Studies describing the development and validation of original dietary inflammatory indexes or assessed associations between established indexes and inflammatory biomarkers were included. Studies that predominantly focused on nutrient-based indexes were excluded. Forty-three food-based indexes, evaluated across 65 studies, were categorized into 4 distinct groups based on dietary patterns (n = 18), dietary guidelines (n = 14), dietary inflammatory potential (n = 6), and therapeutic diets (n = 5). Established indexes based on the Mediterranean diet and dietary guidelines were the most extensively utilized, demonstrating inverse associations with several inflammatory biomarkers across diverse populations. The Anti-Inflammatory Diet Index, Dietary Inflammation Score, and Empirical Dietary Inflammatory Index were identified as robust, empirically derived indexes to assess diet quality based on their inflammatory potential. The dietary composition of the evaluated indexes ranged from 4 to 28 dietary components, with fruits, vegetables, whole grains, and legumes consistently classified as favorable, whereas red/processed meats and added sugars were unfavorable. This scoping review identified several promising food-based indexes for assessing inflammation-related diet quality. Methodological variations and inconsistencies in algorithms underscore the need for further validation across diverse populations. Future research should consider the scoring methods, dietary composition, and validated inflammatory biomarkers when selecting indexes to evaluate diet-inflammation associations. Understanding the characteristics that underpin these indexes informs their application in nutrition research and clinical practice.

Acupuncture therapies for post-stroke depression: the evidence mapping of clinical studies

Background

Acupuncture-related therapies have been widely used in previous studies, of which the ones for post-stroke depression (PSD) is on the rise. This study aims to map the current clinical research landscape and identifies gaps to provide direction and information for future research.

Methods

Eight databases were searched on acupuncture-related therapies for PSD from inception until April 2024. The publication profile, study objects, intervention categories, outcome indexes were graphically displayed. The Cochrane Collaboration's bias risk assessment tool was used to independently assess randomized controlled trials (RCTs) quality, and the methodological quality of the systematic reviews were assessed using the AMSTAR 2 checklist.

Results

A total of 666 clinical studies and 34 systematic reviews/Meta-analyses (SRs/MAs) were included in the evidence map, and the earliest report was found in 1996. The studies were mostly from China, and 89% of the evidence of the studies were of the RCTs. Body acupuncture and electroacupuncture were the most commonly used interventions. Most of the intervention durations were 2-4 weeks, and few patients were followed up. The main outcome was measured by effective rate and the Hamilton Rating Scale for Depression (HAMD). Evidences from clinical studies and SRs/MAs suggest that acupuncture has significant advantages in improving PSD, but the overall quality of studies could be improved.

Conclusions

Acupuncture-related therapies have great prospect in relieving the clinical symptoms of PSD, although there are some design and methodological defects in the current studies. In the future, the quality of research needs to be improved for the robustness of clinical evidence.

Poststroke eHealth Technologies-Based Rehabilitation for Upper Limb Recovery: Systematic Review

BACKGROUND

Stroke is one of the most common cerebral vascular diseases, usually affecting people aged 60 years and older. It leads to a variety of disabilities requiring motor and cognitive rehabilitation. Poststroke rehabilitation is critical for recovery, particularly for upper limb impairments, which affect approximately 80% of stroke survivors. Conventional rehabilitation often faces barriers such as cost, accessibility, and patient adherence. In contrast, eHealth technologies offer a promising alternative by providing accessible, cost-effective, and engaging rehabilitation solutions.

OBJECTIVE

While numerous systematic reviews have explored various aspects of technology-based rehabilitation for poststroke upper limb recovery, there is a notable lack of comprehensive synthesis of these findings. This gap presents challenges, primarily due to the focus on specific technologies, which complicates understanding the overall effectiveness of these interventions. Consequently, clinicians and researchers may find it difficult to assess the field holistically, potentially hindering informed decision-making in clinical practice. This review synthesizes evidence from systematic reviews evaluating the effectiveness of eHealth technology-based interventions for upper limb recovery in poststroke individuals. Two main questions are examined: (1) Are eHealth technology-based therapies more or equally effective than conventional therapies for stroke rehabilitation? (2) What are the main clinical considerations for low-cost eHealth technology-based rehabilitation?

METHODS

Comprehensive literature searches were conducted in PubMed, Web of Science, Scopus, Embase, and Google Scholar using predefined inclusion criteria based on the Population, Intervention, Comparison, Outcome, and Study Design (PICOS) framework. Systematic reviews published in English without date restrictions were included. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) flowchart guided study selection. Methodological quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR 2) criteria.

RESULTS

A total of 1792 records were screened, resulting in 7 systematic reviews published between 2019 and 2023 being included. These reviews encompassed 95 studies involving 2995 participants with a mean age of 58.8 years across acute, subacute, and chronic stroke phases. Interventions included telerehabilitation, mobile health (mHealth) apps, augmented reality (AR), virtual reality (VR), wearable devices, and exergames. While AR and VR demonstrated potential benefits when combined with conventional therapies (eg, AR showing significant improvements in upper limb function with a standardized mean difference 0.657; P<.001), evidence for stand-alone effectiveness remained inconclusive due to heterogeneity in study designs, intervention protocols, and outcome measures. Most reviews were rated as critically low quality due to methodological limitations.

CONCLUSIONS

eHealth technologies hold promise for enhancing upper limb rehabilitation post stroke by addressing barriers such as cost and accessibility while providing engaging interventions. However, the field remains fragmented with insufficient evidence to establish clear efficacy. Future research should focus on standardizing protocols, optimizing neurorehabilitation principles such as dosage and task specificity, and improving methodological rigor to evaluate these interventions' long-term impact better.

Fecal Microbiota Transplantation (FMT) and Clinical Outcomes Among Inflammatory Bowel Disease (IBD) Patients: An Umbrella Review

BACKGROUND AND AIMS

Recent systematic reviews and meta-analyses (SRMAs) have shown inconsistent effectiveness of FMT among patients with IBD. This study aimed to appraise the evidence for clinically relevant outcomes with FMT in patients with IBD using published SRMAs.

METHODS

We searched major databases from inception through Nov 2023 to identify SRMAs assessing the effectiveness of FMT in patients with IBD. Primary outcomes included clinical remission, clinical response, endoscopic remission/response, a composite endpoint, and adverse effects. We included SRMAs investigating FMT's effect in patients with IBD using RCTs and observational studies data. Methodological quality and evidence certainty were assessed using AMSTAR 2 and GRADE.

RESULTS

Out of 106 citations, 16 SRMAs were included with varying study sizes (2 to 60 primary studies) and participants (112 to 1169 per SRMA). Five SRMAs assessed FMT in IBD, while 11 focused on Ulcerative Colitis (UC). Seven SRMAs included RCTs only, and nine included both RCTs and observational studies. Methodological quality was critically low in 9 SRMAs (56%) and low in 7 studies (44%). FMT showed clinical remission benefit in all 16 SRMAs, with varying certainty: 3 high, 4 moderate, 4 low, and 5 very low. Endoscopic remission/response was reported in 5 meta-analyses on UC, with 1 high, 3 moderate, and 1 very low certainty. Combined clinical remission and endoscopic response were reported in 3 SRMAs on UC, with 1 low and 2 moderate certainty. Adverse events were reported in 6 SRMAs, with 1 high, 3 moderate, 1 low, and 1 very low certainty.

CONCLUSION

Current evidence shows potential benefits of FMT in IBD, particularly UC, supported by significant associations in 16 meta-analyses. However, poor methodological quality and variability in evidence certainty call for high-quality RCTs to strengthen the evidence.

Effectiveness of pharmacological and non-pharmacological interventions for treatment-resistant depression in older patients: a systematic review and meta-analysis

BACKGROUND

Depression in older adults is often undertreated. A 2011 systematic review of treatments for treatment-resistant depression (TRD) in older adults identified one placebo-controlled randomised controlled trial (RCT). We aimed to update this review, synthesising evidence for the effectiveness of treatments for TRD in older people.

METHODS

We systematically searched electronic databases (PubMed, Cochrane, Web of Science) from 9 January 2011 through 10 December 2023 (updating our search on 7 January 2024 for RCTs investigating TRD therapies in adults aged ≥55 years, defining treatment resistance as ≥1 unsuccessful treatment. We assessed bias with the Cochrane Risk of Bias (RoB) 2 tool, meta-analysed remission rates and evaluated evidence using GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria.

RESULTS

14 studies (11 newly identified, 3 from previous review) involving 1196 participants (mean age 65.0, male/female 548/648) met the inclusion criteria; 10 were placebo controlled and 4 were rated as low RoB. The pooled proportion of participants in intervention arms remitting was 0.35 (17 arms; 95% CI=0.26; 0.45). Relative to placebo, intervention participants were more likely to remit (9 studies; OR 2.42 (95% CI=1.49; 3.92)). Relative to controls, remission rates favoured ketamine (n=3; OR 2.91 (1.11; 7.65)), with a trend towards transcranial magnetic stimulation (TMS) (n=3; 1.99 (0.71; 5.61)), and in single placebo-controlled studies, selegiline, aripiprazole augmentation, pharmacogenetic-guided prescribing (PGP) and cognitive remediation favoured interventions.

CONCLUSIONS

We identified weak evidence that ketamine therapy and aripiprazole augmentation, and very weak evidence that TMS, PGP and cognitive remediation increased remission. Lack of evidence regarding routinely prescribed antidepressants and psychosocial treatments is problematic, requiring clinicians to extend evidence from younger populations.

PROSPERO REGISTRATION NUMBER

CRD42023494513.

The Oncological Outcome of Postoperative Radiotherapy in Patients with Node-Negative Early-Stage (T1/T2/N0) Oral Squamous Cell Carcinoma and Perineural Invasion: A Meta-Analysis

Objective: To evaluate the impact of postoperative radiotherapy (PORT) on oncological outcomes in node-negative early-stage oral squamous cell carcinoma (OSCC) with perineural invasion (PNI). Methods: A systematic review and meta-analysis was conducted using the PubMed, EMBASE, and Scopus databases for the period from 2000 to 2024. Studies comparing PORT versus observation in pN0 early-stage OSCC with PNI were included. Oncological outcomes assessed included overall survival (OS), disease-free survival (DFS), and local control (LC). A random-effects model was used to calculate log odds ratios, and heterogeneity was assessed using tau2, chi2, and I2 statistics. Results: Seven retrospective studies comprising 522 patients (281 PORT, 241 no-PORT) were included. The 3-year overall survival (OS) was 86.3% in the PORT group compared to 71.1% in the no-PORT group (logOR = -1.03, p = 0.0012), while the 5-year OS was 88.1% versus 77.3% (logOR = -0.97, p = 0.0061). Disease-free survival (DFS) also favored PORT, with 3-year DFS at 86.3% versus 58.1% (logOR = -1.19, p < 0.001) and 5-year DFS at 86.3% versus 55% (logOR = -0.78, p = 0.003). Local control (LC) was higher in the PORT group, with 3-year LC rates of 89% compared to 72.2% in the no-PORT group (logOR = -1.13, p = 0.025). Conclusions: PORT significantly improves OS, DFS, and LC in node-negative early-stage OSCC with PNI as the sole adverse feature.

Medical professionalism education: a systematic review of interventions, outcomes, and sustainability

Introduction

Medical professionalism (MP) is a vital competency in undergraduate medical students as it enhances the quality and safety of patient care as it includes professional values, attitudes and professional behaviours (PB). However, medical institutes are uncertain about how optimally it can be learnt and assessed. This review aims to systematically provide a summary of evidence from systematic reviews reporting MP educational interventions, their outcomes and sustainability to foster PB.

Methods

Eight major databases (CINAHL, EMBASE, ERIC, Health business, Medline, OVID, PsycINFO, SCOPUS and Web of Science) and grey literature were systematically searched from database inception to June 2024. The inclusion criteria were (1) systematic review studies (2) of educational interventions of any type; (3) targeting any aspect of MP; (4) provided to undergraduate medical students; and (5) with no restrictions on comparator group or outcomes assessed. A qualitative narrative summary of included reviews was conducted as all included reviews did not conduct quantitative nor meta-analysis of results but rather a qualitative summary. Methodological quality of included reviews was assessed using A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 tool.

Results

The search identified 397 references for eligibility screening. Ultimately, eight systematic reviews were deemed eligible for inclusion. The majority of these reviews have reported a successful improvement in various aspects of MP (i.e., MP as a whole, empathy and compassion) through teaching and exposure to hidden curriculum. The included studies displayed significant methodological heterogeneity, with varying study designs and assessment methodologies to professional outcomes. A gap remains in reporting the sustainable effect on professionalism traits and on a standardised approach to MP teaching.

Conclusion

This review suggests that more interventions are needed in this area with a focus on methodological quality and teaching methods in a multicultural context to support PB and professional identity formation.

Clinical trial registration

PROSPERO [CRD42024495689].

Effects of Vegetarian or Vegan Diets on Glycemic and Cardiometabolic Health in Type 2 Diabetes: A Systematic Review and Meta-analysis

CONTEXT

Uncertainties still exist about the effect of vegetarian or vegan diets on glycemic and cardiometabolic risk factors in individuals with type 2 diabetes mellitus (T2DM), although plant-based diets are thought to be beneficial for cardiometabolic health.

OBJECTIVE

The aim was to investigate whether vegetarian or vegan diets can improve blood glucose and cardiometabolic health in patients with T2DM compared with omnivorous diets.

DATA SOURCES

Five databases (PubMed, Web of Science, Cochrane Library, Scopus, and Embase) were searched for eligible randomized controlled trials (RCTs) up to May 24, 2024.

DATA EXTRACTION

Two authors independently performed the data extraction and quality assessment.

DATA ANALYSIS

Nine RCTs (681 participants) were included in this meta-analysis. The results indicated that vegetarian or vegan diets could reduce glycosylated hemoglobin, type A1C (HbA1c) (weighted mean difference [WMD] = -0.36%; 95% CI: -0.54, -0.19; P < .001), low-density-lipoprotein cholesterol (WMD = -0.16 mmol/L; 95% CI: -0.26, -0.07; P = .001, and body mass index (WMD = -0.94 kg/m2; 95% CI: -1.43, -0.45; P = .0002) in a population with T2DM; however, they resulted in no significant improvement in systolic blood pressure and fasting plasma glucose. In subgroup analyses, the positive effects of a vegan diet were superior to a vegetarian diet for cardiometabolic health. HbA1c was reduced when vegetarian or vegan intake was more than 12 weeks.

CONCLUSION

In conclusion, vegetarian or vegan diets could be utilized as a synergistic intervention in the T2DM population, contributing to cardiovascular disease prevention. In the future, the proportion of components that make up a plant-based diet should be explored.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42024578613.

Implication of surgical loupes on complications following thyroidectomy: a meta-analysis

OBJECTIVE

To determine the effectiveness of surgical loupes in reducing postoperative RLN palsy and hypocalcemia following thyroidectomy.

DATA SOURCES

PubMed, Scopus and Google Scholar databases were searched between 2000 and 2024.

REVIEW METHODS

Studies were included if they reported at least one complication outcome following thyroidectomy using surgical loupes. The outcome measure was the log odds ratio, with negative log odds indicating results favouring the experimental group. The model utilized the DerSimonian-Laird estimator, and Wald-type tests.

RESULTS

The qualitative data synthesis included 813 patients from 6 included studies, including 410 patients with surgical loupes and 403 patients without surgical loupes. There was a statistically significant reduction in the rate of temporary RLN palsy in the surgical loupe group log(OR) = - 0.87 [(- 1.58, - 0.15), DL (Dersimonian and Laird method), REM (random effects model), CI (confidence interval) = 95%], or a 41.8% lower probability. The rates of permanent RLN palsy log(OR) =  - 0.31 [(- 1.45, 0.82), DL, REM, CI = 95%], temporary hypocalcemia log(OR) =  - 0.34 [(- 1.25, 0.57), DL, REM, CI = 95%], and permanent hypocalcemia log(OR) =  - 0.85 [(- 2.24, 0.54), DL, REM, CI = 95%] were not statistically significant between the two groups, although there were trends toward decreases in these rates in the loupes group.

CONCLUSIONS

Surgical loupe use during thyroidectomy can lead to a 41.8% lower probability of temporary RLN palsy compared to operating without loupes.

LEVEL OF EVIDENCE

3a.

Comparison of short-and long-term outcomes between endovascular and open repair for descending thoracic aortic aneurysm: a systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis aimed to evaluate and compare the efficacy of endovascular versus open repair for the treatment of patients with descending thoracic aortic aneurysm (DTAA).

METHODS

A systematic search of the PubMed, Embase, and Cochrane Library databases for relevant studies was performed. Outcome data, including postoperative mortality and morbidity, operative details, all-cause survival, freedom from aortic-related survival and freedom from aortic-related re-intervention, were independently extracted by two authors in a standardized way.

RESULTS

Twenty-nine studies comprising 49 972 patients (22 049 endovascular repair; 27 923 open repair) were included. Endovascular repair was associated with a significantly lower postoperative mortality rate [odd ratio (OR): 0.57, 95% confidence interval (CI): 0.45-0.72; I 2  = 72.58%] and morbidity. In terms of long-term survival, endovascular repair yielded better freedom from aortic-related survival [hazard ratio (HR): 0.71, 95% CI: 0.54-0.93, P = 0.012] but inferior freedom from aortic-related reintervention (HR: 2.10, 95% CI: 1.45-3.04, P < 0.001). Landmark analysis revealed that the open repair group experienced better all-cause survival beyond 16 months (HR: 1.64, 95% CI: 1.53-1.75, P < 0.001). In addition, in the subgroup of patients with intact DTAA, those who underwent open repair exhibited a higher rate of postoperative mortality (OR: 0.58, 95% CI: 0.38-0.88; I 2  = 83.34%) but had better all-cause survival beyond 7 months (HR: 1.72, 95% CI: 1.61-1.84, P < 0.001) than those who underwent endovascular repair.

CONCLUSION

Among patients treated for DTAA, endovascular repair was associated with better freedom from aortic-related survival, a lower risk for postoperative mortality and morbidity, and shorter lengths of intervention, intensive care unit stay, and hospital stay than those who underwent open repair. Open repair yielded significantly better long-term all-cause survival and freedom from aortic-related re-intervention than endovascular repair.

[Breastfeeding, an analgesic technique for painful care that can be used in rehabilitation?]

Pain management in infants is crucial during painful care. This work evaluates the effect of breastfeeding on procedural pain, measured by the Neonatal Infant Pain Scale score. A rapid review included nine randomized controlled trials (RCT) on PubMed, comparing breastfeeding with other techniques (maternal contact, sucrose, etc.). Breastfeeding significantly reduces pain compared with maternal contact, and is comparable in efficacy to sucrose. Despite methodological limitations, this simple and effective technique could be integrated into pain management in pediatric rehabilitation. Further studies are needed to clarify its benefits.