Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement

Strengths-based interventions for patients with chronic diseases and/or caregivers: a systematic review protocol

BACKGROUND

Strengths-based interventions have great potential among individuals living with chronic illnesses, helping to improve patient outcomes and address the rapidly increasing burden of chronic diseases. The main objective of this systematic review is to synthesise the evidence on strengths-based interventions for patients with chronic diseases and/or caregivers.

METHODS AND ANALYSIS

Seven databases, including PubMed, Cochrane Library, Web of Science, CINAHL, EMBASE, PsycINFO and SCOPUS, will be searched. The literature screening and data extraction will be conducted independently by two researchers. A third researcher will be involved when a consensus is needed. The quality and risk of bias in the included studies will be assessed by using the Cochrane risk-of-bias tool. The systematic review protocol will be reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol checklists.

ETHICS AND DISSEMINATION

Ethics approval is not required. The findings of the systematic review will be disseminated in a conference and a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42024570495.

Urinary metabolites as biomarkers of dietary intake: a systematic review

Background

Current diet assessment tools, such as food frequency questionnaires, may result in misclassification bias from measurement error and misreporting. These limitations can be mitigated by diet-related biomarkers in urine specimens, an emerging approach to characterize dietary intake.

Objective

We conducted a systematic review to identify urinary biomarkers with utility in accurately assessing dietary intake, including individual foods and food groups.

Method

We retrieved studies from 2000 to 2022 from databases including Embase, CINAHL, Cochrane, and PubMed. Data extraction from included articles was conducted by two independent reviewers for cross validation. Articles identifying urinary biomarkers in relation to food groups/items with adult populations were included and were evaluated for bias using the Joanna Briggs Institute Critical Appraisal.

Results

A total of 65 articles were included and categorized as biomarkers of fruit (n = 13), vegetables (n = 5), aromatics (n = 5), fruits and vegetables (n = 3), grains/fiber (n = 5), dairy (n = 3), soy (n = 10), coffee/cocoa/tea (n = 9), alcohol (n = 6), meat and proteins (n = 6), nuts/seeds (n = 3), and sugar and sweeteners (n = 4). Results expanded the context to which metabolites of foods were compared across similar and dissimilar food groupings. Plant-based foods were often represented by polyphenols, while others were distinguishable by innate food composition, such as sulfurous compounds in cruciferous vegetables or galactose derivatives in dairy.

Conclusion

Current evidence suggests urinary biomarkers may have utility in describing intake of broad food groups, such as citrus fruits, cruciferous vegetables, whole grains, and soy foods, but may lack the ability to clearly distinguish individual foods. These findings indicate the potential of urinary biomarkers to monitor changes in dietary patterns. The improvement of diet assessment methodology is a key step toward strengthening research data validity and accurately measuring outcomes in chronic disease management.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/view/CRD42022308255, Prospero CRD42022308255.

Religiosity, spirituality, and cardiovascular reactivity to acute psychological stress: A systematic review

Cardiovascular reactivity to acute psychological stress may be an underlying mechanism that links religiosity and spirituality to better cardiovascular health. However, studies examining religiosity, spirituality and cardiovascular reactivity to acute stress have inconsistent findings; further whether it is religiosity or spirituality or both that is driving reported effects is not clear. To address this gap, we conducted a systematic review of the literature examining religiosity and/or spirituality and cardiovascular reactions to acute stress. Electronic databases were systematically searched (PubMed, PsycArticles, PsycInfo, CINAHL and Web of Science). After removal of duplicates, screening titles and abstracts, twelve peer-reviewed studies were included in the review. Overall, the majority of studies reported on an inverse relationship between religiosity and/or spirituality and cardiovascular reactivity, showing higher levels of religiosity and spirituality were associated with attenuated cardiovascular responses. This was particularly evident when measures assessed facets of intrinsic religiosity and focused on internalized spiritual beliefs, focusing on spiritual aspects such as finding meaning and purpose in life. However, in three studies, religiosity and/or spirituality showed exaggerated cardiovascular responses, importantly these studies examined religious/spiritual struggles, indicating that religiosity/spiritual struggles can have a negative impact on health. To date, no study has controlled for religiosity when examining spirituality and cardiovascular reactivity, or vice versa, to explore whether the outcomes differ. Overall, this review highlights that religiosity, and spirituality have potential health benefits for cardiovascular reactivity, however religious/spirituality struggles can diminish these positive effects. It is a priority for future research to clearly define, differentiate and measure the constructs of religiosity and spirituality separately, as both have demonstrated beneficial effects on cardiovascular reactivity.

Prevalence of bacterial eye infections and multidrug resistance patterns among eye infection suspected patients in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Bacterial eye infections are major global health issue in developing countries like Ethiopia, poor hygiene, limited healthcare infrastructure, and inadequate treatment options contribute to the increased burden of these infections, leading to significant ocular morbidity and potential blindness. Major bacterial pathogens, including Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae, and Pseudomonas aeruginosa, are responsible for these infections. The objective of this systematic review and meta-analysis is to synthesize existing literature on the prevalence of bacterial eye infections in Ethiopia, identify common bacterial pathogens, and analyze antibiotic resistance patterns.

METHODS

Comprehensive search were performed across electronic databases and grey literature using specific search terms. Eligible studies were organized in MS Excel and imported into STATA version 14 for statistical analysis. The pooled prevalence of bacterial eye infections and multidrug resistance patterns was calculated using a random-effects model, with heterogeneity assessed via the I² statistic. Publication bias was evaluated through funnel plots and Egger's test. A sensitivity analysis was conducted to assess the influence of individual studies on the overall effect size.

RESULT

The systematic review and meta-analysis of 19 studies conducted in Ethiopia revealed significant regional variations in the prevalence of bacterial eye infections and multidrug resistance (MDR). The overall pooled prevalence of bacterial eye infections was 54.07%, with substantial heterogeneity (I² = 99.2%). Prevalence rates varied across regions, with the highest in Oromia (62.98%) and the lowest in SNNPR (34.3%). Staphylococcus aureus was the most common pathogen (45.47%), followed by coagulase-negative Staphylococci (36.14%). The pooled prevalence of MDR was 66.06%, with the highest rates in Somali (87.7%) and the lowest in Tigray (37.9%). Subgroup analysis showed higher prevalence in studies before 2020 and with smaller sample sizes.

CONCLUSION

In conclusion, the study highlights a high prevalence of bacterial eye infections and multidrug resistance in Ethiopia, with significant regional variation. These findings highlight the urgent need for targeted interventions and antimicrobial stewardship programs to address the growing challenge of antibiotic resistance in Ethiopia.

Dissemination planning in exercise oncology trials-a systematic review of trial protocols

PURPOSE

The paucity of exercise rehabilitation services for cancer survivors indicates a research-to-practice gap. Dissemination and Implementation research addresses this gap by focusing on the adoption, implementation, and sustainability of evidence-based interventions. Dissemination, the active process of sharing research findings, is critical to the implementation of evidence-based practice. This systematic review examined adherence of exercise oncology trial protocols to the SPIRIT 2013 checklist items pertaining to dissemination planning, items 31a, 31b, and 31c, which address how dissemination is planned, authorship eligibility is considered, and what plans are in place to share data and the protocol.

METHODS

A systematic review was conducted following the PRISMA guidelines. EMBASE, MEDLINE, CINAHL, Web of Science-Core Collection, Google Scholar, and the Central Trial Registry via Cochrane were searched (16/05/2024). Title and abstract screening, full-text review, and data extraction were completed in duplicate.

RESULTS

Eighty-six trial protocols were included, thirty-one (36.1%) did not report dissemination plans. Item 31 was reported as follows (n = number of trials, frequency (%)); 31a plans to communicate trial results to: participants (n = 19, 22.1%), healthcare professionals (n = 43, 50%), the public (n = 25, 29.2%), and other relevant groups (n = 22, 25.6%), 31b: author eligibility (n = 3, 3.5%) and plans regarding use of professional writers (n = 4, 4.7%), and 31c plans for granting access to participant level dataset (n = 28, 32.6%), full protocol (n = 1, 1.2%) and statistical code (n = 1, 1.2%). Peer-reviewed journal (n = 41, 47.67%) and conferences/professional meetings (n = 38, 44.2%) were the most frequently reported planned dissemination strategies.

CONCLUSION

Reporting of the SPIRIT 2013 checklist Item 31 is generally low in exercise oncology trial protocols. Greater consideration of dissemination planning is required to support the implementation of exercise oncology research into practice.

REGISTRATION

https://doi.org/10.17605/OSF.IO/M8HFP.

Robotic surgery governance structures: a systematic review

Since the Food and Drug Administration in the United States approved the first robotic platform for use in humans in 2000, there has been a steady increase in the popularity of robotic approaches to surgery. Robotic-assisted surgery (RAS) offers enhanced 3D visualisation of the operative field and increased flexibility and agility of the instruments, amongst other benefits. However, robotic platforms are complex systems and there is evidence that they may be associated with increased patient risk, particularly in the initial learning curve of a surgeon's robotic training. To ensure the continued safe use of RAS, adequate governance policies must be in place to regulate training, ensure patient safety and maximise the benefits of RAS programs. This systematic review synthesises all available evidence on RAS governance structures internationally for the first time. It was conducted and reported per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. This systematic review identified, for the first time, three guidelines offering recommendations on the Governance Structures for RAS programs. We extracted the key recommendations to provide a holistic set of guidelines. Through consensus, we offer recommendations for the composition of a RAS governance committee, the frequency with which the committee should sit, and the remit of the committee, including training, granting of privileges, quality assurance and continued professional development. We also stress future research needs in RAS team credentialing and vendor-agnostic training pathways. These recommendations may serve as a template for establishing future RAS programs.

Dysautonomia in Alzheimer's Disease: A Systematic Review

Background: Alzheimer's disease (AD) is the most common cause of dementia. In addition to cognitive decline, non-cognitive symptoms, including dysautonomia, have been reported, although these symptoms are rarely acknowledged by patients. Dysautonomia in AD is thought to arise from either cholinergic deficits or hypothalamic involvement. A wide range of tests has been used to investigate the role of the autonomic nervous system; however, the results have been inconsistent. Aim: To systematically review all published research investigating autonomic nervous system (ANS) involvement in patients with AD. A comprehensive literature search was conducted in December 2024 across the following databases: PubMed, Cochrane Library, ScienceDirect, and Scopus. Results: A total of 1422 records were identified, of which 30 studies fulfilled the inclusion criteria and were included in the review. Several autonomic tests were employed, with Heart Rate Variability (HRV) being the most frequently used. Other tests included assessments of orthostatic hypotension (OH), postprandial hypotension (PPH), sympathetic skin response (SSR), the tilt test, 123I-MIBG cardiac scintigraphy, norepinephrine (NE) measurements in serum and cerebrospinal fluid, and baroreflex sensitivity. In most studies, AD patients were compared to either healthy controls or patients with other types of dementia. Discussion: The primary finding of this review is that, although patients with AD rarely report dysautonomic symptoms, they frequently exhibit abnormal results on various autonomic tests. In some cases, these findings were sufficient to differentiate AD patients from healthy controls as well as from patients with Diffuse Lewy Body disease (DLB). The inconsistency in reporting symptoms, along with the variability in test results, suggests that autonomic dysfunction in AD may be under-recognized and warrants further investigation. Conclusions: The heterogeneity of the included studies limits the generalizability of the results. However, given the potential impact of dysautonomia on both quality of life and mortality, it is recommended that AD patients be systematically assessed for autonomic dysfunction. Even in the absence of overt symptoms, appropriate treatment should be considered where indicated to mitigate potential risks.

Therapeutic mechanisms of fascia manipulation: A scoping review

BackgroundFascia manipulation is gaining attention due to their potential benefits in pain management, neuromuscular function, and tissue healing. However, the mechanisms underlying these effects remain unclear, limiting treatment optimization.ObjectivesThis scoping review (ScR) aimed to summarize current evidence on the physiological, structural, and neuromuscular mechanisms underlying fascia manipulation as a therapeutic intervention.MethodsThis ScR followed the Joanna Briggs Institute guidance. A comprehensive search of MEDLINE, Web of Science, CINAHL, Cochrane Central, EMBASE, Scopus, PEDro, ClinicalTrials.gov, and ICTRP was conducted in January 2025. Two independent reviewers selected studies and extracted data. Two independent reviewers selected studies and extracted data.ResultsEleven studies were included: eight on humans and three on animals. In humans, manual therapy triggered a transient local inflammatory response, raising temperature without activating coagulation or thrombosis risk. It also reduced unbound water in deep fascia, aiding pain relief and mobility. Animal studies showed anti-inflammatory effects via cytokine regulation and adenosine receptor involvement, with caffeine blocking pain relief. Massage-like stroking produced opioid-independent analgesia. Fascia manipulation relieved pain from densification and improved proprioception. Neuromusculary, it enhanced reaction time, movement efficiency, and motor performance, lasting up to a week.ConclusionsThis ScR suggests that fascia manipulation exerts its therapeutic effects through a combination of anti-inflammatory cytokine modulation, mechanoreceptor stimulation, and improvement in fascial gliding and proprioceptive feedback. These mechanisms collectively support its role in pain relief and neuromuscular function. Further research using standardized protocols and objective outcome measures is needed to validate and expand upon these findings.

Efficacy and safety of novel complement inhibitors in atypical haemolytic uremic syndrome: a protocol for systematic review and meta-analysis

BACKGROUND

Atypical Haemolytic Uremic Syndrome (aHUS) is a rare but life-threatening thrombotic microangiopathy. If inadequately managed, aHUS can lead to progressive kidney failure, cardiovascular complications and multiorgan dysfunction, resulting in high healthcare costs and a substantial impact on patients' quality of life. Novel complement inhibitors offer potential advantages, yet comprehensive evidence comparing their efficacy and safety is limited. This protocol elaborates the systematic review plans to evaluate the effectiveness and the drug safety of complement inhibitors in aHUS.

METHODS

A systematic search will be conducted across PubMed, Embase, Cochrane Library, Web of Science and Scopus to identify relevant studies. Eligible studies include randomised controlled trials (RCTs), observational studies and case series with at least three aHUS patients treated with novel complement inhibitors. Two independent reviewers will perform data extraction and quality assessment using standardised tools, including the Risk of Bias Tool 2 for RCTs and the Newcastle-Ottawa Scale for observational studies. A meta-analysis will be conducted if feasible, utilising a random-effects model to account for study heterogeneity.

ETHICS AND DISSEMINATION

Ethical approval is not required as only previously published data will be used. Results will be disseminated via peer-reviewed journals and conferences, targeting healthcare professionals and policymakers to support evidence-based decision-making in aHUS management.

PROSPERO REGISTRATION NUMBER

CRD42025629879.

Impact of Different Types of Physical Exercises for the Management of Older Women with Urinary Incontinence: A Systematic Review of Randomized Clinical Trials

Background/Objectives: Urinary incontinence (UI) is particularly prevalent in women of all ages, but especially in older women, due to risk factors that contribute to pelvic floor muscle weakness. Urinary incontinence can have a significant psychosocial impact and compromise the quality of life of affected women. It is reported that physical activity seems to be inversely associated with UI. The aim is to summarize the impact of different modalities of physical exercises in management of older women with UI. Methods: Searches were performed in the databases PubMed, Web of Science, EMBASE and Scopus. The searches were performed on 10 December 2024. Only randomized clinical trials were included. Ninety-three papers were initially screened, and five full papers reached all the inclusion criteria describing the effects of exercise on urinary incontinence. The studies included a total of 352 elderly participants aged 60 years or older. Of these participants, 268 lived in nursing homes and 84 lived in a local community. The intervention period varied among the selected studies from 6 weeks to 12 months, and in general, the pelvic floor training was used. Results: Improvements in the quality of life and in the physical performance of the older women with UI were reported, although the risk of bias was classified as "some concerns". Conclusions: Moreover, it is revealed that different types of exercises are used to "work" the pelvic floor muscle and contribute, in general, to reducing the symptoms, and improving the quality of life of older women with UI due to the positive impact of the exercises.

Cardiovascular disease burden in the homeless population

INTRODUCTION

The burden of cardiovascular disease (CVD) among the homeless population has been rising, driven by factors such as lack of healthcare access, rising mental health disorders and substance use. This study aims to systematically analyse the CVD burden among homeless adults and characterise its prevalence and risk factors. Additionally, our literature review revealed a significant lack of cardiac-focused interventions in this population, thus we build on existing models to propose new CVD-specific interventions.

METHODS

A comprehensive systematic review and meta-analysis were performed on data collected from PubMed and Scopus until 22 October 2024. All observational studies that assessed homeless populations and met inclusion criteria were analysed. The primary outcomes reported were mortality, morbidity and hospitalisation due to CVD. These measures were collectively analysed to evaluate the overall CVD burden.

RESULTS

Our search strategy identified 22 studies, of which 12 were suitable for meta-analysis. We analysed data from 226 205 adults spanning more than 1 000 000 person-years and sought to characterise CVD distribution by demographic subgroups. Our findings indicate that homeless adults experience greater morbidity and mortality due to CVD than non-homeless adults (pooled OR 2.77; 95% CI 1.93 to 3.93; p<0.001; I2 =96.2%). Subgroup analyses by age, sex and geographic region were performed, but no significant differences in CVD morbidity and mortality were found.

CONCLUSION

Homeless adults have approximately three times greater odds of CVD than the general population. We found that the risk of CVD remains elevated regardless of demographic subgroup. Our findings emphasise the urgent need for targeted interventions within this population and highlight its associated risk factors, providing a foundation for the development of targeted interventions and policies.

Factors influencing adolescents' decision-making about COVID-19 vaccination: a systematic review with qualitative synthesis

Introduction

Attitudes towards vaccination are influenced by a broad range of factors, yet little is known about the drivers shaping adolescents' vaccination beliefs. The aim of this study was to qualitatively explore the factors influencing adolescents' individual decision-making towards COVID-19 vaccination.

Methods

A systematic review was conducted using Medline, Web of Science, Sociological Abstracts, and Publicly Available Content Database. Studies on attitudes, beliefs, and perceptions of adolescents regarding COVID-19 vaccines were included. The JBI Critical Appraisal Checklist was used for quality assessment, followed by thematic synthesis of the included studies.

Results

In total, 13 studies were included, revealing 5 key themes: (1) Limited vaccine literacy influences adolescents' attitudes towards COVID-19 vaccines; (2) Family, peers, and community strongly influence adolescents' COVID-19 vaccine decision-making; (3) Different levels of trust in vaccine providers and governments influence adolescents' attitudes towards COVID-19 vaccines; (4) Desire to go back to normality influences adolescents' COVID-19 vaccine attitudes towards vaccine acceptancy; (5) Autonomy influences adolescents' COVID-19 vaccine decision-making.

Discussion

The review findings suggest that vaccine acceptance among adolescents could be improved through tailored and accessible vaccine literacy messaging, addressing structural mistrust, and empowering adolescents to make autonomous health decisions that take into account diverse contexts and populations.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024512197, identifier CRD42024512197.

The impact of warm ischemia time on short-term renal function after partial nephrectomy: a systematic review and meta-analysis

PURPOSE

This study aimed to assess the impact of warm ischemia time on short-term renal function in individuals undergoing partial nephrectomy.

METHODS

We conducted a comprehensive search for primary research articles from 1990 to October 15, 2024 across several databases, including MEDLINE, Embase and the Cochrane Library. A random effects model was applied to determine multivariable adjusted odds ratios (ORs) and their corresponding 95% confidence intervals (CIs). Country and study design were utilised as outcome indicators in the regression model.

RESULTS

Ten studies including 4,993 patients who underwent partial nephrectomy met the inclusion criteria. The threshold of potentially harmful ischemia time for renal artery occlusion ranges between 10 and 45 min. Our results revealed that long warm ischemia time was associated with decreased postoperative eGFR and poor short-term renal function (OR = 1.08; 95% CI = 1.02-1.15; P = 0.006) after partial nephrectomy. Sensitivity and meta-regression analyses demonstrated the robustness of the study's findings.

CONCLUSIONS

Extended periods of warm ischemia, specifically exceeding 25-30 min, can inflict damage on kidneys undergoing surgical treatment. Minimising the duration of warm ischemia while simultaneously prioritising surgical safety and achieving clear margins is imperative. Moreover, ischemia time remains a modifiable risk factor and must be reduced to maintain overall short-term renal function. Relevant prospective and randomised controlled trials must be conducted to validate these findings.

PROSPERO REGISTRATION NUMBER

CRD42024560051.

Meta-analysis of the effects of exercise interventions on dialysis patients with cardiac function disorders

Background

Prolonged dialysis can lead patients to multiple complications, with heart failure being the most dangerous and the leading cause of death among dialysis patients. Concurrently, exercise has been shown to improve several indicators of heart function.

Methods

A comprehensive search was conducted across seven databases. The search was limited to studies published between January 2010 and July 2024.

Results

(1) Compared to conventional care, exercise significantly increased the left ventricular ejection fraction (LVEF) in dialysis patients (MD = 2.00, 95% CI: 1.15-2.84, p < 0.001). Subgroup analysis revealed that combined aerobic and resistance exercise led to a more substantial increase in LVEF compared to aerobic exercise (MD = 2.78, 95% CI: 1.17-4.38, p < 0.001). Each workout lasting more than 30 min was associated with a significant increase in LVEF compared to sessions lasting 30 min or less (MD = 2.5, 95% CI:0.57-4.43, p = 0.001). An exercise intervention cycle of 10 to 12 weeks resulted in a significant increase in LVEF compared to cycles longer than 12 weeks (MD = 3.36, 95% CI: 2.04-4.68, p < 0.001). A weekly exercise frequency of more than three times per week significantly improved LVEF compared to three times per week or less (MD = 2.73, 95% CI: 1.21-4.25, p < 0.001). (2) In comparison to conventional care, exercise effectively reduced the left ventricular mass index (LVMI) of dialysis patients (MD = -7.93, 95% CI: -14.67--1.19, p = 0.02). However, exercise interventions did not demonstrate statistically significant improvements in pulse wave velocity (PWV), left ventricular end-systolic volume (LVESV), and left ventricular end-diastolic volume (LVEDV).

Conclusion

Exercise can significantly enhance LVEF and decrease LVMI in dialysis patients. However, no significant improvements were observed in PWV, LVESV, or LVEDV. The subgroup analysis indicated that a combination of aerobic and resistance exercise had a better effect on improving LVEF compared to aerobic exercise, and exercise intervention with each workout lasting for more than 30 min, an exercise intervention cycle of 10 to 12 weeks, and an exercise frequency of more than three times per week were more effective in improving LVEF.

Autonomy at the table: the role of food parenting practices in children's fruit and vegetable consumption - a systematic review and meta-analysis protocol

INTRODUCTION

Despite parents' efforts, many children have nutrient-poor diets with insufficient fruit and vegetable consumption. Parents significantly influence children's eating habits at home through their food parenting practices. Although previous systematic reviews have explored food parenting practices, they were conducted some time ago. Therefore, it is timely to investigate the relationship between autonomy-supportive practices and fruit/vegetable consumption in children aged 2 to 12.

METHODS AND ANALYSIS

The systematic review and meta-analysis protocol will be conducted by Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. The databases PubMed, Scopus, Web of Science, PsycINFO, EMBASE, LILACS and Google Scholar will be searched with no restrictions on publication year, country or language. In addition to the databases, the search will be supplemented by manual searches of reference lists from the included articles. Studies that assess at least one parental autonomy-supportive food practice and its relationship with fruit and vegetable consumption in healthy children aged 2 to 12 years will be included. Results will be organised in tables and figures. A meta-analysis will be conducted if data availability permits. Risk of bias will be assessed using Joanna Briggs Institute tools. All steps will be conducted independently by two reviewers.

ETHICS AND DISSEMINATION

Findings from this review will be important for understanding the influence of parental autonomy-supportive food practices on children's fruit and vegetable consumption, potentially informing health practices that promote healthy eating habits from childhood. No ethical approval is required for this review, and we plan to publish the findings in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42023442680.

Techniques and accuracy for aligning facial and intraoral digital scans to integrate a 3-dimensional virtual patient: A systematic review

STATEMENT OF PROBLEM

The optimal method of aligning intraoral scans with facial scans to generate a 3-dimensional (3D) virtual patient remains unclear. Distortions in the alignment of intraoral and facial scans would lead to an inadequate virtual patient representation and, therefore, to inadequate diagnosis and treatment planning.

PURPOSE

The purpose of this systematic review was to evaluate the available techniques for generating a 3D virtual patient by aligning facial and intraoral scans and to assess their accuracy.

MATERIAL AND METHODS

A systematic search was conducted in 3 databases: Medline, Scopus, and Web of Science. A manual search was also conducted. Specific descriptors were used to identify alignment techniques. Two independent reviewers screened titles and abstracts, with a third independent reviewer resolving ambiguities. A qualitative analysis was performed, and interexaminer agreement was assessed using the Cohen kappa statistic.

RESULTS

After screening, 48 of the 2832 identified articles were included for qualitative analysis. They focused on 3 alignment techniques: guided by retracted facial scans, extraoral scan bodies, and perioral intraoral scans. Interexaminer agreement was high (kappa=0.82 to 0.88). Integration techniques guided by extraoral scan bodies, influenced by extraoral scan body design and protocols, showed the best accuracy. The outcome variables for the evaluation of the effectiveness of these protocols were heterogeneous.

CONCLUSIONS

Integrating facial and intraoral scans was found to enhance diagnosis and treatment planning by providing essential esthetic and functional parameters. Integration techniques guided by extraoral scan bodies and combination techniques showed higher accuracy, especially for complex implant-supported prostheses or edentulous patients.

Risk predictors of severe adverse maternal outcomes in pre-eclampsia: a systematic review and meta-analysis protocol

INTRODUCTION

Pre-eclampsia (PE) remains a major contributor to maternal morbidity and mortality globally. Early identification of risk factors and evaluation of prognostic models for severe adverse maternal outcomes are essential for improving management and reducing complications. While numerous studies have explored potential risk markers, there is still no consensus on the most reliable factors and models to use in clinical practice. This systematic review aims to consolidate research on both individual predictors and prognostic models of severe adverse maternal outcomes in PE, providing a comprehensive overview to support better clinical decision-making and patient care.

METHODS AND ANALYSIS

This review follows the Meta-analyses Of Observational Studies in Epidemiology (MOOSE) guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Protocol 2015 checklist. A systematic search will be performed using a detailed strategy across Medline, Embase, Cochrane, ProQuest dissertations, and grey literature from inception to 2 April 2024. Eligible studies will include those investigating clinical, laboratory-based, and sociodemographic predictors of severe adverse maternal outcomes in PE. Two reviewers will independently assess titles, abstracts, full texts, and extract data and assess study quality using the Quality In Prognostic Studies (QUIPS) tool for studies on risk predictors and the Prediction model Risk of Bias Assessment Tool (PROBAST) for prognostic models. The inclusion criteria will encompass cohort, case-control, and cross-sectional studies published in English and French involving women diagnosed with PE and reporting on the risk prediction for adverse maternal outcomes. The main outcomes of interest will include severe maternal morbidity and mortality during pregnancy, delivery, or within the postpartum period. Analyses will include both narrative synthesis and, where appropriate, meta-analysis using random-effects models. Pooled estimates will be calculated, with publication bias assessed through funnel plots and statistical tests (eg, Begg's and Egger's). Heterogeneity will be primarily assessed through visual inspection of forest plots, supported by statistical measures, such as the I² test, with further exploration through sensitivity, subgroup, and meta-regression analyses.

ETHICS AND DISSEMINATION

This systematic review will be based on published data and will not require ethics approval. Results will be disseminated through peer-reviewed publications and presentations at academic conferences.

PROSPERO REGISTRATION NUMBER

CRD42024517097.

Tirofiban efficacy and safety for percutaneous coronary intervention in patients with acute coronary syndrome: protocol for a systematic review and meta-analysis

INTRODUCTION

Percutaneous coronary interventions (PCI) have become a cornerstone in the management of acute coronary syndromes (ACS), yet they carry risks of complications like stent thrombosis and reinfarction. Glycoprotein IIb/IIIa inhibitors, particularly tirofiban, have been employed as adjunctive therapies to reduce these risks. Despite its potential benefits, the use of tirofiban remains a subject of debate, with varying recommendations across major clinical guidelines.

METHODS AND ANALYSIS

We systematically searched five databases from 1 January 1992 to 1 April 2025, including Medline, Embase, Lilacs, Clinicaltrials.org and Cochrane Central Register of Controlled Trials (CENTRAL), in addition to three grey literature databases. Randomised controlled trials and cluster randomised trials investigating the use of intravenous or intracoronary tirofiban in patients with ACS, unstable angina or myocardial infarction were considered for inclusion. Only published studies in English, Portuguese, Spanish and French were included. Data selection and extraction will be performed independently by two researchers, with any inconsistencies resolved with consensus or by consulting a third senior researcher. The risk of bias will be assessed through the risk of bias measurement tool (Rob-2) for interventions and/or cluster trials by two researchers independently, and the overall certainty of evidence will be assessed by using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool. A meta-analysis will be carried out if there is sufficient homogeneity between studies, with subgroup analysis being performed if significant heterogeneity is detected. Additionally, a metaregression model will be conducted if sufficient data are available.

ETHICS AND DISSEMINATION

As this study involves secondary analysis of published data, ethics approval is not required. The results will be disseminated through peer-reviewed publication, conference presentations and will be shared with relevant clinical guideline committees.

PROSPERO REGISTRATION NUMBER

CRD42024585252.

Silver-Based Dressings for Surgical Site Infection Prevention: Evidence from Randomized Trials

BACKGROUND

Surgical site infections (SSIs) are a major cause of postoperative complications, increasing morbidity and healthcare costs. Silver-based dressings are commonly used due to their antimicrobial properties, but their effectiveness in reducing SSIs remains unclear.

AIM

This systematic review and meta-analysis aim to evaluate the efficacy of silver-based dressings compared to non-silver dressings in preventing SSIs in randomized controlled trials (RCTs) METHODS: A systematic search was conducted in PubMed, Cochrane Library, and Embase to identify RCTs comparing silver-based to non-silver dressings for SSI prevention. The study protocol was registered in PROSPERO (CRD42024592966). Meta-analysis using random-effects models calculated pooled risk ratios (RR) with 95% confidence intervals (CI). Heterogeneity was assessed with the I2 statistic, and publication bias evaluated through funnel plots and Egger's test.

RESULTS

12 RCTs with 2,928 participants were included in the meta-analysis. Silver-based dressings significantly reduced SSI risk by 40% compared to non-silver dressings (RR: 0.60, 95% CI: 0.41-0.89, p<0.05), with moderate heterogeneity (I2 = 53%) CONCLUSIONS: : Silver-based dressings significantly reduce the risk of SSIs; however, further high-quality RCTs are needed to confirm their benefits across different surgical contexts and patient populations.

Psychometric properties of the sit-to-stand test for patients with pulmonary hypertension: A systematic review

BACKGROUND

Pulmonary hypertension (PH) is defined as an increase in mean pulmonary arterial pressure, often accompanied by indicators such as dyspnea on exertion, exercise intolerance, and systemic muscle dysfunction. Various protocols exist that can indirectly assess these indicators through the sit-to-stand test (STST).

OBJECTIVE

Assess the psychometric properties of different STST protocols in patients with PH.

METHODS

This study is a systematic review. We searched the PubMed, EMBASE, SciELO, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases. The risk of bias was assessed using the COSMIN tool and the certainty of evidence using the modified Recommendations, Assessment, Development, and Evaluation (GRADE) classification. Two investigators evaluated independently, and a third evaluator was consulted as needed.

RESULTS

Out of a total of 7933 articles identified, only 5 articles met the criteria for inclusion in the analysis. Four psychometric properties were assessed across the five protocols used. The 1-STST protocol provided high-quality evidence for both convergent validity and responsiveness. The 30-STST protocol showed moderate-quality evidence for convergent validity and responsiveness, while the 5-STST also demonstrated moderate-quality evidence for responsiveness. The between-groups validity and reliability of the 30-STST protocol were considered to be low and very low, respectively.

CONCLUSION

Despite the limited number of studies, we can infer that the most commonly used protocol is the 1-STST, which has a high degree of convergent validity and responsiveness when compared to other assessment tools.

Factors Explaining Age-Related Prospective Memory Performance Differences: A Meta-analysis

OBJECTIVES

The age-prospective memory paradox states that younger adults perform better than older adults in laboratory tasks, whereas the opposite has been observed for naturalistic tasks. These terms insufficiently characterize tasks and task settings. We therefore revisited the age-prospective memory paradox using a newly developed taxonomy to better understand how task characteristics or task settings contribute to age-related differences in performance.

METHODS

We conducted a meta-analysis of 138 studies, classifying prospective memory tasks according to our newly developed taxonomy. The taxonomy included 9 categories that considered how close any task or task setting was to daily life.

RESULTS

When categorizing relevant studies with this taxonomy, we found that older adults did better than younger adults in "close to real-life" tasks done at home and, particularly, in to-do lists and diary tasks. However, they did worse in "far from real-life" tasks done in naturalistic environments or in simulations of real-life tasks in a laboratory.

DISCUSSION

Results of this meta-analysis suggest that the level of abstraction of a task and familiarity with the environment in which the task is taken can explain some of the differences between the performances of younger and older people. This is relevant for the choice of task settings and task properties to experimentally address any prospective memory research questions that are being asked.

Significant Heterogeneity in Pooled Patient Acceptable Symptom State Threshold for Shoulder Pain: A Systematic Review and Meta-analysis

PURPOSE

To identify studies reporting patient acceptable symptom state (PASS) thresholds in diverse shoulder pain populations and to investigate whether patient-reported outcome measurements measuring shoulder pain severity provide similar estimates of the PASS across groups of people experiencing shoulder pain.

METHODS

Web of Science, Scopus, CENTRAL, and OVID (MEDLINE) databases were searched for studies on PASS related to shoulder pain using terms for PASS, shoulder pathologies, and pain-related patient-reported outcome measurements. Risk of bias (RoB) was categorized using a modified the Quality in Prognosis Studies Tool. The meta-analysis applied random effects models, with heterogeneity assessed via I2 and Cochran's Q-test. Subgroup analysis was performed, with bias evaluated using funnel plots and the Egger test.

RESULTS

Twenty-one studies were included, involving 8.992 participants with an average age of 50.55 years. The PASS thresholds for shoulder pain varied across the interventions and follow-up periods. The pooled PASS estimate was 20.18 (95% confidence interval 16.63-23.73, prediction interval 2.98 to 37.38), with significant heterogeneity (I2 = 97%). Surgical interventions had lower PASS thresholds than nonsurgical approaches. Studies with longer follow-up duration and moderate RoB had lower PASS thresholds. A significant publication bias was identified.

CONCLUSIONS

This systematic review and meta-analysis established a pooled PASS threshold for shoulder pain, highlighting substantial heterogeneity and significant differences in PASS thresholds across RoB levels, follow-up durations, and types of intervention.

LEVEL OF EVIDENCE

Level IV, systematic review and meta-analysis of Level II-IV studies.

Social determinants of health and epigenetic clocks: Meta-analysis of 140 studies

Social determinants of health are social factors that affect health and survival. Two of the most powerful social determinants are socioeconomic status (SES) and race/ethnicity; people with lower SES or marginalized race/ethnicity tend to experience earlier onset of aging-related diseases and have shorter lifespans. DNA methylation (DNAm) measures of biological aging, often referred to as "epigenetic clocks", are increasingly used to study the social determination of health. However, there are several generations of epigenetic clocks and it remains unclear which are most sensitive to social factors affecting health. Moreover, there is uncertainty about how technical factors, such as the tissue from which DNA is derived or the technology used to measure DNA methylation may affect associations of social determinants with epigenetic clocks. We conducted a pre-registered multi-level meta-analysis of 140 studies, including N = 65,919 participants, encompassing 1,065 effect sizes for associations of SES and racial/ethnic identity with three generations of epigenetic clocks. We found that associations were weakest for the first generation of epigenetic clocks developed to predict age differences between people. Associations were stronger for the second generation of epigenetic clocks developed to predict mortality and health risks. The strongest associations were observed for a third generation of epigenetic clocks, sometimes referred to as "epigenetic speedometers", developed to predict the pace of aging. In studies of children, only the speedometers showed significant associations with SES. Effects of sex and technical factors were minimal and there was no evidence of publication bias.

Less than 4% of participants in studies of carbohydrate-based fuelling strategies for soccer performance have been female: results from an audit of her representation

Women's soccer has increased markedly in popularity and professionalisation in recent years. Achieving adequate carbohydrate (CHO) availability before and during performance is often advised as a key priority for players. The aim of this study was to audit the literature that informs the current CHO-based guidelines for soccer performance and to assess the extent of evidence supporting their application to female players. Using an established protocol for auditing the published literature, seven databases were searched for research investigating the effects of acute CHO-based fuelling strategies before or during soccer performance. A total of 43 studies met the inclusion criteria. There were a total of 542 participants, of which 3.7% were female (n = 20 individuals) and 96.3% were male (n = 522 individuals). The majority of the studies were designed to examine the effects of CHO intake during soccer (n = 31; 72.1%), with the remaining studies employing pre-exercise CHO intake (n = 5; 11.6%) or CHO loading (n = 7; 16.3%) protocols. Most studies involved male-only cohorts (n = 41; 95.3%), while female-only (n = 1; 2.3%) and mixed-sex cohorts (n = 1; 2.3%) were less prevalent. Of the two studies that included females, neither provided any information around categorisation or control of menstrual cycle status. The current guidelines on acute CHO-based fuelling strategies for soccer are not informed by an adequate evidence base when applied to female players. Given the potential for between-sex differences in physiology and metabolism, the lack of female-specific research means that it is presently unknown whether the current guidelines on CHO-based fuelling strategies for soccer are optimal for female players.

Improving career readiness in middle school students: a systematic review of intervention approaches

Introduction

To address the challenges posed by the rapidly evolving career landscape on adolescent development, this study systematically reviews career intervention pathways for middle school students.

Methods

It explores the theoretical frameworks, intervention structures, evaluation systems, and outcomes associated with career interventions at middle school educational stage. Seven key terms, three databases, and four eligibility criteria were established for the review. Out of 417 articles collected, 21 were selected for comprehensive analysis.

Results

The results indicate that the theoretical framework for middle school career interventions includes career theory and psychotherapy, with the main intervention approach group-based. The evaluation system typically relies on quasi-experimental pre- and post-test assessments. The outcomes demonstrate positive developments in career decisionmaking and career adaptability.

Discussion

This study emphasizes the critical role of career interventions and educational programs during middle school, advocating for their integration into the curriculum to support students' career development.

Effect of timed exercise interventions on patient-reported outcome measures: A systematic review

BACKGROUND

Exercising at a specific time of day has the potential to mitigate the negative effects of disrupted circadian rhythms caused by irregular work and sleep schedules on the development of chronic diseases. Afternoon/evening exercise is postulated to be superior to morning exercise for various health outcomes, but patient acceptance of timed exercise remains unclear. The aim of this systematic review was to assess the impact of exercise timing on patient-reported outcomes (PROMs).

METHODS

We conducted a systematic review, following Cochrane and PRISMA guidelines (PROSPERO: CRD42022322646). We systematically searched databases including MEDLINE, SCOPUS, Embase, APA PsycInfo, CINAHL, and Web of Science, to identify studies which reported on PROMs related to timed exercise interventions: either acutely after a bout of exercise or following extended training (>1 month). Studies were included if they reported primary data from randomized or non-randomized experiments of timed exercise interventions (against any comparator), published in English until August 2023 and reporting on any PROM. Machine-learning software (AR Reviews) was used to aid in abstract screening. Subsequently, two independent reviewers reviewed the included full texts, extracted study details (participants, interventions, outcomes), and evaluated the risk of bias using Cochrane tools (ROB-2 and ROBINS-I). Exercise interventions were summarized using the TIDieR reporting method and results were presented in accordance with the Synthesis Without Meta-analysis (SWiM) guidelines for systematic reviews.

RESULTS

Seventeen studies with 403 participants were included in the review. The interventions varied widely in exercise modality, duration, and participant characteristics, contributing to substantial heterogeneity in the findings. Most studies found no significant impact of exercise timing on PROMs. There was some inconsistency between studies for certain outcomes.

DISCUSSION

The review suggests that there are no clear detrimental effects of afternoon or evening exercise on PROMs compared to morning exercise. However, the lack of homogeneity in study populations and small sample sizes resulting in low power for PROM outcomes are major limitations of the research in this field. If future research confirms the metabolic advantages of afternoon/evening exercise, this may be an acceptable alternative for individuals.

Pain and sedation management for screening or treatment of retinopathy of prematurity

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of pain and sedation management for screening or treatment of retinopathy of prematurity in preterm infants compared to placebo, no intervention, or other interventions.

Healthcare use and its variation in people with fibromyalgia: a systematic review protocol

AIM

A crucial step towards improving the care of people with fibromyalgia is understanding current practice. Our systematic review aims to address this by synthesising the global evidence around healthcare use in people with fibromyalgia, including its variation across groups of people, geographical locations, and over time.

BACKGROUND

Fibromyalgia is a chronic condition characterized by widespread pain alongside a broad range of non-pain symptoms. Its substantial impact on peoples' lives and high prevalence mean that ensuring people with fibromyalgia receive evidence-based and appropriate care is a clinical and research priority. Whilst guidelines recommend that people with fibromyalgia receive a prompt diagnosis, care that focuses on non-pharmacological interventions, and in many countries should be predominantly managed in the community, existing evidence indicates they often wait many years for a diagnosis, commonly receive long-term opioid medicines, and see multiple hospital specialists.

METHODS

Relevant databases will be searched, with 25% of screening, data extraction, and quality appraisal conducted by two reviewers. Eligible studies will have evaluated healthcare use in adults with fibromyalgia using data obtained from electronic health record, registry, or insurance databases (providing generalizable findings in large, representative datasets). Data will be synthesized using meta-analysis and/or synthesis without meta-analysis where possible.

RESULTS

By providing an in-depth analysis of healthcare use and its variation in people with fibromyalgia, the results from this systematic review could be used to benchmark practice, inform targeted management strategies to those with the highest levels of healthcare use (and therefore care need), and provide insight into whether certain countries require specific guideline/policy changes.

Repetitive transcranial magnetic stimulation in conjunction with scalp acupuncture in treating poststroke cognitive impairment: a protocol for systematic review and meta-analysis

INTRODUCTION

Approximately 70% of patients with stroke experience varying degrees of cognitive impairment, which imposes a substantial direct and indirect socioeconomic burden. Previous studies have shown that scalp acupuncture (SA) or repetitive transcranial magnetic stimulation (rTMS) in combination with other therapies is effective for poststroke cognitive impairment (PSCI). Limited by interstudy heterogeneity and the limited number of included studies, there is insufficient evidence of the efficacy of rTMS in combination with SA in treating PSCI. Therefore, this protocol aims to investigate the effectiveness of rTMS in conjunction with SA for patients with PSCI through a comprehensive meta-analysis.

METHODS AND ANALYSIS

This study will undertake a comprehensive search across nine distinct databases (Web of Science, Embase, Cochrane Library, PubMed, China National Knowledge Infrastructure, Wanfang Data, China Science and Technology Journal Database, China Biology Medicine and SCOPUS). The primary outcome will encompass the Montreal Cognitive Assessment and the Mini-Mental State Examination. The secondary outcomes are the modified Barthel Index, the Rivermead Behavioral Memory Test and the Digit Span Test. The bias risk assessment tool from the Cochrane Handbook for Systematic Reviews of Interventions will be used to evaluate bias risk, and the GRADE will be applied to gauge the quality of evidence. Furthermore, we plan to perform an analysis of subgroups to investigate the heterogeneity, employ the leave-one-out approach for sensitivity evaluation and use funnel plots and Egger's test to determine publication bias, respectively.

ETHICS AND DISSEMINATION

Ethical approval is not required in systematic review and meta-analysis. The review will be published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42024571762.

Motor interventions initiated prior hospital discharge to prevent neurodevelopmental impairment in preterm infants

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of motor interventions initiated prior hospital discharge to prevent neurodevelopmental and motor impairment in preterm infants compared to standard care, post-discharge motor interventions, and different modalities of the same motor intervention.

Association between sedentary behaviour and chronic pelvic pain in women: a protocol for systematic review and meta-analysis

INTRODUCTION

In light of the rising prevalence of sedentary behaviour worldwide, its impact on health has become a subject of growing interest. To clarify whether there is a significant correlation between sedentary behaviour and chronic pelvic pain in women and to explore its potential clinical implications, this study aims to provide a systematic review and meta-analysis of the association between the two. The findings of this study will inform the development of effective prevention and intervention strategies.

METHODS AND ANALYSIS

This study will conduct an exhaustive search across electronic databases, encompassing PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials and Scopus, for records published up until 26 June 2024. Two independent researchers will conduct the study selection, data extraction and assessment of bias risks, with any discrepancies resolved through the collaboration of a third reviewer. To accurately discern the underlying sources of heterogeneity, sensitivity, subgroup analyses and meta-regression will be conducted in parallel. Additionally, to ensure the rigour and integrity of our research, Begg's and Egger's tests will serve as the primary means of evaluating the potential for publication bias within the studies under consideration.

ETHICS AND DISSEMINATION

Ethical approval will not be required for this study, as it will use publicly accessible, non-identifiable data from the published literature. The research team will ensure data privacy and participant confidentiality through anonymised data processing and strict compliance with relevant regulations. The results of this study will be disseminated through publication in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42024562443.

Behavioural analysis of factors influencing prescribing for neurodegenerative diseases: A rapid review

BACKGROUND

The incidence and prevalence of neurodegenerative diseases (NDs) are growing worldwide. In an environment where healthcare resources are already stretched, it is important to optimise treatment choice to help alleviate healthcare burden. This rapid review aims to consolidate evidence on factors that influence healthcare professionals (HCPs) to prescribe medication for NDs and map them to theoretical models of behaviour change to identify the behavioural determinants that may support in optimising prescribing.

METHODS AND FINDINGS

Embase and Ovid MEDLINE were used to identify relevant empirical research studies. Screening, data extraction and quality assessment were carried out by three independent reviewers to ensure consistency. Factors influencing prescribing were mapped to the Theoretical Domains Framework (TDF) and key behavioural determinants were described using the Capability, Opportunity, Motivation - Behaviour (COM-B) model. An initial 3,099 articles were identified, of which 53 were included for data extraction. Fifty-six factors influencing prescribing were identified and categorised into patient, HCP or healthcare system groups, then mapped to TDF and COM-B domains. Prescribing was influenced by capability of HCPs, namely factors mapped to decision making (e.g., patient age or symptom burden) and knowledge (e.g., clinical understanding) behavioural domains. However, most factors were influenced by HCP opportunity, underpinned by factors mapped to social (e.g., prescribing support or culture) and contextual (e.g., lack of resources or medication availability) domains. Less evidence was available on factors influencing the motivation of HCPs, where evident; factors primarily related to HCP belief about consequences (e.g., side effects) and professional identify (e.g., level of specialism) were often described.

CONCLUSIONS

This systematic analysis of the literature provides an in-depth understanding of the behavioural determinants that may support in optimising prescribing practices (e.g., drug costs or pressure from patients' family members). Understanding these approaches provides an opportunity to identify relevant intervention functions and behaviour change techniques to target the factors that directly influence HCP prescribing behaviour.

The impact of probiotics therapy on cognitive and metabolic characteristics in patients with cognitive impairment: An umbrella review of meta-analysis of randomized controlled trials

BACKGROUND

While existing meta-analysis suggest that probiotic therapies may enhance cognitive functions and influence metabolic characteristics, the findings have been inconclusive. In light of these discrepancies, our study undertakes an umbrella review to more precisely determine the aggregate effects and rigorously evaluate the credibility and quality of evidence.

METHODS

We conducted a systematic search across seven databases, including PubMed, Embase, the Cochrane Library, ProQuest, Web of Science, CINAHL, and Scopus, from their inception to June 20, 2024. We utilized the AMSTAR-2 tool to evaluate the quality of the meta-analyses and applied the GRADE system to rate the quality of the evidence. We estimated the final effect sizes (ESs) along with their 95% confidence intervals (CI) and performed both sensitivity and subgroup analyses to explore the sources of heterogeneity.

RESULTS

Among the 314 articles identified in our search, 13 meta-analysis that met the criteria were included in the study. The quality of the evidence in these studies was graded from high to very low. Our results demonstrate that probiotic treatment significantly enhances cognitive function in patients (ESSMD = 0.39, 95%CI: 0.19 to 0.59, p < 0.001). Moreover, probiotic treatment notably decreased level of serum malondialdehyde (MDA), insulin resistance as detected by homeostasis model assessment method (HOMA-IR) and high-sensitivity C-reactive protein (hs-CRP) (p < 0.001). Conversely, probiotic treatment did not significantly impact triglycerides and very-low-density lipoprotein (VLDL) in patients (p > 0.05).

CONCLUSION

Although preliminary evidence indicated that probiotic therapy may positively impact cognitive function, MDA, HOMA-IR, and hs-CRP, the overall quality of the existing evidence is insufficient to provide strong support. Therefore, future research must employ more rigorous designs or initiate larger clinical trials to produce more compelling evidence to further validate the efficacy of probiotic therapy on cognitive function of patients with cognitive dysfunction.

The roles and signalling pathways of lncMALAT1 in coronary artery disease: A protocol for systematic review of in vivo and in vitro studies

BACKGROUND

Coronary artery disease (CAD) is a major cardiovascular disease that affects global population health. Several studies have indicated the association between high expression level of a non-coding RNA, lncMALAT1 and an increased risk of CAD. In this study, we conducted a protocol of systematic review aims to evaluate the role and mechanism of lncMALAT1 that may contributed to CAD based on animal and in vitro studies. The roles of lncMALAT1 will be elucidated focusing on activating upstream signalling Klotho/FGF23 or regulate the downstream Wnt/β-catenin or extracellular signal-regulated kinase/mitogen-activated protein kinase(ERK/MAPK) and any other pathways with the vascular changes in term of proliferation, migration, lumen formation and apoptosis.

METHODS

A systematic review protocol with a reproducible strategy according to the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) guidelines and Population, Intervention, Comparison Outcome and Study (PICOS) framework were proposed to evaluate the existing literature on the roles and mechanisms of the lncMALAT1. A PRISMA-compliant electrical systematic research was performed in the databases including PubMed, Web of Science and Scopus for English publication from their inceptions until January 2024. Data for collection will include primary CAD animal models and any cardiomyocyte cell line with primary hypoxia model. The article title, authors, type of models, signaling pathways and biological changes (proliferation, migration, lumen formation and apoptosis) will be recorded.

CONCLUSION

This will provide a new approach in understanding molecular interactions on CAD for new perspective and target treatment for CAD patients in future, especially that intolerance of invasive coronary therapy.

REGISTRATION

Registered in PROSPERO on 10 April, 2024. (CRD42024504245) (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024504245).

Communication strategies for delivering personalised dementia care and support: a mixed-methods systematic review and narrative synthesis

BACKGROUND

Given the significant burden and rising prevalence of dementia, it is essential that personalised care is available to people with dementia (PWD) and their family carers. This involves tailoring support to meet individuals' unique needs and preferences. Effective communication is fundamental to delivering such care, yet dementia impacts communication, posing challenges in meeting individuals' needs.

AIM

To understand key communication strategies used by healthcare professionals (HCPs) in delivering personalised dementia care.

METHODS

A systematic search across MEDLINE, EMBASE, EMCare, PsycINFO, CINAHL, Scopus, and Web of Science was conducted (April 2024) without limits on care setting, country or publication date. We identified studies examining communication strategies, barriers, and facilitators for delivering personalised care for PWD and their carers. Study quality was assessed using Joanna Briggs Institute critical appraisal tools and the Mixed Methods Appraisal Tool. Using codebook thematic analysis, a narrative synthesis of findings was developed.

RESULTS AND CONCLUSION

The review included 33 studies, encompassing qualitative, quantitative and mixed-methods research conducted in hospitals, care homes and community settings. Most studies originate from high-income countries and care homes, limiting generalisability. Three themes on communication strategies for delivering personalised dementia care were developed: understanding the person, their family and their care context; communication techniques (verbal, nonverbal and use of external aids); and support for the workforce. The review underscores the importance of combining practical, emotional and relational approaches while highlighting current gaps, such as the need for better workforce support and more research in primary care and culturally diverse contexts.

The use and effect of virtual reality as a non-pharmacological intervention for behavioural and psychological symptoms of dementia: a systematic review and meta-analysis

BACKGROUND

Behavioural and psychological symptoms of dementia (BPSD) are complex neuropsychiatric symptoms that contribute to caregiver strain, increased rates of institutionalisation and reduced quality of life. Virtual reality (VR) has gained interest as a non-pharmacological approach to potentially reduce BPSD severity.

OBJECTIVE

This review sought to synthesise evidence on the effectiveness of VR in reducing BPSD severity, while exploring its acceptability, safety, and optimal dosage in dementia care.

METHODS

MEDLINE, EMBASE, CINAHL and SCOPUS were searched for randomised and quasi-experimental trials assessing VR's effect on BPSD. JBI critical appraisal checklists were used to assess methodological quality. Findings were presented narratively, with meta-analysis performed on a subset of BPSD symptoms where data were available.

RESULTS

Of the ten included studies, four found no significant change in overall BPSD. Mixed findings were observed for individual BPSD symptoms. Meta-analysis showed a significant reduction in depressive symptoms (mean diff -0.38, P= .026) and no reduction in agitation (mean diff 1.87, P = .2). Two studies reported reduced aggression and mixed findings were found for anxiety. Reduced apathy was observed in one study following each VR session and during the session in another. VR was generally well-accepted with few side effects reported.

CONCLUSION

VR appears to be an acceptable non-pharmacological intervention for BPSD reduction. However, the limited available studies, methodological variations and quality issues suggest the need for future larger-scale research to confirm its efficacy and effectiveness.

Biannual azithromycin mass drug administration for reduction of childhood mortality: a systematic review and meta-analysis

BACKGROUND

Biannual mass drug administration of azithromycin (MDA-azithromycin) has been proposed as a strategy to reduce childhood mortality in high-mortality regions, particularly sub-Saharan Africa. However, its effectiveness across different age groups and potential risks, including antibiotic resistance, require further evaluation.

METHODS

We systematically searched PubMed, Cochrane CENTRAL, Web of Science and ClinicalTrials.gov through September 2024 for randomized controlled trials (RCTs) comparing biannual MDA-azithromycin to placebo in children aged 1-59 months. The primary outcomes were mortality in children <1 year and 12-59 months. Secondary outcomes included adverse events and antibiotic resistance. Data were analysed using a random-effects model in Review Manager 5.4, with heterogeneity assessed via I2. Trial sequential analysis (TSA) evaluated cumulative evidence reliability, and the Cochrane RoB2 tool assessed risk of bias. PROSPERO registration: CRD42024589170.

RESULTS

Five RCTs (691 235 children) were included. Among children <1 year, azithromycin showed a non-significant mortality reduction (RR: 0.90 [0.78, 1.04]; P = 0.14; I2 = 55%), with TSA indicating inconclusive evidence. Among children 12-59 months, MDA-azithromycin significantly reduced mortality (RR: 0.85 [0.79, 0.91]; P < 0.00001; I2 = 26%), with TSA confirming sufficient evidence. Adverse events were rare, but antibiotic resistance data were limited, warranting further monitoring. Evidence quality ranged from moderate to very low, with one trial at high risk of bias.

CONCLUSION

Biannual MDA-azithromycin significantly reduces mortality in children 12-59 months, supporting its use in high-mortality settings per WHO recommendations. Its impact on infants remains uncertain. Adverse events were minimal, but continued resistance surveillance is essential.

Freehand vs. computer-aided implant surgery: a systematic review and meta-analysis-part 1: accuracy of planned and placed implant position

OBJECTIVES

This systematic review aimed to investigate and compare the accuracy of free-hand and computer-aided implant surgery (CAIS) approaches in dental implant placement.

MATERIAL AND METHODS

The PICO question as follows: In patients receiving dental implants, does computer-aided implant surgery superior in accuracy compared to non-computer-aided implant surgery? The primary outcome was angular deviation between the planned and placed position of the implant. An electronic search was made to identify all relevant studies reporting the accuracy of CAIS approaches and freehand for dental implant placement. The data were extracted in the descriptive description, and a meta-analysis of single means was performed to estimate the deviations for each variable using a random-effects model.

RESULTS

Out of 1609 initial articles, 55 were selected for data extraction. The mean value of angular, entry, and apex deviations were 7.46°, 1.56 mm, and 2.22 mm for freehand, 5.94°, 1.13 mm, and 1.43 mm for pilot drill-sCAIS, 2.57°, 0.72 mm, 0.88 mm for fully guided-sCAIS (fg-sCAIS), and 3.67°, 1.01 mm, and 1.36 for dynamic CAIS (dCAIS), respectively. Significant differences were found between the freehand and CAIS approaches (p < 0.04). Fg-sCAIS was significantly more accurate than dCAIS systems at the entry (p < 0.001).

CONCLUSIONS

Compared to the freehand approach, both sCAIS and dCAIS improve implant placement accuracy, with angular deviations ranging from 2° to 6°. Detailed planning is crucial for CAIS, particularly for fg-sCAIS, which demonstrated the highest accuracy than others. As apex deviations of 1 to 2 mm have been observed in CAIS approaches, a 2-mm safety margin should be implemented to minimize surgical risks.

Task Specificity of Dynamic Resistance Training and Its Transferability to Non-trained Isometric Muscle Strength: A Systematic Review with Meta-analysis

BACKGROUND

Resistance training (RT) specificity has been confirmed for movement patterns (e.g., multi-joint or single joint), movement velocities, ranges of motion, and contraction types (e.g., dynamic vs isometric). However, a systematic analysis of the effects of dynamic mass-loaded (e.g., isoinertial) RT on dynamic versus isometric strength tests is lacking.

OBJECTIVE

We aimed to examine the specific effects of dynamic RT on dynamic (isoinertial) versus isometric muscle strength, including possible moderating factors (e.g., training length, single joint and multi-joint, upper body and lower body, RT status) and mechanisms (e.g., hypertrophy, muscle activation).

METHODS

A systematic literature search was conducted in MEDLINE (EBSCO), Web of Science, and Scopus up to March 2024. The included interventions contained at least ten training sessions, both dynamic and isometric muscle strength assessments before and after the training period, and healthy participants aged 16-60 years (encompassing untrained and trained individuals). Advanced RT approaches, such as electrical stimulation, isokinetic training, velocity-based training, and blood flow restriction training, were excluded. Within-subject, weighted standardized mean differences (SMDs) of the pre-intervention to post-intervention tests were calculated for both dynamic and isometric muscle strength measures using a random-effects model. Univariate sub-group analyses of RT status, intervention length, complexity (i.e., single-joint or multi-joint exercises), and body segments (i.e., upper and lower body) were independently computed. Random-effects meta-regressions were computed to examine if dynamic RT effects on dynamic and isometric muscle strength are predicted by RT effects on muscle hypertrophy or muscle activity.

RESULTS

Overall, 43 studies with 1660 participants across 72 different RT interventions were eligible for inclusion. The overall effect on dynamic strength was significant and moderate magnitude (SMD = 0.98, 95% confidence interval 0.91-1.06, p < 0.001), whereas the transfer to non-trained isometric strength measures was significant but small (SMD = 0.42, 95% confidence interval 0.35-0.49, p < 0.001). Sub-analyses demonstrated moderate-to-large task-specific effects (range SMD; 95% confidence interval 0.75-1.30) of conducting dynamic RT and only small-to-medium effects (range SMD; 0.29-0.70) of the transferability of muscle strength to the non-trained isometric contraction form. Muscle hypertrophy and activity changes did not significantly predict dynamic RT effects on dynamic and isometric muscle strength (p ≥ 0.222).

CONCLUSIONS

Our findings demonstrated task specificity of dynamic RT, as dynamic strength increased with a two-fold larger effect size than non-trained isometric muscle strength. Medium-to-large effects were observed for the dynamic strength improvements in the different sub-group analyses with small-to-medium effects in the isometric improvements. The limited transferability of dynamic (task-specific) strength to non-trained isometric contractions suggests that these two strength outcomes represent different neuromuscular domains.

Efficacy and safety of cholinergic modulators in patients with schizophrenia: meta-analysis of randomised controlled trials

BACKGROUND

One-third of schizophrenia patients show a lack of response to conventional antipsychotic drugs because of adverse effects and limited efficacy. Emerging treatments target muscarinic and nicotinic receptors, leveraging cholinergic dysfunction implicated in the pathophysiology of schizophrenia.

AIMS

To evaluate the efficacy and safety of cholinergic modulators in schizophrenia.

METHODS

Reviewers extracted data from clinical trials sourced via MEDLINE/PubMed, Embase, Scopus, Cochrane databases and registries. Quality was assessed with a risk-of-bias tool and a random-effects model estimated effect size. Subgroup analysis, meta-regression and sensitivity analysis were performed as needed, adhering to PRISMA guidelines.

RESULTS

A total of 30 randomised controlled trials (3128 participants) tested cholinergic modulators as monotherapy or adjunct therapy. They did not significantly improve Positive and Negative Syndrome Scale (PANSS) total scores (standardised mean difference (SMD): -0.38; 95% CI: -0.93, 0.18; moderate certainty evidence) but did improve negative symptom scores (SMD: -0.42; 95% CI: -0.59, -0.25; moderate certainty evidence). Muscarinic agonists improved total (SMD: -0.57; 95% CI: -0.72, -0.42), positive (SMD: -0.58; 95% CI: -0.73, -0.43) and negative symptoms of PANSS (SMD: -0.40; 95% CI: -0.59, -0.21), as well as Clinical Global Impression-severity (CGI-S) (SMD: -0.48; 95% CI: -0.65, -0.31). Nicotinic agonists aided negative symptoms (SMD: -0.28; 95% CI: -0.47, -0.09) and CGI-S (SMD: -1.31; 95% CI: -2.38, -0.24). Adverse events were higher (odds ratio: 1.21; 95% CI: 0.94, 1.56) in the experimental group.

CONCLUSION

Cholinergic modulators significantly improve negative symptoms, with muscarinic agonists showing improvement across symptom domains and severity, without notable differences in adverse effects from placebo. Most studies were at low bias risk; evidence quality ranged from very low to moderate.

Zoonotic Agents in Farmed Fish: A Systematic Review from the Interdisciplinary Perspective of the One Health Concept

This systematic review aims to synthesize evidence on zoonotic agents in farmed fish from the interdisciplinary One Health perspective. The review followed a protocol, following the PICOS strategy, where P represents population (farmed fish), I represents intervention (fish diseases), C represents comparison (healthy fish), O represents outcome (One Health) and S represents the type of study (experimental studies). The searches were conducted in the SCOPUS, Science Direct and PubMed Central databases. Of the 400 articles identified, 23 met the inclusion criteria due to their methodological robustness. These articles focused predominantly on parasitic (60.9%) and bacterial (39.1%) zoonotic agents. The One Health approaches discussed throughout the articles included host-parasite interactions (35%), antimicrobial resistance (22%), infections and food safety (18%), nutrition and immune responses (17%), stress and immune responses (4%) and anthelmintic testing (4%). The findings indicate that high-level scientific production is often confined to specific fields, such as veterinary medicine, biological sciences and animal science/fishery resources. There is a lack of broad interdisciplinary collaboration, limiting the integration of diverse fields to improve scientific production.

Baseline High-Sensitivity C-Reactive Protein as a Predictor of Adverse Clinical Events in Patients with Coronary Artery Disease Undergoing Percutaneous Coronary Intervention: A Meta-Analysis

Inflammation in patients with coronary artery disease (CAD) has been linked to adverse clinical outcomes. A useful biomarker for measuring inflammation levels, high-sensitivity C-reactive protein (hs-CRP) in the blood can be used to detect the presence of low-grade inflammation. This study sought to assess the predictive value of baseline hs-CRP levels for adverse clinical events in CAD patients undergoing percutaneous coronary intervention (PCI). To investigate this topic, a meta-analysis was performed. We conducted a systematic search of PubMed, Embase, and the Cochrane Library for original articles reporting the correlation between hs-CRP levels and adverse clinical events in CAD patients undergoing PCI. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and conducted a meta-analysis by extracting relevant data. Our pooled calculations yielded hazard ratios or odds ratios with 95% confidence intervals. A total of 28 studies comprising 60544 patients were included in this analysis. High baseline hs-CRP levels predicted increased risk for major adverse cardiac events ( P = 0.037), major adverse cardiac and cerebrovascular events ( P = 0.020), all-cause mortality ( P = 0.001), cardiovascular mortality ( P < 0.001), death and/or myocardial infarction ( P = 0.017) in patients, as well as restenosis ( P < 0.001). However, there was no association between elevated baseline hs-CRP levels and thrombosis. In conclusion, in CAD patients undergoing PCI, baseline hs-CRP levels are reliable predictors of major adverse cardiac events, major adverse cardiac and cerebrovascular events, all-cause mortality, cardiovascular mortality, death and/or myocardial infarction, and restenosis. Therefore, hs-CRP can effectively assist in prognosis determination for CAD patients undergoing PCI.

A systematic review of the comparative effects of sound and music interventions for intensive care unit patients' outcomes

BACKGROUND

Despite syntheses of evidence showing efficacy of music intervention for improving psychological and physiological outcomes in critically ill patients, interventions that include nonmusic sounds have not been addressed in reviews of evidence. It is unclear if nonmusic sounds in the intensive care unit (ICU) can confer benefits similar to those of music.

OBJECTIVE

The aim of this study was to summarise and contrast available evidence on the effect of music and nonmusic sound interventions for the physiological and psychological outcomes of ICU patients based on the results of randomised controlled trials.

METHODS

This systematic review was directed by a protocol based on the Methodological Expectations of Cochrane Intervention Reviews. Quality of studies was assessed with the Cochrane risk of bias assessment tool. Searches were performed in the following databases: MEDLINE, Embase, APA PsycInfo, CINAHL Plus with Full Text, Academic Search Complete, RILM Abstracts of Music Literature, Web of Science, and Scopus.

RESULTS

We identified 59 articles meeting the inclusion criteria, 37 involving music and 22 involving nonmusic sound interventions, with one study comparing music and sound. The identified studies were representative of a general ICU population, regardless of patients' ability to communicate. Our review demonstrated that both slow-tempo music and sound interventions can significantly (i) decrease pain; (ii) improve sleep; (iii) regulate cortisol levels; (iv) reduce sedative and analgesic need; and (v) reduce stress/anxiety and improve relaxation when compared with standard care and noise reduction. Moreover, compared to nonmusic sound interventions, there is more evidence that music interventions have an effect on stress biomarkers, vital signs, and haemodynamic measures.

CONCLUSION

These results raise the possibility that different auditory interventions may have varying degrees of effectiveness for specific patient outcomes in the ICU. More investigation is needed to clarify if nonmusic sound interventions may be equivalent or not to music interventions for the management of discrete symptoms in ICU patients.

REGISTRATION OF REVIEWS

The protocol was registered on Open Science Framework in November 6 2023 (https://doi.org/10.17605/OSF.IO/45F6E).

Seroprevalence and risk factors for Toxoplasma gondii infection in solid organ transplant patients: A global systematic review and meta-analysis

This study aimed to assess the global seroprevalence of IgG and IgM antibodies against Toxoplasma gondii (T. gondii) in solid organ transplant (SOT) recipients (kidney, liver, heart) through a literature review of studies published until October 24, 2024. Selected studies reported data on anti-T. gondii IgG and IgM seroprevalence in the post-transplant stage of SOT recipients. A random-effects model estimated pooled seroprevalence rates, and heterogeneity was evaluated using the I2 statistic. Sensitivity analysis examined prevalence changes after excluding studies, while subgroup analysis of IgG seroprevalence accounted for publication years, countries, continents, WHO regions, sample sizes, and types of transplanted organs. Out of 26 articles and 29 datasets analyzed, 21 articles and 24 datasets involving 19,391 transplant recipients and 880 controls were used to assess anti-T. gondii IgG and IgM seroprevalence and odds ratios (ORs). Additionally, 8 articles reported the anti-T. gondii IgG serostatus of donors and recipients. The pooled IgG seropositivity for T. gondii in SOT recipients was 9.8 % (95 % CI, 4.7-19.4 %), showing significant variation by region and organ type. The anti-T. gondii IgM seroprevalence in SOT recipients was 6.4 % (95 % CI, 3.3-12 %). Renal transplant recipients exhibited higher IgG seroprevalence compared to liver and heart transplant recipients. The pooled OR for T. gondii infections in SOT recipients vs. controls was 1.39 (95 % CI, 0.95-2.04, P = 0.08). The highest pooled anti-T. gondii IgG serostatus was 50.7 % in the undetermined group, followed by 38 % in the D-/R- group, 15.4 % in the D-/R+ group, 10.6 % in the D+/R- group, and 9.9 % in the D+/R+ group. Overall, T. gondii active infections and its increased risk trend in SOT recipients should not be overlooked.

Lipid-lowering effect of combined therapy with high-intensity statins and CETP inhibitors: a Systematic Review and meta-analysis

Background

This study aimed to evaluate the impact of combining high-intensity statins with CETP inhibitors on lipid levels, as well as to explore their potential clinical significance.

Methods

We conducted a comprehensive search of relevant studies in the PubMed, Embase, Cochrane Library, and Web of Science databases. The Cochrane Risk of Bias Tool RoB 2.0 was employed to evaluate the quality of the included studies. Statistical analyses were carried out using STATA 15 software, with primary outcomes being high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C).

Results

Out of 2,552 records, 7 studies were included in the final analysis. The findings revealed that the combination of high-intensity statins with CETP inhibitors significantly raised HDL-C levels (SMD 2.47 [1.77, 3.18], p < 0.001) and lowered LDL-C levels (SMD -1.75 [-2.19, -1.31], p < 0.001).

Conclusion

Compared to statin monotherapy, the combination of high-intensity statins and CETP inhibitors resulted in a more pronounced increase in HDL-C and ApoAI, while reducing LDL-C, triglycerides (TG), and ApoB levels, without increasing the incidence of adverse events.

Impact of intraprostatic PSMA maximum standardised uptake value following prostatectomy: a systematic review and meta-analysis

OBJECTIVE

To perform a systematic review and meta-analysis to assess the relationship between intraprostatic maximum standardised uptake value (SUVmax) of the dominant prostatic lesion as measured on preoperative prostate-specific membrane antigen (PSMA) positron emission tomography (PET) with radical prostatectomy International Society of Urological Pathology (ISUP) Grade Group, pathological tumour (pT) staging, and biochemical recurrence (BCR).

METHODS

Prostate-specific membrane antigen PET may offer non-invasive assessment of histopathological and oncological outcomes before definitive treatment. SUVmax of the dominant lesion has been explored as a prognostic biomarker. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we performed reviews of digital libraries and databases and retrieved studies reporting SUVmax quantified on PSMA PET computed tomography or magnetic resonance imaging and subsequent radical prostatectomy ISUP Grade Group, pT stage, and BCR. Quality assessment was performed using Quality Assessment of Diagnostic Accuracy Studies-2 and Prediction model Risk of Bias Assessment tools. Random effects meta-analysis and meta-regression by ISUP Grade Group and pT2 vs pT3/4 stage was performed. This study was registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023408170).

EVIDENCE SYNTHESIS

After removing duplicates, 23 studies were included for review. Pooled SUVmax (95% confidence interval [CI]) increased monotonically with advancing ISUP Grade Group, with ISUP 1: 5.8 (95% CI 3.9-7.7), through to ISUP 5: 17.3 (95% CI 13.1-21.5). For pT2 disease, pooled SUVmax: 9.7 (95% CI 7.8-11.5) increasing to 13.8 (95% CI 10.9-16.7) for pT3/4 disease. Substantial inconsistency was noted (I2 >50%) for all subgroups. This was not attenuated by restricting analysis only to studies using [68Ga]Ga-PSMA-11. Narrative synthesis of six papers reporting BCR showed increasing SUVmax was associated with reduced time to BCR.

CONCLUSION

Preoperative intraprostatic PSMA SUVmax increases monotonically with higher ISUP Grade Group and pathological tumour stage. Higher SUVmax is associated with reduced BCR-free survival. However, the use of single SUVmax thresholds for clinical decision making is not recommended as variability between studies is high.

Establishing the best step-up treatments for children with uncontrolled asthma despite inhaled corticosteroids: the EINSTEIN systematic review, network meta-analysis and cost-effectiveness analysis using individual participant data

Background

There is no clear preferential option for initial step-up of treatment for children with uncontrolled asthma on inhaled corticosteroid.

Objectives

Evaluate the clinical effectiveness of pharmacological treatments to use in children with uncontrolled asthma on inhaled corticosteroid; identify and evaluate the potential for treatment effect modification to optimise treatment delivery; assess the cost-effectiveness of treatments.

Methods

Systematic review and individual participant data network meta-analysis. Studies were eligible if they were parallel or crossover randomised controlled trials comparing at least one of the pharmacological treatments of interest in participants aged < 18 years with uncontrolled asthma on any dose inhaled corticosteroid alone. We searched MEDLINE®, Cochrane Library, Cochrane Central Register of Controlled Trials, EMBASE, National Institute for Health and Care Excellence Technology Appraisals, and the National Institute for Health and Care Research Health Technology Assessment series. Primary outcomes: exacerbation and asthma control. Secondary outcomes: health-related quality of life, mortality, forced expiratory volume in 1 second, adverse events, hospital admissions, symptoms (not analysed). We assessed the Risk Of Bias using the Cochrane Risk Of Bias tool and carried out Bayesian meta-analyses, network meta-analysis and network meta-regression, including treatment by covariate (age, sex, ethnicity, eczema, eosinophilia, asthma severity) interactions. A Markov decision-analytic model with a 12-month time horizon, which adopted the perspective of the National Health Service and Personal Social Services in the United Kingdom, was developed to compare alternative treatments. Cost-effectiveness was based on incremental costs per quality-adjusted life-years gained, with uncertainty considered in one-way, structural and probabilistic sensitivity analyses.

Results

We identified and screened 4708 publications from the search and confirmed 144 randomised controlled trials as eligible. We obtained individual participant data from 29 trials (5381 participants) and extracted limited aggregate data from a further 19 trials. The majority of trials had low risk of bias. The network meta-analysis suggests that medium-dose inhaled corticosteroid + long-acting β2-agonist is the preferred treatment for reducing odds of exacerbation [odds ratio 95% credibility interval: 0.43 (0.20 to 0.92) vs. low-dose inhaled corticosteroid; 40 studies, 8168 patients] and increasing forced expiratory volume in 1 second [mean difference 95% credibility interval: 0.71 (0.35 to 1.06) vs. low-dose inhaled corticosteroid; 23 studies, 2518 patients] while leukotriene receptor antagonist alone is the least preferred. No clear differences were found for asthma control (16 studies, 3027 patients). Limited pairwise analyses suggest some improvement in health-related quality of life for medium-dose inhaled corticosteroid versus inhaled corticosteroid + long-acting β2-agonist [two studies, paediatric asthma quality of life questionnaire, mean difference 95% credibility interval: 0.91 (0.29 to 1.53)]. The rate of hospitalisation due to an asthma attack ranged from 0.5% to 2.7% of patients across five trials. Slightly fewer patients reported neurological disorders (mild/moderate) on inhaled corticosteroid + long-acting β2-agonist versus inhaled corticosteroid + leukotriene receptor antagonist [odds ratio 95% confidence interval: 0.09 (0.01 to 0.82), one study]. There were no deaths recorded. We did not find convincing, consistent evidence to suggest that age, sex, ethnicity, eczema, eosinophilia, asthma severity would be regarded as an effect modifier. The economic analysis indicated that low-dose inhaled corticosteroid was the most cost-effective treatment option while medium-dose inhaled corticosteroid (alone and + long-acting β2-agonist) was associated with the highest number of quality-adjusted life-years, but their incremental cost-effectiveness exceeded the National Institute for Health and Care Excellence threshold.

Discussion

Medium-dose inhaled corticosteroid + long-acting β2-agonist is recommended for children with asthma that is uncontrolled on inhaled corticosteroid alone; leukotriene receptor antagonist alone should be avoided. We could not include data from 67% of the eligible trials, conclusions should therefore be viewed with some caution.

Study registration

This study is registered as PROSPERO CRD42019127599.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 16/110/16) and is published in full in Health Technology Assessment; Vol. 29, No. 15. See the NIHR Funding and Awards website for further award information.

Delayed Postoperative Radiotherapy in Head & Neck Cancers-A Systematic Review and Meta-Analysis

OBJECTIVES

To evaluate the impact of delayed postoperative radiotherapy (PORT) on overall survival (OS) in patients with head and neck cancers (HNC).

DATA SOURCES

A systematic review and meta-analysis were conducted by searching MEDLINE, Embase, CENTRAL, Web of Science, and CINAHL databases.

REVIEW METHODS

Studies assessing the impact of delayed PORT in adult HNC patients were included. A total of 11,171 titles and abstracts were screened, with 52 studies meeting the inclusion criteria. Data were extracted, and a pooled random-effects analysis was performed. The primary outcome was overall survival (OS), comparing patients receiving timely PORT (within 42 days) to those with delays.

RESULTS

Of the included studies, 31 were conducted in the United States, with 16 using the National Cancer Database (NCDB). Patients who did not receive PORT within 42 days had a 4% increase in mortality (adjusted Hazard Ratio [aHR]: 1.04 [1.03-1.06]; I2 = 78%; N = 254,189; 16 studies). Excluding time-overlapping NCDB-based studies, the OS benefit for timely treatment persisted (aHR: 1.10 [1.01-1.20]; I2 = 39%; N = 52,003; 5 studies).

CONCLUSIONS

Initiating PORT within 42 days is significantly associated with decreased mortality in HNC patients, reinforcing CoC recommendations. However, more research is needed to understand the relationship between different time cutoffs and outcomes, and to identify factors contributing to PORT delays. Future studies should explore the impact of treatment delays on patient-centered outcomes, such as Quality of Life (QoL).

LEVEL OF EVIDENCE

NA Laryngoscope, 135:1563-1570, 2025.

Time efficiency and cost of fabricating removable complete dentures using digital, hybrid, and conventional workflows: A systematic review

STATEMENT OF PROBLEM

Analysis of the cost and time efficiency of removable complete dentures (RCDs) fabricated using conventional and computer-aided design and computer-aided manufacturing (CAD-CAM) processes remains limited.

PURPOSE

The purpose of this systematic review was to evaluate the time efficiency and cost of conventional, hybrid, and completely digital workflows throughout the entire process of RCD fabrication.

MATERIAL AND METHODS

Article selection followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 guidelines and was registered with the international prospective register of systematic reviews (PROSPERO). The bibliographic search covered the PubMed and Cochrane databases using keywords related to removable complete dentures, digital workflows, and economic factors and covered articles from January 2010 to June 2024. In total, 1188 articles were identified and assessed. A bottom-up search identified an additional 10 articles through cited works. Data on cost and time analyses were reported in a qualitative synthesis.

RESULTS

The qualitative synthesis included 8 articles published between 2015 and 2024 showing that digital and hybrid workflows generally reduced both clinical and laboratory time and overall costs compared with conventional workflows. The hybrid protocol required significantly less clinical time, with reductions ranging from approximately 1 to 4 hours. Hybrid and completely digital workflows reduced laboratory manufacturing time by approximately 6 to 7 hours compared with conventional workflows. Cost analyses revealed that digital and hybrid workflows were more profitable and cost effective than conventional workflows.

CONCLUSIONS

The findings suggest that digital and hybrid workflows for RCD fabrication are more time efficient and cost effective than conventional methods.

The effect of meal replacements therapy on blood pressure and C-reactive protein: a systematic review and meta-analysis of randomized controlled trials

Although some evidence shows the beneficial effects of meal replacement (MR) on blood pressure (BP) and inflammation as one of the main factors of cardiovascular disease, there are still no comprehensive findings in this field. Therefore, we investigate the effects of total and partial MRs on BP and C-reactive protein (CRP) in this comprehensive study and meta-analysis. In order to identify all randomized controlled trials that investigated the effects of MRs on BP and CRP levels, a systematic search was conducted in the original databases using predefined keywords. The pooled weighted mean difference (WMD) and 95% confidence intervals (CIs) were computed using the random-effects model. Forty studies were included in this article. The findings indicated significant reductions in systolic blood pressure (SBP) (WMD, -2.51 mmHg; 95% CI, -3.48 to -1.54; P < 0.001), diastolic blood pressure (DBP) (WMD, -1.43 mmHg; 95% CI, -2.02 to -0.85; P < 0.001), and CRP (WMD, -0.50 mg/L; 95% CI, -0.89 to -0.11; P = 0.012) levels following MR consumption compared to the control group. The findings obtained from the subgroup analysis showed that MRs cause a greater reduction in SBP in people over 50 years of age, and the duration of the intervention ≤ 24 weeks. Also, the subgroup analysis shows the greater effect of DBP and CRP, respectively, in the type of intervention with total meal replacement and less equal to 50 years. In conclusion, it appears that MR, along with other lifestyle factors, can lead to significant improvements in BP and CRP.