Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

Telephone and online support programs and assistive technologies that support informal carers of people living with young-onset dementia: A systematic review

Objective: Carers of people with young-onset dementia can be challenged by the care they provide. Little is known about the types of telephone and online support programs and assistive technologies that may help to assist them with caregiving. This review aimed to identify telephone and online support programs and assistive technologies that informal carers find useful for caring for people with young-onset dementia. Design: A systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An electronic search of the following five English databases was conducted: PubMed, PsycINFO, CINAHL, Web of Science, and Embase. In addition, the reference lists of eligible studies were manually searched to identify further studies. Databases were searched using synonyms and derivates for "dementia," "Alzheimer's disease," "young onset", "early onset", "caregiver", "online" and "technology". Results: We found 12 manuscripts that meet the study inclusion criteria. The dominant technologies were telephone and online support programs. Other assistive technologies included safety and monitoring support, telehealth, and a simple TV remote control. While carers reported positive effects of the telephone and online support programs, and technologies, such as improved self-efficacy, satisfaction, knowledge, well-being, and reduced burden, stress, depression, and anxiety, the studies were scarce, and a limited number of assistive technologies were explored. Conclusion: Given the increasing number of telephone and online programs and assistive technologies, it is disappointing to find a paucity of available manuscripts and the limited number of technologies explored for this population. Technologies to assist this population need to be developed and evaluated.

Tumor necrosis factor (TNF) inhibitors for psoriatic arthritis

BACKGROUND

Psoriatic arthritis (PsA) is a chronic arthritis affecting people with psoriasis. If untreated, it may lead to disability. Recommended drugs are non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), biologic DMARDs (bDMARDs), and targeted synthetic DMARDs (tsDMARDs). Tumour necrosis factor inhibitors (TNFi) are the first choice bDMARDs.

OBJECTIVES

To assess the benefits and harms of TNFi in adults with psoriatic arthritis.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, ClinicalTrials.gov and the World Health Organization trials portal up to 28 March 2024.

SELECTION CRITERIA

We included randomized controlled trials (RCTs) in adults with PsA, comparing TNFi to placebo, physiotherapy, NSAIDs, corticosteroids, and cs/b/tsDMARDs. Major outcomes included clinical improvement, minimal disease activity, physical function, health-related quality of life, radiographic progression, serious adverse events, and withdrawals due to adverse events.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. The primary comparison was TNFi versus placebo. The primary time point was 12 weeks for clinical improvement; 24 weeks for minimal disease activity, function, quality of life, and radiographic progression; and the end of the trial period for serious adverse events and withdrawals due to adverse events.

MAIN RESULTS

We included 25 RCTs randomizing 7857 participants. Four studies compared TNFi to methotrexate and one to ustekinumab in DMARD-naïve participants. In csDMARD-inadequate responders, 11 studies compared TNFi to placebo; four studies compared TNFi to placebo and ixekizumab, bimekizumab, tofacitinib, or upadacitinib; and three studies compared TNFi to ixekizumab, secukinumab, and ustekinumab. Two studies compared different TNFi. We found no studies with b/tsDMARD-inadequate responders (b/tsDMARD-IR). No studies compared TNFi to NSAIDs, corticosteroids, or physiotherapy. Performance (32%), detection (56%) and reporting (80%) biases were at high or unclear risk across studies. Only one study had a low risk of bias in all domains. We limit reporting to the primary comparison, TNFi versus placebo. DMARD-naïve We found no studies comparing TNFi with placebo in DMARD-naïve participants. csDMARD-inadequate responders TNFi probably result in a large clinical improvement compared to placebo. At 12 weeks, 149/1926 (8%) participants in the placebo group showed a clinical improvement (ACR50) compared to 784/2141 (37%) participants in the TNFi group (risk ratio (RR) 5.63, 95% confidence interval (CI) 3.98 to 7.96; I2 = 65%; 14 studies, 4067 participants; moderate-certainty evidence). TNFi probably result in a higher proportion of participants in minimal disease activity. At 24 weeks, 95/1017 (9%) participants in the placebo group were in minimal disease activity compared to 428/1336 (32%) participants in the TNFi group (RR 3.76, 95% CI 2.39 to 5.92; I2 = 72%; 5 studies, 2353 participants; moderate-certainty evidence). At 24 weeks, TNFi may improve function compared to placebo. The mean change in function from baseline (assessed with the Health Assessment Questionnaire; score from 0 to 3, 0 = no disability; minimal clinically important difference (MCID) = 0.35) was -0.14 points with placebo and 0.33 points lower (0.41 lower to 0.25 lower) with TNFi (I2 = 72%; 8 studies, 2949 participants; low-certainty evidence). TNFi probably result in a clinically important improvement in health-related quality of life. The mean change in quality of life from baseline (assessed with the Short Form 36-item Mental Component Summary questionnaire; score from 0 to 100, 100 = best score; MCID = 1.7) was 2.4 points with placebo and 3.29 points higher (2.18 points higher to 4.40 points higher) with TNFi (I2 = 52%; 8 studies, 2928 participants; moderate-certainty evidence). TNFi probably slightly reduce radiographic progression. The mean change in radiographic progression (assessed with the Sharp/Van der Heijde-PsA score; scale from 0 to 528, 0 = no damage) was 0.25 points with placebo and 0.37 points lower with TNFi (0.48 lower to 0.25 lower) (I2 = 32%; 7 studies, 2478 participants; moderate-certainty evidence) at 24 weeks. We downgraded the evidence to moderate certainty for clinical improvement, minimal disease activity, quality of life, and radiographic progression due to risk of bias. For function, we downgraded the evidence to low certainty for risk of bias and imprecision. TNFi may result in little to no difference in serious adverse events, but may slightly increase withdrawals due to adverse events, compared to placebo. At the end of follow-up: 56/1826 participants (3%) given placebo and 69/1900 (4%) participants given TNFi experienced serious adverse events (RR 1.00, 95% CI 0.70 to 1.42; I2 = 0%; 13 studies, 3866 participants; low-certainty evidence); and 35/1926 (2%) participants given placebo and 65/2140 (3%) given TNFi withdrew due to adverse events (RR 1.53, 95% CI 1.01 to 2.33; I2 = 0%; 14 studies, 4066 participants; low-certainty evidence). We downgraded the evidence to low certainty for risk of bias and imprecision.

AUTHORS' CONCLUSIONS

In csDMARD-inadequate responders, moderate-certainty evidence showed that TNFi probably result in a large clinical improvement, lower disease activity, small decrease in radiographic progression, and better quality of life compared to placebo. Low-certainty evidence showed that TNFi may lead to a slight improvement in physical function compared to placebo. Low-certainty evidence suggested that TNFi may lead to a slight increase in withdrawals due to adverse events, whereas they may result in little to no difference in serious adverse events compared to placebo. No trials assessed TNFi compared to placebo in DMARD-naïve participants or in b/tsDMARD-IR.

Smartphone apps for mental health: systematic review of the literature and five recommendations for clinical translation

OBJECTIVES

Providing adequate access to mental health services is a global challenge. Smartphone apps offer a potentially cost-effective, available and accessible solution for monitoring, supporting and treating mental health conditions. This systematic review describes and evaluates the usage of smartphone apps across a wide range of mental health disorders in terms of clinical effectiveness, feasibility and acceptability.

DESIGN

This is a systematic review of studies examining treatment, self-monitoring and multipurpose smartphone apps for mental health disorders.

DATA SOURCES

Studies were identified through a comprehensive search of the Ovid and PubMed databases. Articles published up to 14 January 2024 were included based on predefined criteria.

ELIGIBILITY CRITERIA

We included randomised controlled trials that compared mental health apps (single- or multipurpose) with treatment-as-usual or no treatment for clinical populations with mental health disorders. Studies were excluded if they focused on web-based interventions, combined apps with non-TAU treatments or targeted physical health apps.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers screened and selected studies, with a third reviewer resolving inconsistencies. Extracted data included study details, participant characteristics, app information and outcome measures related to effectiveness, feasibility and acceptability. A risk-of-bias assessment for each study was conducted.

RESULTS

Out of 4153 non-duplicate articles screened, 31 studies met full-text eligibility criteria. These included 6 studies on treatment apps, 4 on self-monitoring apps and 21 on multipurpose apps for a range of mental health disorders. Fifteen were identified as having between some and high concern on the risk-of-bias assessment. While smartphone apps were generally effective and acceptable, their feasibility appeared to decline over time.

CONCLUSIONS

Smartphone apps are promising tools for mental healthcare, demonstrating effectiveness and acceptability. However, challenges such as reduced feasibility over time, potential biases and underrepresented demographics require further research. This review proposes five recommendations for improving clinical translation in future studies.

Participant Compliance With Ecological Momentary Assessment in Movement Behavior Research Among Adolescents and Emerging Adults: Systematic Review

BACKGROUND

Adolescence through emerging adulthood represents a critical period associated with changes in lifestyle behaviors. Understanding the dynamic relationships between cognitive, social, and environmental contexts is informative for the development of interventions aiming to help youth sustain physical activity and limit sedentary time during this life stage. Ecological momentary assessment (EMA) is an innovative method involving real-time assessment of individuals' experiences and behaviors in their naturalistic or everyday environments; however, EMA compliance can be problematic due to high participant burdens.

OBJECTIVE

This systematic review synthesized existing evidence pertaining to compliance in EMA studies that investigated wake-time movement behaviors among adolescent and emerging adult populations. Differences in EMA delivery scheme or protocol, EMA platforms, prompting schedules, and compensation methods-all of which can affect participant compliance and overall study quality-were examined.

METHODS

An electronic literature search was conducted in PubMed, PsycINFO, and Web of Science databases to select relevant papers that assessed movement behaviors among the population using EMA and reported compliance information for inclusion (n=52) in October 2022. Study quality was assessed using a modified version of the Checklist for Reporting of EMA Studies (CREMAS).

RESULTS

Synthesizing the existing evidence revealed several factors that influence compliance. The platform used for EMA studies could affect compliance and data quality in that studies using smartphones or apps might lessen additional burdens associated with delivering EMAs, yet most studies used web-based formats (n=18, 35%). Study length was not found to affect EMA compliance rates, but the timing and frequency of prompts may be critical factors associated with missingness. For example, studies that only prompted participants once per day had higher compliance (91% vs 77%), but more frequent prompts provided more comprehensive data for researchers at the expense of increased participant burden. Similarly, studies with frequent prompting within the day may provide more representative data but may also be perceived as more burdensome and result in lower compliance. Compensation type did not significantly affect compliance, but additional motivational strategies could be applied to encourage participant response.

CONCLUSIONS

Ultimately, researchers should consider the best strategies to limit burdens, balanced against requirements to answer the research question or phenomena being studied. Findings also highlight the need for greater consistency in reporting and more specificity when explaining procedures to understand how EMA compliance could be optimized in studies examining physical activity and sedentary time among youth.

TRIAL REGISTRATION

PROSPERO CRD42021282093; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=282093.

Efficacy and safety of dexamethasone or triamcinolone in combination with anti-vascular endothelial growth factor therapy for diabetic macular edema: A systematic review and meta-analysis with trial sequential analysis

BACKGROUND

The clinical efficacy of anti-vascular endothelial growth factors (anti-VEGFs), corticosteroids, and their combined treatment for diabetic macular edema (DME) has been substantiated by numerous studies. However, it remains uncertain whether the therapeutic benefits of the combined treatment with corticosteroids and anti-VEGFs is superior to those of anti-VEGF monotherapy. Consequently, we conducted a meta-analysis to compare the efficacy and safety of combined treatment with dexamethasone or triamcinolone and anti-VEGF versus anti-VEGF monotherapy in DME treatment.

METHODS

An exhaustive search of the literature was performed on February 23, 2024, scanning through the databases including PubMed, Web of Science, Embase, and the Cochrane Library, with the aim of identifying all relevant studies. The combined results for efficacy and safety were analyzed using the standard mean difference (SMD) and relative risk (RR), both of which were presented with 95% confidence interval (CI). The assessment of heterogeneity was conducted via Cochran's Q test, I2 statistics, and the implementation of a 95% prediction interval (PI). All analyses were performed by R 4.3.1, Stata 12.0, and TSA v0.9.5.10 Beta software.

RESULTS

This meta-analysis incorporated 21 eligible studies. The overall analysis revealed that combined treatment of dexamethasone or triamcinolone with anti-VEGF agents did not demonstrate superiority over anti-VEGF monotherapy in improving best-corrected visual acuity (BCVA) (Dexamethasone: SMD -0.266, 95% CI -1.001 to 0.468, 95% PI -2.878 to 2.346; Triamcinolone: SMD -0.340, 95% CI -1.230 to 0.550, 95% PI -3.554 to 2.874) and reducing central macular thickness (CMT) (Dexamethasone: SMD -1.255, 95% CI -2.861 to 0.350; Triamcinolone: SMD -0.207, 95% CI -0.895 to 0.481, 95% PI -2.629 to 2.215). However, the combination therapy significantly increased the risk of elevated intraocular pressure (RR 5.783, 95% CI 3.007 to 11.121, 95% PI 0.520 to 56.931) and ocular hypertension (RR 8.885, 95% CI 2.756 to 28.649, 95% PI 1.262 to 39.208). Subgroup analysis suggests that dexamethasone plus anti-VEGF therapy showed a greater reduction in central subfield thickness (SMD -0.440, 95% CI -0.755 to -0.126) compared to anti-VEGF monotherapy among patients with persistent DME.

CONCLUSION

Our study confirmed that dexamethasone or triamcinolone plus anti-VEGF therapy did not show superior efficacy in improving BCVA and reducing CMT in DME patients compared with anti-VEGF monotherapy. Clinicians should weigh the pros and cons comprehensively when implementing combined therapy.

Aberrant SNHG expression predicts poor prognosis in esophageal cancer using meta-analysis and bioinformatics analysis

BACKGROUND

Small nucleolar RNA host gene (SNHG) family were reported involved in various biological processes and may be used as a promising prognostic marker in esophageal cancer (EC). A meta-analysis was performed to investigate the relationship between SNHG expression and prognosis of EC in this study.

METHODS

Relevant databases were browsed to obtain suitable publications. Hazard ratio (HR) with 95% confidence interval (CI) were extracted to explore the association between SNHG expression and EC prognosis. Odds ratio (OR) with 95%CI were extracted to assess the association between SNHG expression and other clinicopathological parameters. Sensitivity analysis and publication bias were performed to explore the reliability and robustness of the results. Bio-informatics has been explored in order to confirm our conclusions more comprehensively.

RESULTS

16 studies comprising 1229 patients were enrolled. The results showed that increasing SNHG expression indicated worse overall survival (HR: 1.392, 95%CI = 0.876-1.908). SNHG2, SNHG5, and SNHG12 were down-regulated, while other SNHGs were up-regulated in EC. In populations with low expression of SNHG2, SNHG5, and SNHG12, increasing SNHG expression predicted a favorable cancer prognosis (HR: 0.511, 95%CI = 0.322-0.700). Conversely, in populations with high expression of other SNHGs, SNHG expression indicated poor prognosis (OR: 2.340, 95%CI = 1.744-2.936). Elevated SNHG expression also implied advanced TNM stage (OR 1.578, 95%CI = 1.273-1.956) and lymph node metastasis (OR: 1.533, 95%CI = 1.205-1.950).

CONCLUSION

Increased expression of SNHG2, SNHG5, and SNHG12, and decreased expression of other SNHGs tended to have a favorable prognosis in patients with EC. These findings suggest that SNHG may serve as a prognostic marker and therapeutic target for EC.

Bilateral internal iliac artery ligation in trauma patients with severe pelvic hemorrhage: A systematic review

INTRODUCTION

Severe pelvic hemorrhage significantly contributes to mortality in trauma patients, yet the most effective treatment for severe pelvic injuries remains unclear. This systematic review evaluates the mortality and morbidity associated with bilateral internal iliac artery ligation (BIIAL) in patients experiencing severe hemorrhage from traumatic pelvic fractures.

METHODS

Comprehensive searches were conducted in MEDLINE PubMed, EMBASE, and Cochrane databases until February 7, 2024, to identify relevant articles. The risk of bias in observational studies was assessed using the ROBINS-I tool, which evaluates bias risk in nonrandomized intervention studies. The primary outcome was mortality following BIIAL, with the secondary outcome being complications related to the procedure.

RESULTS

The review included eight studies, all observational. The overall mortality rate after BIIAL ranged from 45.0% to 76.9%. Ischemic complications from BIIAL were infrequent. A high and unclear risk of bias due to confounding and participant selection was noted across the studies. Four studies highlighted distinct indications for BIIAL compared to angioembolization. BIIAL was employed for patients with severe hemodynamic instability or when angiography was not available.

CONCLUSION

Due to geographical limitations and significant heterogeneity among the studies reviewed, the true effect size of BIIAL remains indeterminate. Nevertheless, further prospective studies with robust designs are necessary. BIIAL holds potential as a viable option when angioembolization is not accessible or in cases of critical patient instability.

Subfoveal choroidal thickness in pregnancy: A systematic review with meta-analyses

Pregnancy induces a variety of changes in the eye. Mapping these changes provides a pathophysiological basis for understanding pregnancy-associated ocular disorders. In this systematic review and meta-analysis, our aim was to determine how pregnancy affects subfoveal choroidal thickness and to explore temporal changes in subfoveal choroidal thickness during pregnancy and postpartum. On April 7, 2024, we searched eight literature databases for studies which used macular optical coherence tomography to evaluate subfoveal choroidal thickness in healthy pregnant women. We identified 26 studies summarizing data from 1935 healthy women, of which 1096 were pregnant and 839 non-pregnant. We found that pregnant women had a subfoveal choroidal thickness which was 31.1 μm (95% CI: 19.4-42.7 μm) thicker than non-pregnant women. No statistically significant changes were observed throughout trimesters. From the 3rd trimester to postpartum, we found a reduction in the subfoveal choroidal thickness at -41.9 μm (95% CI: -68.5 to -15.2 μm). In conclusion, in healthy women without ocular disease, pregnancy is associated with a thicker subfoveal choroid indicating a higher choroidal perfusion. Choroidal thickness remains stable across trimesters and is reduced postpartum, indicating a temporary physiological adaptation during pregnancy.

The prevalence and risk factors for peripheral nerve injury following arthroplasty: a systematic review and meta-analysis

OBJECTIVE

To assess the prevalence and identify the risk factors for peripheral nerve injury (PNI) following arthroplasty through a systematic review and meta-analysis.

METHODS

PubMed, Embase, and the Cochrane Library were searched for observational studies investigating the prevalence and risk factors for PNI following arthroplasty. Prevalence data for PNI following arthroplasty were extracted and pooled using a random-effects model, with results presented as pooled prevalence with 95% CI. ORs and 95% CIs for identified risk factors were calculated. Subgroup analyses were conducted based on age, study type, sample size, arthroplasty site, region, and others. Publication bias was assessed using funnel plots and Egger's test, and sensitivity analyses were performed.

RESULTS

After screening, a total of 21 studies were included in the meta-analysis. The pooled prevalence of PNI was 0.7% (95% CI: 0.006-0.009) with significant heterogeneity (I² = 99%). The prevalence of PNI following arthroplasty was found to be more likely as a result of several identified factors, including spinal conditions (ORs = 2.269, 95% CI 1.625-3.170), postoperative anemia (ORs = 1.370, 95% CI 1.149-1.633), mechanical complications (ORs = 1.791, 95% CI 1.118-2.868) and hypothyroidism (ORs = 1.189, 95% CI 1.054-1.341).

CONCLUSIONS

The pooled prevalence of PNI was approximately 0.7%. Furthermore, we identified potential risk factors for PNI following arthroplasty, including spinal conditions, postoperative anemia, mechanical complications, and hypothyroidism. Our findings emphasize the importance of recognizing these risk factors in the perioperative management of arthroplasty patients.

Efficacy of Potassium-Competitive Acid Blockers Versus Proton Pump Inhibitors for Gastric Ulcers: Bayesian and Frequentist Network Meta-Analysis With Cross-Inference Through a Quality management System

Purpose

Proton pump inhibitors (PPIs) have been the mainstay treatment for gastric ulcer (GU) for over 30 years. However, since the discovery of a new class of acid suppressants, potassium-competitive acid blockers (P-CABs), the desire for a therapeutic agent has continued and the clinical trials on P-CABs have been conducted. In this regard, we aimed to assess whether P-CABs are noninferior to PPIs in patients with GU in terms of efficacy.

Methods

We performed a systematic review and network meta-analysis (NMA) based on randomized controlled trials (RCTs). Additionally, we used a new methodology of inference concept with the purpose of grouping between P-CABs and PPIs. Moreover, our quality management system was integrated throughout the research to ensure data accuracy.

Findings

We initially screened 438 studies and extracted 10 homogeneous GU RCTs with 6315 participants. The odds ratios (ORs) for the 4-week cure rate in Bayesian + frequentist NMA, tegoprazan 100 mg (OR = 4.14, 95% credible interval [CI] 0.56-26.3) and pantoprazole 40 mg (OR = 4.12, 95% CI 1.90-8.88) were the largest, respectively. The ORs for the 8-week cure rate in Bayesian + frequentist NMA, lansoprazole 30 mg (OR = 8.77, 95% credible interval [CI] 0.95-78.9) and lansoprazole 30 mg (OR = 7.91, 95% CI 2.60-24.03) was the largest, respectively.

Conclusions

The results of the NMA reveal that the cure rates of P-CABs in cases of GU were not inferior to those of PPIs. As the inference by grouping PPIs and P-CABs, the results showed similar trends in terms of effectiveness between the two therapeutic classes.

High Sensitivity and Specificity of Magnetic Resonance Arthrography for Labral Tears, Rotator Cuff Tears, Hill-Sachs Lesions, and Bankart Lesions: A Systematic Review and Meta-analysis

PURPOSE

To compare the diagnostic value of magnetic resonance arthrography (MRA) in different shoulder lesions using arthroscopy as gold standard.

METHODS

We performed a comprehensive search in Cochrane, Scopus, PubMed, and Web of Science databases for articles that reported the diagnostic value of MRA in diagnosing labral tears, rotator cuff tears (RCTs), Hill-Sachs, and Bankart injuries. We used arthroscopic surgery as a reference standard for comparison. The quality of the studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool. We pooled the collected data and used Stata/MP17 to generate summary statistics.

RESULTS

We identified a total of 53 articles compromising 5,487 patients. The sensitivity and specificity for Hill-Sachs lesions were 0.94 (95% confidence interval [CI] 0.80-0.99) and 0.89 (95% CI 0.77-0.95), Bankart lesions were 0.94 (95% CI 0.89-0.97) and 0.99 (95% CI 0.90-1.00), anterior labral tears were 0.91 (95% CI 0.82-0.96) and 0.96 (95% CI 0.90-0.99), posterior labral tears were 0.74 (95% CI 0.58-0.86) and 0.98 (95% CI 0.86-1.00), superior labral tears were 0.77 (95% CI 0.62-0.88) and 0.83 (95% CI 0.54-0.95), SLAP lesions were 0.86 (95% CI 0.80-0.90) and 0.91 (95% CI 0.83-0.96), partial-thickness RCTs were 0.67 (95% CI 0.45-0.83) and 0.92 (95% CI 0.78-0.97), whereas full-thickness RCTs were 0.97 (95% CI 0.91-0.99) and 0.99 (95% CI 0.93-1).

CONCLUSIONS

In conclusion, MRA is a sensitive and specific imaging method for identifying anterior labrum lesions, full-thickness RCTs, Bankart, SLAP, and Hill-Sachs lesions, with lower accuracy in partial-thickness RCTs, both posterior and superior labrum.

LEVEL OF EVIDENCE

Level III, meta-analysis of prospective and retrospective cohort and case-control studies.

Evidence-based Korean guidelines for the clinical management of multiple myeloma: addressing 12 key clinical questions

Multiple myeloma (MM), a hematological malignancy, is characterized by malignant plasma cell proliferation in the bone marrow. Recent treatment advances have significantly improved patient outcomes associated with MM. In this study, we aimed to develop comprehensive, evidence-based guidelines for the diagnosis, prognosis, and treatment of MM. We identified 12 key clinical questions essential for MM management, guiding the extensive literature review and meta-analysis of the study. Our guidelines provide evidence-based recommendations by integrating patient preferences with survey data. These recommendations include current and emerging diagnostic tools, therapeutic agents, and treatment strategies. By prioritizing a patient-centered approach and rigorous data analysis, these guidelines were developed to enhance MM management, both in Korea and globally.

Evaluating the safety of robotic total gastrectomy with D2 lymphadenectomy for gastric cancer against the conventional laparoscopic approach: a systematic review and meta-analysis

Gastric cancer poses a significant global health challenge, necessitating effective surgical interventions. A critical gap in the literature exists, as most studies do not differentiate between various surgical approaches, i.e., total, distal, and subtotal gastrectomy, and level of lymphadenectomy, when comparing robotic to conventional laparoscopic gastrectomy. This leads to a lack of clear evidence regarding the safety and efficacy of robotic total gastrectomy (RTG) specifically in the context of total gastrectomy with D2 lymphadenectomy.This systematic review and meta-analysis evaluates the safety of RTG with D2 lymphadenectomy compared to conventional laparoscopic total gastrectomy (LTG). A literature search was conducted up to November 1, 2024, following PRISMA guidelines. Eligible studies included studies comparing RTG and LTG, focusing on anastomotic leakage, Clavien-Dindo Grade ≥ III complications, conversion rates, mortality, overall complications, and reoperation rates. Data were synthesized using odds ratios (OR) and weighted mean differences (WMD), with statistical heterogeneity assessed using the I2 statistic. Five studies comprising 1131 patients (432 RTG, 700 LTG) were included. No significant differences were found in the following outcomes: anastomotic leakage (OR = 0.79 [95% CI: 0.35, 1.78], I2 = 0%, P = 0.57), Clavien-Dindo Grade ≥ III complications (OR = 0.86 [95% CI: 0.51, 1.45], I2 = 0%, P = 0.56), conversion to open surgery (OR = 0.34 [95% CI: 0.10, 1.18], I2 = 0%, P = 0.09), mortality (OR = 1.78 [95% CI: 0.23, 13.48], I2 = 0%, P = 0.58), overall complications (OR = 0.84 [95% CI: 0.62, 1.14], I2 = 0%, P = 0.26), and reoperation rates (OR = 0.88 [95% CI: 0.29, 2.67], I2 = 0%, P = 0.82). Sensitivity analysis proves the robustness of the findings. The analysis shows no significant differences in safety outcomes between RTG and LTG for gastric cancer, indicating both techniques are comparable. RTG may be a viable alternative to LTG, especially in centers with appropriate robotic capabilities. Further research is warranted to investigate long-term outcomes and the learning curve of robotic surgery.PROSPERO Registration: CRD42024606570.

Past and present marine citizen science around the globe: A cumulative inventory of initiatives and data produced

The marine environment is facing serious changes. This requires scientific understanding of the ocean's responses to pressures and management actions to provide the foundation for sustainable development. At the same time, the production of knowledge for a more sustainable world is undergoing rapid change with the uptake of citizen science as means of opening up science. While there is increasing interest in marine citizen science, it is also often conceived as lagging behind citizen science in other areas, such as biodiversity related citizen science on land. This paper analyses empirical evidence collected >1260 past and present marine citizen science initiatives, substantiating the pervasiveness of marine citizen science around the globe. In doing so, it provides the basis for a cumulative inventory of MArine Citizen Science Initiatives (MARCSI) that can inform and shape both the growing community of marine citizen science practitioners and the science of citizen science.

Mesenchymal Stem Cells Injection Is More Effective Than Hyaluronic Acid Injection in the Treatment of Knee Osteoarthritis With Similar Safety: A Systematic Review and Meta-analysis

PURPOSE

To evaluate the efficacy and safety of intra-articular injection of mesenchymal stem cells (MSCs) versus hyaluronic acid (HA) in the treatment of knee osteoarthritis (KOA).

METHODS

Eligible randomized controlled trials (RCTs) were identified through a search of PubMed, Embase, the Cochrane Library, Web of Science, SinoMed, and CNKI databases from inception to March 2024. For meta-analysis, data on clinical outcomes were measured using visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and data on cartilage repair were measured using the Whole-Organ Magnetic Resonance Imaging Score (WORMS); data on safety were evaluated by the incidence of adverse events. Two researchers independently read the included literature, extracted data and evaluated the quality, used the Cochrane risk bias assessment tool for bias risk assessment, and used RevMan5.3 software for meta-analysis.

RESULTS

Ten RCTs involving 818 patients with KOA ranging from I to Ⅲ on the Kellgren-Lawrence grading scale were included in this meta-analysis. Meta-analysis results showed that at 12 months, the WOMAC total score (mean difference [MD] = -10.22, 95% confidence interval [CI]: -14.86 to -5.59, P < .0001, Z = 4.32), VAS score (MD = -1.31, 95% CI: -1.90 to -0.73, P < .0001, Z = 4.40); and WORMS score (MD = -26.01, 95% CI: -31.88 to -20.14, P < .001, Z = 8.69) of the MSCs group all decreased significantly (P < .05) compared with the HA control group and reached the minimal clinically important differences. Furthermore, there was no significant difference in the incidence of adverse events (relative risk = 1.54, 95% CI: 0.85-2.79, P = .16, I2 = 0) between the 2 groups (P > .05).

CONCLUSIONS

In terms of efficacy, the clinical effects of intra-articular injection therapy using MSCs for KOA are superior to those of HA, and the cartilage repair effect of MSCs is also markedly better than that of HA. Although the clinical effects varied across time periods, the functional score reached the minimum clinically significant difference at both 6 and 12 months. In terms of safety, adverse reactions mainly manifest as joint pain, swelling, and joint effusion. Both intra-articular injections of MSCs and HA did not result in severe adverse reactions, indicating that MSCs and HA have similar safety profiles.

LEVEL OF EVIDENCE

Level I, meta-analysis of Level I studies.

Effectiveness of simulation models and digital alternatives in training ophthalmoscopy: A systematic review

PURPOSE

Traditional direct ophthalmoscopy (TDO) is the oldest method of fundus examination; however, it has fallen out of use due to its technical difficulty and limitations to clinical utility, amidst the advent of potentially better options. A spectrum of new technologies may help in addressing the shortcomings of TDO: simulation mannequins with non-tracked TDO, simulation models with tracked TDO, and smartphone ophthalmoscopy (SFO).

METHODOLOGY

A systematic search of PubMed, Embase, and Cochrane databases for all studies evaluating usage of simulation mannequins/models and SFO in ophthalmology education was performed, from inception till April 2023 with no language restriction. We ensured that we included all possible relevant articles by performing backward reference searching of included articles and published review articles.

RESULTS

We reviewed studies on non-tracked TDO (n = 5), tracked TDO (n = 3) and SFO (n = 12). Non-tracked TDO and SFO were superior in training competency relative to control (TDO on real eyes). Intriguingly, tracked TDO was non superior to controls. SFO appears to enhance the learning effectiveness of ophthalmoscopy, due to real-time projection of the retina view, permitting instantaneous and targeted feedback. Learners reported improved ergonomics, including a wider field of view and more comfortable viewing distance. Retention of images and recordings permitted the audit of learning and paves the way for storage of such images in patients' electronic medical record and rapid dissemination for specialist referral.

CONCLUSIONS

Smartphone ophthalmoscopy (SFO) permits integration of both the practice and learning of ophthalmoscopy, and the auditing of both. These advantages over traditional methods (with simulation or otherwise) may lead to a paradigm shift in undergraduate ophthalmology education. However, the nascency of SFO necessitates preservation of traditional techniques to tide through this period of transition.

Minimally invasive intraperitoneal onlay mesh plus (IPOM +) repair versus enhanced-view totally extraperitoneal (e-TEP) repair for ventral hernias: a systematic review and meta-analysis

INTRODUCTION

Following concerns regarding an intraperitoneal mesh, newer ventral hernia repair (VHR) approaches focus on placing the mesh outside of the peritoneal cavity. The e-TEP technique used the retromuscular space and is suggested to be associated with decreased postoperative pain compared to IPOM +. This study aims to compare the IPOM + with the e-TEP for VHR.

METHODS AND PROCEDURES

We searched for studies comparing endoscopic IPOM + and e-TEP in PubMed, EMBASE, and Cochrane databases from inception until September 2023. Outcomes were Visual Analog Scale (VAS) after 24 h of surgery and between 7 and 10 days after surgery, operative time, length of stay (LOS), seroma, recurrence, and readmission. RStudio was used for statistical analysis. Heterogeneity was assessed with I2 statistics, with random effect for I2 > 25%.

RESULTS

From 149 records, 7 were included, from which 3 were RCTs, 3 were retrospective studies, and 1 was an observational prospective study. 521 patients were included (47% received e-TEP and 53% received IPOM +). 1 study included only robotic surgeries and 6 studies included only laparoscopy. Mean defect width was 3.62 cm ± 0.9 in the e-TEP group and 3.56 cm ± 0.9 in the IPOM + group. IPOM + had higher VAS after 1 day of surgery (MD - 3.35; 95% CI - 6.44; - 0.27; P = 0.033; I2 = 99%) and between 7 and 10 days after surgery (MD - 3.3; 95% CI - 5.33, - 1.28; P = 0.001; I2 = 99%). e-TEP repair showed with longer operative time (MD 52.89 min; 95% CI 29.74-76.05; P < 0.001; I2 = 92%). No differences were seen regarding LOS, seroma, recurrence, and readmission.

CONCLUSION

The e-TEP repair is associated with lower short-term postoperative pain after VHR compared to IPOM +, but with longer operative time. More RCTs are required to assess these results with long-term follow-up and determine its role in the armamentarium of the abdominal wall surgeon.

Cardioneuroablation in patients with vasovagal syncope: An updated systematic review and meta-analysis

BACKGROUND

Cardioneuroablation (CNA) is a novel procedure that shows promising results in reducing syncope recurrence in patients with refractory vasovagal syncope (VVS). However, its effectiveness and safety remain controversial.

OBJECTIVE

We performed an updated meta-analysis evaluating CNA efficacy and safety in patients with refractory VVS.

METHODS

PubMed, Embase, and Cochrane databases were systematically searched for CNA studies in patients with refractory VVS. Our primary efficacy end point was syncope recurrence, and our safety end point was periprocedural complications. Prespecified subgroup analyses were performed for (1) the ganglionated plexus (GP) targeting method and (2) the GP location of ablation.

RESULTS

We included 27 observational studies and 1 randomized controlled trial encompassing 1153 patients with refractory VVS who underwent CNA. The median age was 39.6 years, and follow-up was 21.4 months. The overall weighted rate of syncope recurrence after CNA was 5.94% (95% confidence interval [CI] 3.37%-9.01%; I2 = 64%), and the rate of periprocedural complications was 0.99% (95% CI 0.14%-2.33%; I2 = 0%). Our prespecified subgroup analysis using the GP targeting method and GP ablation location showed a higher prevalence of syncope recurrence in the electroanatomic mapping subgroup (6.21%; 95% CI 2.93%-10.28%; I2 = 0%) and in the right atrium approach (15.78%; 95% CI 3.61%-33.14%; I2 = 65.2%).

CONCLUSION

This study supports the efficacy and safety of CNA in preventing syncope recurrence in patients with VVS. Furthermore, the electroanatomic mapping method of GP targeting and the right atrium approach were associated with a higher syncope recurrence rate than other methods.

Efficacy of Doxycycline as Preexposure and/or Postexposure Prophylaxis to Prevent Sexually Transmitted Diseases: A Systematic Review and Meta-Analysis

INTRODUCTION

Bacterial sexually transmitted infections (STIs), specifically infection by Chlamydia trachomatis , Neisseria gonorrhoeae , and Treponema pallidum , have an important burden worldwide. The use of doxycycline as preexposure prophylaxis (PREP or doxy-PREP) or postexposure prophylaxis (PEP or doxy-PEP) might be effective as prophylaxis because it is effective against C. trachomatis and T. pallidum .

AIMS

Our objective was to evaluate the efficacy of doxycycline as PREP or PEP against bacterial STIs ( C. trachomatis , N. gonorrhoeae , and T. pallidum ).

METHODS

A systematic review and meta-analysis of randomized clinical trials of a high-risk group of individuals was conducted to evaluate whether doxycycline is as effective as PREP or PEP in preventing bacterial STIs. The PubMed-MEDLINE (MEDlars online), Cohrane, Scientific Electronic Library Online (SciELO), and Latin America and the Caribbean Literature on Health Sciences ( Literatura Latino-Americana e do Caribe em Ciências da Saúde -LILACS) databases were searched for randomized clinical trials published up to March 2024. Data were extracted from published reports. Hazard ratios (HRs) and risk ratios (RRs) with 95% confidence interval (CI) were pooled across trials.

MAIN OUTCOME MEASURE

The primary end points were any incidence of bacterial STIs and individual STI infections.

RESULTS

A total of 4 studies were included in the analysis, 3 of which evaluated doxy-PEP and 1 evaluated doxy-PREP. In the doxy-PEP group, a total of 1182 participants were evaluated. In the pooled analysis of doxy-PEP studies, the incidence of the first STI was lower in the doxy-PEP group (HR, 0.538 [95% CI, 0.337-0.859]; I2 = 77%; P < 0.05). Regarding individual infections, only 2 studies were included. In the doxy-PEP group, the incidence of individual infection of C. trachomatis was lower compared with controls (RR, 0.291 [95% CI, 0.093-0.911]) ( I2 = 89%; P < 0.05). Because only one study evaluated doxy-PREP, it was not possible to calculate a meta-analysis index; however, the use of doxycycline as PREP was associated with a decrease in the rate of any STI.

CONCLUSIONS

The use of doxy-PEP might reduce the first STI, mainly C. trachomatis , if used within 72 hours after condomless sex. The use of doxy-PREP might also decrease the chance of any STI; however, only 1 study was evaluated.

The role of footwear in improving running economy: a systematic review with meta-analysis of controlled trials

This systematic review aimed to explore the impact of different types of footwear and footwear characteristics on the running economy (RE) of long-distance runners and providing guidance for running enthusiasts and clinical practice. A comprehensive search of Web of Science, PubMed, SPORTDiscous, SCOPUS, and the China National Knowledge Infrastructure (CNKI) databases from inception to April 2024 was performed. Trials evaluating the RE of adults participating in long-distance running included comparing different footwear characteristics. This review followed the PRISMA statement. Two reviewers screened titles and abstracts to make a relevant shortlist, then retrieved and evaluated full texts against inclusion criteria for eligibility. Two independent reviewers evaluated the methodological quality of each included analysis by employing the Physiotherapy Evidence Database Scale (PEDro scale). The standardized mean difference (SMD) for the results of RE studies in each study was calculated. Of the 1338 records retrieved, 26 studies were identified in the systematic review and meta-analysis. Limited evidence indicated that compared with shod running, barefoot running (SMD = - 0.50 [95% CI - 0.86, - 0.14], P = 0.006) and minimalist running (SMD = - 0.62 [95% CI - 0.83, - 0.42], P < 0.00001) had a positive impact on RE. Compared with barefoot running, minimalist running did not show a beneficial effect (SMD = 0.37 [95% CI - 0.07, 0.81], P = 0.10) on RE. Additionally, compared with the control condition, RE showed some improvement with increased footwear longitudinal bending stiffness (SMD = - 0.53 [95% CI - 0.90, - 0.17], P = 0.005) and cushioning (SMD = - 0.33 [95% CI - 0.61, 0.06], P = 0.02). However, compared with control, RE did not change with footwear comfort (SMD = - 0.11 [95% CI - 0.42, 0.21], P = 0.51). Barefoot running or minimalist running may be more economical than shod running, high longitudinal bending stiffness and high cushioning shoes could improve RE.

Urgent Focus on the Surgical Risks of People Living With HIV: A Systematic Review and Meta-Analysis

With the widespread promotion and application of antiretroviral therapy in clinical practice, people living with HIV (PLWH) have the potential to live as long as non-HIV people and the probability of surgery for PLWH has been increasing dramatically. However, the overall postoperative outcome and risk are still unclear. We performed comprehensive and methodical searches in PubMed, Embase, and Web of Science without date and language restrictions. Study outcomes included: (1) cure rate, (2) mortality, (3) reoperation rate, (4) incidence of any postoperative complications, (5) length of stay, and (6) operation duration. NOS scores were employed to evaluate bias risk, while publication bias was assessed using funnel plots and Egger tests. Review Manager version 5.4.1, R version 4.4.1, and Stata version 14.0 were employed to determine quantitative analysis, considering a significance level of p < 0.05. A total of 50 studies were included, involving 54 565 PLWH undergoing surgical treatment. Synthesis analysis showed that the mortality (OR = 1.70, 95% CI: 1.58-1.83, p < 0.00001), reoperation rate (OR = 1.78, 95% CI: 1.36-2.34, p < 0.00001), complication rate (OR = 1.56, 95% CI: 1.26-1.95, p < 0.00001), LOS (OR = 1.63, 95% CI: 1.28-1.99, p < 0.00001), and operation time (OR = 7.37, 95% CI: 1.14-13.59, p = 0.02) were increased in PLWH. However, there was no significant difference in the cure rate compared to the control group (OR = 1.27, 95% CI: 0.90-1.79, p = 0.18). Subgroup analysis showed that complication rates increased again in orthopedic (OR = 1.65, 95% CI: 1.34-2.05, p < 0.00001) and general surgery (OR = 1.72, 95% CI: 1.08-2.74, p = 0.02). However, the type of procedure, publication quality, study type, and patient origin were not sources of complication rate heterogeneity. Meta-regression showed that CD4 count had no effect on complication rate, but the anti-retroviral therapy rate had 34.89% explanatory power. There is an increased risk of postoperative death, reoperation, complications, and prolonged hospital stay and surgical duration in PLWH. However, conducting extensive prospective studies across multiple centers is crucial to validate these findings.

Skin Cancer Diagnosis by Lesion, Physician, and Examination Type: A Systematic Review and Meta-Analysis

Importance

Skin cancer is the most common cancer in the US; accurate detection can minimize morbidity and mortality.

Objective

To assess the accuracy of skin cancer diagnosis by lesion type, physician specialty and experience, and physical examination method.

Data Sources

PubMed, Embase, and Web of Science.

Study Selection

Cross-sectional and case-control studies, randomized clinical trials, and nonrandomized controlled trials that used dermatologists or primary care physicians (PCPs) to examine keratinocytic and/or melanocytic skin lesions were included.

Data Extraction and Synthesis

Search terms, study objectives, and protocol methods were defined before study initiation. Data extraction was performed by a reviewer, with verification by a second reviewer. A mixed-effects model was used in the data analysis. Data analyses were performed from May 2022 to December 2023.

Main Outcomes and Measures

Meta-analysis of diagnostic accuracy comprised sensitivity and specificity by physician type (primary care physician or dermatologist; experienced or inexperienced) and examination method (in-person clinical examination and/or clinical images vs dermoscopy and/or dermoscopic images).

Results

In all, 100 studies were included in the analysis. With experienced dermatologists using clinical examination and clinical images, the sensitivity and specificity for diagnosing keratinocytic carcinomas were 79.0% and 89.1%, respectively; using dermoscopy and dermoscopic images, sensitivity and specificity were 83.7% and 87.4%, and for PCPs, 81.4% and 80.1%. Experienced dermatologists had 2.5-fold higher odds of accurate diagnosis of keratinocytic carcinomas using in-person dermoscopy and dermoscopic images compared with in-person clinical examination and images. When examining for melanoma using clinical examination and images, sensitivity and specificity were 76.9% and 89.1% for experienced dermatologists, 78.3% and 66.2% for inexperienced dermatologists, and 37.5% and 84.6% for PCPs, respectively; whereas when using dermoscopy and dermoscopic images, sensitivity and specificity were 85.7% and 81.3%, 78.0% and 69.5%, and 49.5% and 91.3%, respectively. Experienced dermatologists had 5.7-fold higher odds of accurate diagnosis of melanoma using dermoscopy compared with clinical examination. Compared with PCPs, experienced dermatologists had 13.3-fold higher odds of accurate diagnosis of melanoma using dermoscopic images.

Conclusions and Relevance

The findings of this systematic review and meta-analysis indicate that there are significant differences in diagnostic accuracy for skin cancer when comparing physician specialty and experience, and examination methods. These summary metrics of clinician diagnostic accuracy could be useful benchmarks for clinical trials, practitioner training, and the performance of emerging technologies.

The Impact of Acupuncture on Pain Intensity, Nausea, and Vomiting for Laparoscopic Cholecystectomy: A Meta-analysis Study

BACKGROUND

Acupuncture may have some potential in pain relief after laparoscopic cholecystectomy, and this meta-analysis aims to explore the impact of acupuncture on pain intensity, nausea and vomiting for patients undergoing laparoscopic cholecystectomy.

METHODS

PubMed, EMbase, Web of science, EBSCO, Cochrane library databases, CNKI, VIP, and Wangfang were systematically searched, and we included randomized controlled trials (RCTs) assessing the effect of acupuncture on pain control for laparoscopic cholecystectomy.

RESULTS

Five RCTs and 366 patients were included in the meta-analysis. Overall, compared with control intervention for laparoscopic cholecystectomy, acupuncture was associated with significantly reduced pain scores at 6 hours [mean difference (MD)=-0.86; 95% CI=-1.37 to -0.34; P =0.001, 2 RCTs) and pain scores at 8 to 10 hours (MD=-0.71; 95% CI=-1.13 to -0.28; P =0.001, 2 RCTs), decreased incidence of nausea (odds ratio=0.10; 95% CI=0.03-0.34; P =0.0003, 3 RCTs), and vomiting (odds ratio=0.11; 95% CI=0.01-0.85; P =0.03, 3 RCTs), but demonstrated no obvious impact on pain scores at 12 to 24 hours (MD=-0.38; 95% CI=-1.02 to 0.27; P =0.25, 2 RCTs).

CONCLUSIONS

Acupuncture may be effective to reduce pain intensity, nausea, and vomiting for laparoscopic cholecystectomy.

Lactational performance effects of 3-nitrooxypropanol supplementation to dairy cows: A meta-regression

A meta-regression was conducted to determine the production effects of 3-nitrooxypropanol (3-NOP) and investigate their associations with dose, dietary nutrient composition, and supplementation length in dairy cows. Forty treatment and control mean comparisons extracted from 21 studies conducted or published between 2014 to 2024 were used in the meta-regression. Response variables were DMI, milk yield (MY), ECM yield, ECM feed efficiency, BW, BW change, and concentrations of milk fat, true protein, lactose, and MUN. Treatment and control mean differences (MD) as well as standardized MD were calculated and used for data presentation and statistical analysis, respectively. Dose (± SD; 77.0 ± 33.17 mg 3-NOP/kg DMI), forage-to-concentrate ratio (FC; 58.9 ± 8.83%, expressed as average ± SD% of forage in the diet), dietary concentrations of CP, ether extract, NDF, and starch (16.3 ± 1.84%, 4.3 ± 1.03%, 33.7 ± 4.40%, and 20.9 ± 3.97%, as average ± SD% of DM, respectively), supplementation length (days), and DIM and BW of the cows at the beginning of the study were used as continuous explanatory variables. Mixed-effects models were fitted using the robust variance estimation method. Full models containing uncorrelated explanatory variables (Pearson correlation <0.50) were fitted, and variables were removed from the final model if nonsignificant using the stepwise selection approach. Compared with control, supplementation of 3-NOP decreased DMI and MY by 0.80 ± 0.149 and 0.98 ± 0.250 kg/d, respectively, but only numerically decreased ECM by 0.50 ± 0.298 kg/d. Consequently, feed efficiency was increased by 0.05 ± 0.012 kg ECM/kg DMI with 3-NOP supplementation. Body weight and BW change were not affected by 3-NOP supplementation. Milk fat, true protein, and MUN concentrations were increased by 0.09 ± 0.028%, 0.02 ± 0.006%, and 0.59 ± 0.106 mg/dL, respectively. Increasing 3-NOP dose further decreased DMI and increased milk fat and MUN concentrations. Increasing dietary NDF and FC lessened the negative effect of 3-NOP on DMI and MY, respectively, and decreased its effect on milk fat and MUN (dietary NDF concentration effect only). Similarly, increasing dietary CP lessened the negative effect of 3-NOP on DMI and decreased its effect on MUN. To explain some of the production effects herein observed, ruminal fermentation data from 6 published studies were included in the meta-regression. Supplementation of 3-NOP tended to increase rumen pH and decreased NH3 concentration. Concentrations of total VFA, acetate, and the acetate-to-propionate ratio were decreased, whereas the concentration of propionate was increased, and that of butyrate was numerically increased by 3-NOP supplementation. Overall, 3-NOP supplementation of dairy cow diets decreased DMI and MY but did not affect ECM because of increased milk fat and true protein contents. Increased milk fat and MUN responses can be explained by shifted ruminal fermentation, and the increased milk true protein response may be explained by increased rumen propionate molar proportion by 3-NOP supplementation.

Cost-effectiveness of hysterectomy, first- and second-generation endometrial ablation, and levonorgestrel-releasing device for treatment of heavy menstrual bleeding: a systematic review

OBJECTIVES

This study aims to provide a clear understanding of the relative economic evaluation of hysterectomy, first- and second-generation endometrial ablation, and levonorgestrel-releasing intrauterine device for treatment of heavy menstrual bleeding.

METHODS

A comprehensive search was conducted without restrictions until October 5, 2023, across databases including PubMed, EMBASE, Scopus, Cochrane, and others. The review included studies using full economic evaluation methods to compare treatments, excluding review articles, editorials, abstracts, and non-English articles. Methodological quality of included studies was assessed using the QHES checklist and analyzed with Incremental Cost-Effectiveness Ratios.

RESULTS

Out of 156 articles assessed for full-text evaluations, 23 publications were selected for qualitative analysis. Two studies deemed to be of low quality were excluded from the final analysis, while the majority of studies showcased high quality. The findings presented diverse perspectives on the most cost-effective treatment, with LNG-IUD frequently emerging as the preferred choice.

CONCLUSION

There are diverse methodologies in economic evaluations, impacting reported health economic outcomes due to varying perspectives, time horizons, and modeling approaches. The review highlighted the need for further research to establish optimal HMB treatment strategies and to guide healthcare resource allocation.

REGISTRATION

PROSPERO (CRD42024530176).

Arthroscopic Repair of Bursal-Sided Partial-Thickness Rotator Cuff Tears: Literature Review and Meta-analysis

BACKGROUND

The surgical management of bursal-sided partial-thickness rotator cuff tendon tears is controversial. The 2 methods used are in situ repair (ISR), preserving the contingent of intact articular tendon fiber, or tear completion before repair (TCBR) according to the operating surgeon's usual technique. No study with sufficient power has demonstrated a superior technique.

HYPOTHESIS

The 2 techniques are equivalent in terms of clinical outcome and tendon healing.

STUDY DESIGN

Systematic literature review and meta-analysis; Level of evidence, 4.

METHODS

A systematic review was carried out in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations on the PubMed, Embase, and Cochrane Library databases from January 2003 through March 2023. Only articles dealing with Ellman grade 3 bursal-sided tears with a minimum follow-up of 1 year were included. Primary endpoints were American Shoulder and Elbow Surgeons and Constant-Murley scores, pain on a visual analog scale, and retear rate. The secondary endpoint was recovery of active mobility.

RESULTS

Twelve studies were included with overlap of 3, leaving 8 ISR studies (360 patients; mean follow-up, 30 months) and 7 TCBR studies (224 patients; mean follow-up, 51 months) for statistical analysis. No significant clinical differences were found when comparing mean American Shoulder and Elbow Surgeons (92.2 [95% CI, 88.1-96.2] vs 88.9 [95% CI, 85.8-92.0]; P = .21), Constant-Murley (86.3 [95% CI, 81.5-91.0] vs 91.8 [95% CI, 88.1-95.6]; P = .07), and visual analog scale (0.8 [95% CI, 0.2-1.4] vs 1.0 [95% CI, 0.5-1.4]; P = .63) scores in the TCBR and ISR groups, respectively. The retear rate was 6.8% (95% CI, 3.1%-14.3%) in the TCBR group and 9.5% (95% CI, 6.1%-14.3%) in the ISR group (P = .46). Active mobility was also comparable.

CONCLUSION

This meta-analysis suggests that ISR and TCBR provide comparable results in the surgical management of Ellman grade 3 bursal-sided partial-thickness rotator cuff tears.

Comparing the efficacy and safety between femtosecond laser-assisted cataract surgery and conventional phacoemulsification cataract surgery: systematic review and meta-analysis

OBJECTIVE

To investigate the efficacy and safety of femtosecond laser-assisted cataract surgery (FLACS) compared with conventional phacoemulsification cataract surgery (CPCS).

METHODS

Randomized controlled trials (RCTs) were systematically searched in PubMed, Embase, Cochrane Library, ClinicalTrials.gov, CNKI, and Wanfang. Main outcomes were visual acuity, capsulotomy parameters, effective lens position, and complications. Secondary outcomes included refractive outcomes, intraoperative parameters, and corneal parameters.

RESULTS

In total, 41 RCTs involving 9310 eyes were included. There was a statistically significant difference in favour of FLACS over CPCS for uncorrected distance visual acuity at 12 months (mean difference [MD] -0.03; 95% CI -0.05 to -0.01); corrected distance visual acuity at 1 week (MD -0.05; 95% CI -0.07 to -0.02) and 12 months (MD -0.02; 95% CI -0.04 to -0.00); area of capsulotomy at 1 month (MD 4.04 mm2; 95% CI 3.45-4.64) and 6 months (MD 5.02 mm2; 95% CI 3.28-6.77); and intraocular lens centroid-pupil centroid distance at 1 week (MD -0.06 mm; 95% CI -0.08 to -0.05), 1 month (MD -0.07 mm; 95% CI -0.09 to -0.06), and 6 months (MD -0.06 mm; 95% CI -0.07 to -0.04). With regard to surgical complications, FLACS was less than CPCS for the incidence of decentred IOL (odds ratio 0.06; 95% CI 0.01-0.24). However, FLACS did not increase the incidence of other intraoperative or postoperative complications except subconjunctival hemorrhage.

CONCLUSIONS

Both FLACS and CPCS are effective and safe. FLACS achieves better visual outcomes in the early postoperative period and long-term follow-up, accompanied by more accurate capsulotomy and more optimized effective lens position than CPCS. However, no difference of visual outcomes was found after middle-term follow-up.

The perceptions and experiences of community nurses and patients towards shared decision-making in the home setting: An integrative review

AIM

To explore patients' and community nurses' perceptions and experiences of shared decision-making in the home.

DESIGN

Integrative review.

DATA SOURCES

CINAHL, British Nursing Index, Psycinfo, Medline and Social Services Abstracts were searched for qualitative, quantitative and mixed methods papers published between 1 December 2001 and 31 October 2023.

REVIEW METHODS

A systematic search of electronic databases was undertaken using defined inclusion criteria. The included papers were appraised for quality using the Joanna Briggs Institute critical appraisal checklist for qualitative research. Relevant data were extracted and thematically analysed.

RESULTS

Fourteen papers comprising 13 research studies were included. Patients attached great importance to their right to be involved in decision-making and noted feeling valued as a unique individual. Communication and trust between the patient and nurse were perceived as fundamental. However, shared decision-making does not always occur in practice. Nurses described tension in managing patients' involvement in decision-making.

CONCLUSION

The findings demonstrate that although patients and community nurses appreciate participating in shared decision-making within the home, there are obstacles to achieving a collaborative process. This is especially relevant when there are fundamentally different perspectives on the decision being made. More research is needed to gain further understanding of how shared decision-making plays out in practice and to understand the tensions that patients and nurses may experience.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This paper argues that shared decision-making is more than the development of a relationship where the patient can express their views (though of course, this is important). Shared decision-making requires acknowledgement that the patient has the right to full information and should be empowered to choose between options. Nurses should not assume that shared decision-making in community nursing is easy to facilitate and should recognize the tensions that might exist when true patient choice is enabled.

IMPACT

This paper demonstrates how the idea of shared decision-making needs to be explored in the light of everyday practice so that challenges and barriers can be overcome. In particular, the tensions that arise when patients and nurses do not share the same perspective. This paper speaks to the potential of a gap surrounding shared decision-making in theory and how it plays out in practice.

REPORTING METHOD

The reporting of this review was guided by the 2020 guidelines for the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Page et al., 2021).

PATIENT OR PUBLIC CONTRIBUTION

This review was carried out as part of a wider study for which service users have been consulted.

Women's experiences of premature ovarian insufficiency: a thematic synthesis

OBJECTIVE

Receiving a diagnosis of premature ovarian insufficiency (POI) can be an emotional and distressing experience for women. The aim of this meta-synthesis was to examine women's experiences of POI both before and after diagnosis to provide new understandings of those experiences.

DESIGN

A systematic review of ten studies examining women's experiences of POI.

RESULTS

Using thematic synthesis, three analytical themes were identified, demonstrating the complexity of experiences of women diagnosed with POI: 'What is happening to me?', 'Who am I?' and 'Who can help me?'. Women experience profound changes and losses associated with their identity that they must adjust to. Women also experience an incongruence between their identity as a young woman and that of a menopausal woman. Difficulty was also experienced accessing support pre-and post-diagnosis of POI, which could hinder coping with and adjustment to the diagnosis.

CONCLUSION

Women require adequate access to support following diagnosis of POI. Further training should be provided to health care professionals not only on POI but including the importance of psychological support for women with POI and the resources available to provide the much needed emotional and social support.

Enhancing Hepatitis C Virus Testing, Linkage to Care, and Treatment Commencement in Hospitals: A Systematic Review and Meta-analysis

Background

The hospital-led interventions yielding the best hepatitis C virus (HCV) testing and treatment uptake are poorly understood.

Methods

We searched Medline, Embase, and Cochrane databases for studies assessing outcomes of hospital-led interventions for HCV antibody or RNA testing uptake, linkage to care, or direct-acting antiviral commencement compared with usual care, a historical comparator, or control group. We systematically reviewed hospital-led interventions delivered in inpatient units, outpatient clinics, or emergency departments. Random-effects meta-analysis estimated pooled odds ratios [pORs] measuring associations between interventions and outcomes. Subgroup analyses explored outcomes by intervention type.

Results

A total of 7872 abstracts were screened with 23 studies included. Twelve studies (222 868 participants) reported antibody testing uptake, 5 (n = 4987) reported RNA testing uptake, 7 (n = 3185) reported linkage to care, and 4 (n = 1344) reported treatment commencement. Hospital-led interventions were associated with increased antibody testing uptake (pOR, 5.83 [95% confidence interval {CI}, 2.49-13.61]; I 2 = 99.9%), RNA testing uptake (pOR, 10.65 [95% CI, 1.70-66.50]; I 2 = 97.9%), and linkage to care (pOR, 1.75 [95% CI, 1.10-2.79]; I 2 = 79.9%) when data were pooled and assessed against comparators. Automated opt-out testing (5 studies: pOR, 16.13 [95% CI, 3.35-77.66]), reflex RNA testing (4 studies: pOR, 25.04 [95% CI, 3.63-172.7]), and care coordination and financial incentives (4 studies: pOR, 2.73 [95% CI, 1.85-4.03]) showed the greatest increases in antibody and RNA testing uptake and linkage to care, respectively. No intervention increased uptake at all care cascade steps.

Conclusions

Automated antibody and reflex RNA testing increase HCV testing uptake in hospitals but have limited impact on linkage to treatment. Other interventions promoting linkage must be explored.

A Pantropical Analysis of Fire Impacts and Post-Fire Species Recovery of Plant Life Forms

Fires are a key environmental driver that modify ecosystems and global biodiversity. Fires can negatively and positively impact biodiversity and ecosystem functioning, depending on how frequently fire occurs in the focal ecosystem, but factors influencing biodiversity responses to fire are inadequately understood. We conduct a pan-tropical analysis of systematically collated data spanning 5257 observations of 1705 plant species (trees and shrubs, forbs, graminoids and climbers) in burnt and unburnt plots from 28 studies. We use model averaging of mixed effect models assessing how plant species richness and turnover (comparing burnt and unburnt communities) vary with time since fire, fire type, protected area status and biome type (fire sensitive or fire adaptive). Our analyses bring three key findings. First, prescribed and non-prescribed burns have contrasting impacts on plant species richness (trees/shrubs and climbers); prescribed fire favours increased species richness compared to non-prescribed burns. Second, the effect of time since fire on the recovery of species composition varies across all life form groups; forb's species composition recovered faster over all life forms. Third, protection status alters fire impacts on the species richness of trees/shrubs and climbers and species recovery of graminoids. Non-protected areas exhibit higher species richness compared to protected areas in trees/shrubs, and climbers. Graminoid species composition recovered quicker in protected sites compared to unprotected ones. Since fire intervals are decreasing in fire-sensitive biomes and increasing in fire-adaptive biomes, plant communities across much of the tropics are likely to change in response to exposure to fire in the future.

Neuromuscular Blocking Agents and Tracheal Intubation: Systematic Review and Meta-Analysis of Effects on Laryngeal Complications and Intubating Conditions

Background and Aims

The use of neuromuscular blocking agents (NMBAs) in tracheal intubation is widely accepted in anesthetic induction, but adverse effects are possible. We performed a systematic review and meta-analysis to compare influence of use and nonuse of NMBAs on incidence of laryngeal complications and intubating conditions in surgical patients.

Methods

We searched PubMed, Web of Science, Embase, and Cochrane Library for randomized controlled trials comparing use of NMBAs with either placebo or no treatment for oral tracheal intubation in adult patients under general anesthesia. Studies were evaluated using a risk-of-bias assessment. We conducted random-effects or fixed-effects meta-analyses on extracted data and calculated risk ratio (RR), risk difference (RD), and 95% confidence interval (CI).

Results

Nine trials with 1176 participants were included. Incidence of postoperative sore throat or hoarseness did not differ between groups receiving and not receiving NMBAs at 24 h (RR: 1.18; 95% CI: 0.96-1.46; I2 = 45%), 48 h (RR: 0.84; 95% CI: 0.46-1.52; I2 = 42%), or 72 h (RD: -0.00; 95% CI: -0.08 to 0.07; I2 = 59%). Compared with use of NMBAs, induction without NMBAs reduced the occurrence of acceptable intubating conditions (RR: 0.80; 95% CI: 0.67-0.94; I2 = 92%) and with increased risk for poor intubating conditions (RR: 4.77; 95% CI: 3.20-7.10; I2 = 0%). The pharmacological interventions for hemodynamic changes after intubation did not differ significantly between the NMBAs and non-NMBAs groups (RR: 1.02; 95% CI: 0.53-1.95; I2 = 78%).

Conclusion

Endotracheal intubation without NMBAs does not increase the incidence of postoperative hoarseness or sore throat in adult surgical patients, which may be considered as a safe and effective technique of anesthesia induction. Although NMBAs use was associated with acceptable intubating conditions and reduced risk for poor intubation conditions.

Trial Registration

PROSPERO CRD42021284813.

Impact of Virtual Reality, Augmented Reality, and Sensor Technology in Knee Osteoarthritis Rehabilitation: A Systematic Review

Knee osteoarthritis (KOA) is a progressive degenerative joint disorder that significantly impacts mobility, pain levels, and overall quality of life. Conventional rehabilitation methods, while effective, often suffer from limitations related to patient adherence, accessibility, and cost. This systematic review examines the role of virtual reality (VR), augmented reality (AR), and sensor-based technologies in KOA rehabilitation, evaluating their effectiveness in pain reduction, functional improvement, and patient engagement. A comprehensive literature search identified four randomized controlled trials (RCTs) comprising 405 participants, with an average Physiotherapy Evidence Database (PEDro) score of 6/10, indicating moderate to high methodological quality. Findings suggest that VR and AR interventions enhance rehabilitation adherence and engagement, while sensor-based systems provide real-time biofeedback, enabling personalized therapeutic adjustments. These technologies demonstrated significant improvements in pain management, muscle strength, and functional mobility. However, challenges such as high costs, limited accessibility, and the absence of standardized treatment protocols remain barriers to widespread clinical adoption. Further research should focus on long-term efficacy, cost-effectiveness, and the integration of these innovations into routine clinical practice.

Safety and Effectiveness of Drug-Eluting Embolic Bronchial Arterial Chemoembolization for Lung Cancer: A Systematic Review and Meta-Analysis

PURPOSE

To assess the effectiveness and safety of drug-eluting embolic (DEE) bronchial arterial chemoembolization (BACE) in lung cancer and compare its outcomes with those of conventional BACE (cBACE).

MATERIALS AND METHODS

A comprehensive search was conducted across PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIP, and Wanfang databases. Random-effects model analysis was applied when I2 was ≥50%; otherwise, fixed-effects model analysis was used. Subgroup analysis was performed for I2 values of ≥50%. Eighteen studies involving 681 patients were included, with 501 patients receiving DEE-BACE and 110 patients undergoing cBACE.

RESULTS

Among patients with lung cancer treated with DEE-BACE, the pooled objective response rates (ORRs) at 1 and 6 months were 64.4% and 50.3%, respectively; the disease control rates (DCRs) at 1, 3, and 6 months were 93.4%, 74.4%, and 71.7%, respectively. The 1-year overall survival and progression-free survival rates were 48.2% and 22.5%, respectively. The incidences of adverse events such as cough, fever, chest discomfort, nausea, fatigue, and leukopenia were reported at 30.7%, 22.8%, 22.4%, 29.6%, 7.4%, and 21.8%, respectively. Compared with the cBACE group, the DEE-BACE group exhibited higher 1-month DCR (pooled relative risk [RR], 1.236; 95% confidence interval [CI], 1.028-1.486) and 6-month ORR (pooled RR, 2.036; 95% CI, 1.226-3.383) and DCR (pooled RR, 1.824; 95% CI, 1.249-2.662). Both DEE-BACE and cBACE exhibited similar rates of adverse events.

CONCLUSIONS

DEE-BACE presents a favorable effectiveness and safety profile for lung cancer treatment compared with cBACE, particularly for nonresectable cases or when chemotherapy or radiation therapy options are limited. However, the lack of direct comparisons with standard treatments requires cautious interpretation of these results.

Association between Mediterranean diet adherence and Parkinson's disease: a systematic review and meta-analysis

BACKGROUND AND AIMS

Parkinson's disease (PD) is a chronic neurodegenerative disorder, and past research suggests that adherence to the Mediterranean diet (MD) may influence the risk of PD. However, there are varying conclusions among different studies regarding the correlation between long-term adherence to the MD and the occurrence of PD. This meta-analysis aimed to investigate the association between MD adherence and PD incidence.

METHODS

This meta-analysis was registered on PROSPERO (CRD42024520410). We searched PubMed, Embase, Web of Science, and Cochrane databases to identify observational studies, including prospective cohorts, case-control, and cross-sectional studies, up to February 2024. Studies reported on MD adherence were included, with MD adherence categorized through a quantifying score or index. The pool odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for the highest versus the lowest categories of MD score in relation to PD risk, using random-effects models. Additionally, bias assessment, heterogeneity assessment, sensitivity analysis, and subgroup analysis were performed. A total of 12 studies were included in the meta-analysis.

RESULTS

The overall effect size of PD risk was as follows: compared to the lowest adherence to the MD, the highest adherence to MD showed a significant negative correlation with the incidence of PD, with an overall OR of 0.75 (95% CI: 0.66, 0.84). Specifically, in studies diagnosing PD, the overall OR was 0.83 (95% CI: 0.74, 0.94), while in studies diagnosing prodromal Parkinson's disease (pPD), the overall OR was 0.67 (95%CI: 0.59, 0.76). For individuals aged <60 years, the overall OR was 0.70 (95%CI: 0.62, 0.78), whereas, for those aged ≥60 years, the overall OR was 0.86 (95%CI: 0.74, 0.99).

CONCLUSIONS

The evidence from this meta-analysis demonstrates a significant negative correlation between adherence to MD patterns and the risk of PD, suggesting that the MD may serve as a protective factor for PD. This dietary pattern may be particularly beneficial in reducing the risk of pPD.

Inconsistencies in measuring glenoid version in shoulder arthroplasty: a systematic review

BACKGROUND

Glenoid version is a critical anatomic parameter relied upon by many surgeons to inform preoperative planning for shoulder arthroplasty. Advancements in imaging technology have prompted measurements of glenoid version on various imaging modalities with different techniques. However, discrepancies in how glenoid version is measured within the literature have not been well characterized.

METHODS

A literature search was performed by querying PubMed, EMBASE, CINAHL, and Cochrane computerized databases from their inception through December 2023 to identify studies that assessed the relationship between preoperative glenoid version and at least one clinical or radiologic outcome following shoulder arthroplasty. Study quality was assessed via the Methodologic Index for Nonrandomized Studies criteria. Imaging modalities and techniques for measuring glenoid version, along with their association with clinical outcomes, were aggregated.

RESULTS

Among 61 studies encompassing 17,070 shoulder arthroplasties, 27 studies (44.3%) described explicitly how glenoid version was measured. The most common imaging modality to assess preoperative glenoid version was computed tomography (CT) (63.9%), followed by radiography (23%); 11.5% of studies used a combination of imaging modalities within their study cohort. Among the studies using CT, 56.5% utilized two-dimensional (2D) CT, 41.3% utilized three-dimensional (3D) CT, and 2.2% used a combination of 2D and 3D CT. The use of 3D CT increased from 12.5% of studies in 2012-2014 to 25% of studies in 2018-2020 to 52% of studies in 2021-2023 (ptrend = 0.02). Forty-three (70.5%) studies measured postoperative version, most commonly on axillary radiograph (22 [51.2%]); 34.9% of these studies used different imaging modalities to assess pre- and postoperative version.

CONCLUSIONS

This systematic review revealed marked discrepancies in how glenoid version was measured and reported in studies pertaining to shoulder arthroplasty. A temporal trend of increased utilization of 3D CT scans and commercial preoperative planning software was identified. Improved standardization of the imaging modality and technique for measuring glenoid version will enable more rigorous evaluation of its impact on clinical outcomes.

Tinidazole vs metronidazole for the treatment of bacterial vaginosis: a systematic review and meta-analysis

INTRODUCTION

Tinidazole shows potential as a first-line treatment for bacterial vaginosis (BV). However, its superiority to metronidazole remains uncertain. Therefore, this meta-analysis compares tinidazole versus metronidazole in patients with BV.

METHODS

We systematically searched PubMed, Embase and Cochrane for studies comparing tinidazole and metronidazole in patients with BV. Statistical analyses were performed using R Studio 4.3.2. Heterogeneity was examined with the Cochran Q test and I2 statistics. Risk ratios (RR) with 95% confidence intervals (CI) were pooled across trials. Outcomes of interest were BV cure at the first and the second follow-up appointment, and adverse events such as nausea and bad or metallic taste.

RESULTS

Five randomized controlled trials and 1 prospective observational study, reporting data on 1,036 patients were included in this meta-analysis. Among them, 511 (49%) received tinidazole and 525 (51%) received metronidazole. Follow-up ranged from 1 to 6 weeks. There was no significant difference between groups for BV cure at the first follow-up appointment (RR 1.03; 95% CI 0.92 to 1.14; I2 = 76%), cure at the second follow-up appointment (RR 1.05; 95% CI 0.80-1.38; I2 = 88%), nausea (RR 0.89; 95% CI 0.39-2.04; I2 = 83%), and bad or metallic taste (RR 0.74; 95% CI 0.12-4.45; I2 = 89%).

CONCLUSION

In patients with BV, tinidazole and metronidazole exhibit similar efficacy and safety, with equivalent cure rates and incidence of adverse events.

A systematic review of the effectiveness of digital cognitive assessments of cognitive impairment in Parkinson's disease

Background: Digitalization in healthcare has been extended to how we examine and manage Parkinson's Disease Mild Cognitive Impairment (PD-MCI). Methods: Moyer Population (those with PD and in some cases control groups), Intervention (digital cognitive test) and Outcome (validity and reliability) (PIO) and Campbell et al. Synthesis Without Meta-analysis (SWiM) methods were employed. A literature search of MEDLINE, PsycINFO, CINAHL, OpenGrey, and ProQuest Theses and Dissertations Sources screened for articles. Results: The digital trail-making test (dTMT) was the most used measure. There was strong validity between the dTMT and pencil-paper TMT, Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA) scores (ranging from r = .55 to .90, p < .001). Validity between the TMT pencil-paper and digital versions were adequate (ranging from r = .51 to 90, p < .001). Reliability was demonstrated between PD and control groups' scores (ranging from r = .71 to .87). One study found excellent inter-rater reliability (ICC = .90 to .95). The dMoCA was the most used screen that assessed more than two cognitive domains. There was a range in the strength of agreement between digital and pencil-paper versions (ICC scores = .37 to .83) and only one study demonstrated adequate validity (r = .59, p < .001). Poor internal consistency (α = .54) and poor test re-test reliability (between PD and control groups' scores, p > .05) were found. Conclusion: This review found that digitalized cognitive tests are valid and reliable methods to assess PD-MCI. Considerations for future research are discussed.

Safety and efficacy of catheter-directed thrombectomy without thrombolysis in acute pulmonary embolism: A systematic review and meta-analysis

BACKGROUND

This meta-analysis aims to investigate the safety and efficacy of catheter-directed thrombectomy (CDT) without using adjunct thrombolysis as reperfusion therapy to manage intermediate and high-risk pulmonary embolism (PE).

METHODS

A literature search of Ovid MEDLINE, Embase, CiNAHL, Cochrane Library, and Web of Science was conducted from inception to January 2024. Eligible studies reported more than 10 patients treated for acute PE with catheter-directed thrombectomy only, who were over 18 years of age. Primary endpoints were major bleeding, in-hospital mortality, and hemodynamic changes.

RESULTS

Eighteen studies (n = 803) were included for quantitative analysis. The pooled estimate of incidences of in-hospital mortality and major bleeding was 1.8 % (95 % CI 0.009, 0.027) and 2.1 % (95 % CI 0.011, 0.031) respectively. A pooled estimate reported a post-procedural increase in oxygen saturation and systolic blood pressure by 8.96 % (95 % CI: 3.54, 14.38) and 15.02 mmHg (95 % CI 6.35, 23.69) respectively. Post-procedural mean pulmonary artery pressure, right ventricle/left ventricle (RV/LV) ratio, and Miller score were reduced by 10.30 mmHg (95 % CI -14.94, -5.66), 0.29 (95 % CI -0.50, -0.08) and 8.09 (95 % CI -10.70, -5.47) respectively.

CONCLUSION

CDT without adjunctive thrombolysis may lead to improvements in hemodynamic outcomes and exhibits favorable safety profiles. This meta-analysis provides a rationale for lowering the threshold for considering this technique, and ongoing randomized trials will further advance the field to determine optimal managment strategies for intermediate and high-risk acute PE.

Outcomes of Dual Mobility Versus Fixed-Bearing Components in Revision Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

BACKGROUND

Dual mobility (DM) implants have received increasing interest in revision surgery due to their increased stability. The aim of this systematic review was to compare outcomes of DM versus conventional fixed-bearing (FB) implants in revision total hip arthroplasty (rTHA).

METHODS

A comprehensive search was performed using the PubMed, Embase, and MEDLINE databases between January 2000 and 2023. Outcome measures included rerevision due to dislocation, rerevision for other causes, all-cause rerevision, total complication rate, and functional outcome measures. The Methodological Index for Nonrandomized Studies assessment tool was used to evaluate methodological quality and the risk of bias. A pooled meta-analysis was conducted, with an assessment of heterogeneity using the Chi-square and Higgins I2 tests. A further subgroup analysis was performed between DM implants and larger femoral head (> 36 mm) FB implants.

RESULTS

A total of 13 studies met the final inclusion criteria, with an overall number of 5,004 rTHA hips included (2,108 DM and 2,896 FB). The DM implants had significantly lower odds of rerevision due to dislocation (odds ratio [OR] 0.38, P < 0.001), aseptic loosening (OR 0.54, P = 0.004), and all-cause rerevision (OR 0.55, P < 0.001) compared to FB implants. No statistically significant difference was seen in the odds of rerevision due to periprosthetic joint infection (OR 0.99, P = 0.94) or periprosthetic fracture (OR 0.59, P = 0.13) between the 2 groups. The total number of complications showed an odds benefit in favor of DM implants (OR 0.43, P < 0.001). In the subgroup analysis, there was no significant difference in the odds of rerevision due to dislocation (OR 0.69, P = 0.11) between DM and larger femoral head FB implants.

CONCLUSIONS

Based on current literature, it appears DM implants are an effective modality for reducing dislocation following rTHA with lower complication rates compared to FB implants. However, further prospective randomized controlled trials with longer term follow-up are required.

Identifying Unique Integrated Care Competencies to Inform Health Profession Curriculum Development

BACKGROUND

Integrated care can enhance health outcomes for patients, as well as improve healthcare efficiency for organisations. However, it is unclear what values and competencies health professionals need to develop at the pre-qualification stage to engage in integrated care practice upon graduation. Therefore, this review aimed to identify published integrated care competencies for professional entry health professional education programmes.

METHODS

Guided by the systematic search methods of the Preferred Reporting Items for Systematic Review and Meta-Analyses, PubMed and CINAHL were searched for publications between January 2013 and December 2022. A two-stage screening process was used to determine eligibility of papers against the set inclusion criteria.

FINDINGS

The initial search yielded 493 articles, with 35 articles eligible for full text screening. Of these, five articles addressed integrated care curriculum in a general sense and were included in the review. The focus of these articles was mainly educational activities and professional attributes deemed important for students to experience and develop if they are to work across sectors and systems. However, no studies described a specific set of integrated care competencies for students enrolled in any health discipline at professional entry level.

DISCUSSION

Since our review, several frameworks covering a broad range of professional competency domains for integrated care have been recently published. A distillation of these frameworks is now needed to identify the unique capabilities required for new health professionals to deliver integrated care.

CONCLUSION

Educators now need specific integrated care competencies so they can create appropriate, learning, teaching and assessment experiences for pre-entry students.

Assessing methodological quality of systematic reviews with meta-analysis about clinical pharmacy services: A sensitivity analysis of AMSTAR-2

BACKGROUND

Systematic reviews are critical for evidence-based healthcare decisions, but their validity depends on the quality of conduct and reporting. AMSTAR-2, a widely used tool for assessing the quality of systematic reviews, identifies seven critical domains influencing review validity, although its developers recommend flexibility in prioritizing these domains. To date, no studies have analyzed the impact of this change on systematic reviews with meta-analysis (SRMAs) evaluating clinical pharmacy services.

OBJECTIVE

To evaluate the quality of SRMAs on clinical pharmacy services and the effect of modifying AMSTAR-2 domains criticality on quality assessment.

METHODS

Systematic searches (updated January 1, 2023) were conducted in PubMed, Scopus, and Web of Science to identify SRMAs reporting the effects of clinical pharmacy services. Manual reference list searches of included studies were also performed. The methodological quality of SRMAs was assessed using the AMSTAR-2 tool. Changes in the overall classification of each SRMA were analyzed by hypothetically removing the critical designation for domains in the original tool.

RESULTS

Out of 153 eligible SRMAs, 138 (90.2 %) were classified as critically low quality, 13 (8.5 %) as low quality, and 2 (1.3 %) as moderate quality. Despite slight improvement in methodological quality over time, this change was not directly linked to the creation of various reporting and conducting guidelines and registries. Our analysis showed that the hypothetical removal of the criticality of each AMSTAR-2 domain did not significantly impact the overall quality assessment. Furthermore, all critical domains in AMSTAR-2 are considered essential in the field of pharmacy practice.

CONCLUSION

Most SRMAs on clinical pharmacy services were classified as low or critically low quality and modifying the AMSTAR-2 domain criticality did not improve these assessments. Researchers, journal editors, and peer reviewers must work to enhance SRMAs quality, which are crucial for providing robust evidence for pharmaceutical services.

Racial-Ethnic Disparities in Hearing Aid Use: Price Responsiveness Among Older Adults with Hearing Loss

OBJECTIVE

To explore the role of racial-ethnic background, income, residential context, and historic variation in hearing aid (HA) price HA usage among a nationally representative cohort of older adults with hearing loss.

METHODS

Multilevel logistic regression models evaluated data from the 2012 through 2017 Medical Expenditure Panel Survey (MEPS) to 1) compare historic HA use between subgroups, 2) test for differential responsiveness to price changes between racial and ethnic groups, and 3) assess the relative role of demographic characteristics and HA use.

RESULTS

Between 2012 and 2017, the price of economy HAs decreased by 5% while HA use among Non-Hispanic (NH) Whites and Hispanics with hearing loss increased by 30% and 20% respectively, but usage among NH-Blacks increased by less than 10%. After controlling for relevant covariates, NH-Blacks were two times less likely than NH-Whites to use a HA. Household income and price were only significant for NH-Whites who showed that a 1% increase in income was associated with a 10% increase in the likelihood of HA use. Calculation of subgroup participation showed that, when the price of HAs dropped by 1%, the likelihood of HA use by NH-Whites increased by 14.2%, Hispanics increased by 13.2%, and Others increased by 14.8%, but only 2.8% among NH-Blacks.

CONCLUSION

Results suggest that cost is not the primary barrier to HA utilization among minoritized individuals from racial and ethnic groups. Additional analyses are needed to evaluate the role of social, cultural, and environmental influences on HA utilization.

Implementing and Delivering Culturally Centred Pharmacy Services Tailored to Ethnically Minoritised Populations: A Qualitative Systematic Review and Meta-Ethnography

INTRODUCTION

Health inequities disproportionately affect people from ethnic minority communities and require a comprehensive effort across healthcare disciplines to tackle them. Ethnically minoritised populations continue to be underserved, despite the growing awareness of the detrimental link between ethnicity and poorer health- and medication-outcomes. Pharmacy has been recognised as an accessible and inclusive healthcare setting, with the ability to meet diverse patient needs. Yet, there still remain distinct gaps in knowledge of how to best design, implement and deliver culturally centred pharmacy services for members of ethnic minority communities.

METHODS

A systematic literature search was undertaken in November 2023, across four databases: MEDLINE, Embase, CINAHL and PsycINFO. Qualitative studies were included if they addressed barriers, enablers and interventions aimed at tackling medicines- and health service inequalities affecting people from ethnic minority communities. Study quality was assessed using the Joanna Briggs Institute critical appraisal checklist. Data were synthesised using a meta-ethnographic approach, according to Noblit and Hare, forming a qualitative evidence synthesis to further understanding.

RESULTS

This meta-ethnographic systematic review synthesised data from 13 international studies eligible for inclusion. Four overarching third-order constructs (termed 'themes') were developed through reciprocal translation and focused on: (i) navigating pharmacy systems across the globe; (ii) understanding cultural needs and beliefs that may influence medicine use; (iii) strengthening relationships with pharmacists and other healthcare providers and (iv) addressing possible language and communication barriers.

CONCLUSION

Pharmacists and policymakers should aim to raise awareness of pharmacy services, increase the provision of cultural competency training within the profession, build stronger relationships with minority communities, and facilitate access to interpretation services. A template of recommendations has been developed to further implement and deliver such services on an individual pharmacy-, community- and profession-basis. Future research should seek to utilise lived-experience narratives and participatory co-design methods to further explore ways to address wider healthcare accessibility inequalities for this minoritised population.

PATIENT OR PUBLIC CONTRIBUTION

Public contributors and authors (inequity research champions, G.K. and T.G.) informed and shaped this project during study design and conceptualisation; they helped to ensure that the study was conducted, and the findings were reported, with sensitivity.

Remote workers' life quality and stress during COVID-19: a systematic review

COVID-19 pandemic led to the adoption of a different working approach: "The remote working." Evidence about the association of remote working with stress outcomes and life quality is lacking. This systematic review provides an overview of the effects of COVID-19 pandemic on remote-workers' stress and life quality. We conducted systematic literature searches in databases including Pubmed, Scopus and Web of science, from September 2020 to September 2023. Screening of titles, abstracts, and full texts were performed according to the Preferred Reporting Item for Systematic Review and Meta-analyses. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. The review highlighted possible predictors (work-family conflict or a condition of social isolation) associated with improvement or worsening of quality of life and stress. The results highlighted the association between stress and family difficulties (β: -0.02, P-value <0.05), isolation during the first (β: -0.22, P-value <0.05) and second pandemic waves (β: -0.40, P-value <0.05) or due to the advancing age of workers (β:0.19, P-value <0.05) and (β: -0.05, P-value <0.05), furthermore some job categories presented greater stress such as teachers (16.94 ± 5.46). Conversely, remote working positively affected life quality, enhancing factors such as creativity (Average Variance Extracted, AVE: 0.41, R2: 0.17) and self-efficacy (AVE: 0.60, R2: 0.36). Future research should focus more on the relationship between work and family and on interventions that counteract social isolation.

Complications of Endonasal Odontoidectomy in Pediatric versus Adult Populations: A Systematic Review and Meta-Analysis

Introduction  Endonasal odontoidectomy (EO) is a procedure for addressing compressive pathology of the craniovertebral junction. While EO has been well established in adults, its complications and cervical fusion practices are less understood in pediatric patients, despite differences in sinonasal and craniocervical anatomy. This study summarizes and compares EO complications and need for cervical fusion in pediatric and adult patients. Methods  This was a systematic review and meta-analysis. Literature review was conducted using PubMed, Web of Science, and Embase to identify studies reporting complications post-EO in adult and pediatric patients. Complications were categorized as neurologic, swallowing, or respiratory. Complication and posterior fusion rates were compared using a random-effects model. Results  A total of 738 articles were identified, of which 28 studies including 307 adult cases and 22 pediatric cases met inclusion criteria for systematic qualitative and quantitative review. The rates for adult and pediatric cases, respectively, were: respiratory complications 13.4 versus 9.1%, swallowing complications 12.1 versus 4.5%, neurologic complications 8.5 versus 9.1%, and cervical fusion rates 73.3 versus 86.4%. Across eight studies qualifying for meta-analysis, there were no differences in cervical fusion (odds ratio [OR]: 0.5, 95% confidence interval [CI]: [0.1, 2.1]), respiratory complications (OR: 3.5, 95% CI: [0.8, 14.5]), or swallowing complications (OR: 3.5, 95% CI: [0.5, 26.0]); however, pediatric patients had a higher rate of neurologic complications (OR: 5.2, 95% CI: [1.1, 25.0]). Conclusion  In EO, rates of aerodigestive complications and cervical fusion are similar in both populations. There may be an increased risk of neurologic complications in pediatric patients, although more high-quality studies are needed.

Small intestinal bacterial overgrowth in chronic liver disease: an updated systematic review and meta-analysis of case-control studies

Background

Small Intestinal Bacterial Overgrowth (SIBO) has been implicated in the pathophysiology of chronic liver disease (CLD). We conducted a systematic review and meta-analysis to assess and compare the prevalence of SIBO among CLD patients (with and without with complications of end stage liver disease) and healthy controls.

Methods

Electronic databases were searched from inception up to July-2024 for case-control studies reporting SIBO in CLD. Prevalence rates, odds ratios (ORs), and 95% confidence intervals (CIs) of SIBO in patients with CLD and controls were calculated utilizing a random-effects model. The protocol was prospectively registered with PROSPERO (CRD42022379578).

Findings

The final dataset included 34 case-control studies with 2130 CLD patients and 1222 controls. Overall, the odds for SIBO prevalence in CLD patients compared to controls was 6.7 (95% CI 4.6-9.7, p < 0.001). Although the prevalence of SIBO among patients with CLD with cirrhosis was higher at 42.9% (95% CI: 35.9-50.2) compared to 36.9% (95% CI: 27.4-47.6) in those without cirrhosis, this difference failed statistical significance. However, CLD patients with decompensated cirrhosis had a significantly higher prevalence of SIBO compared to those with compensated cirrhosis, with an OR of 2.6 (95% CI: 1.5-4.5, p < 0.001). Additionally, the prevalence of SIBO was significantly higher in CLD patients with portal hypertension (PHT) than in those without PHT, with an OR of 2.1 (95% CI: 1.4-3.1, p < 0.001). The highest prevalence of SIBO was observed in patients with spontaneous bacterial peritonitis (SBP) (57.7%, 95% CI 38.8-74.5), followed by patients with hepatic encephalopathy (41.0%, 95% CI 16.0-72.3) and patients with variceal bleed (39.5%, 95% CI 12.1-75.6).

Interpretation

Overall, there is a significantly increased prevalence of SIBO in CLD patients compared to controls. The prevalence is even higher in CLD patients with PHT, especially those with SBP. This meta-analysis suggests that SIBO is associated with complications of CLD and potentially linked to the progression of CLD.

Funding

National Health and Medical Research Council, Centre for Research Excellence (APP170993).

Ovarian-stimulating drug use and risk of ovarian tumor in infertile women: a meta-analysis

OBJECTIVE

To explore whether ovarian-stimulating drugs increase the risk of ovarian cancer in infertile women.

METHODS

This meta-analysis involved searching PubMed, Cochrane Library, Web of Science, and Embase. The methodological quality of observational studies was assessed using the modified Newcastle-Ottawa Scale. Data were summarized as OR with 95% CIs. The primary objective was to assess the effect of ovarian-stimulating drugs on ovarian tumors and the secondary objective was to assess this effect in different sub-groups.

RESULTS

Forty studies were eligible for this meta-analysis. Overall, compared with unexposed infertile women and unexposed general population, ovarian-stimulating drugs increased the risk of invasive ovarian cancer (OR 1.23, 95% CI 1.14 to 1.32, p =.001) and borderline cancer (OR = 1.32, 95% CI 1.19 to 1.47, p < .001) in women receiving any fertility drugs. Our sub-group analysis showed a higher risk of both invasive and borderline ovarian cancer in infertile women using ovarian-stimulating drugs compared to infertile women with no exposure and the general unexposed population. An increased risk of ovarian cancer was observed in nulliparous women, but not in parous women. In addition, a cumulative clomiphene dose of <900 mg and a number of gonadotropin cycles ≥6 were factors that increased the risk of invasive ovarian cancer. Combined treatment with clomiphene and gonadotropin was associated with an increased risk of borderline cancer. Risk analyses further revealed that prolonged use of oral contraceptives (>60 months) and a family history of ovarian cancer significantly increased the odds of developing ovarian cancer among women treated with ovarian-stimulating drugs.

CONCLUSION

Our study showed that ovarian-stimulating drugs increased the risk of ovarian tumors.

Biopsychosocial Approaches for the Management of Female Chronic Pelvic Pain: A Systematic Review

BACKGROUND/OBJECTIVE

Current guidelines recommend biopsychosocial-informed treatment for chronic pelvic pain (CPP). The objective of this systematic review was to describe the available biopsychosocial approaches for the treatment of CPP, and the outcomes reported, to understand how guideline-recommended treatments can be applied.

SEARCH STRATEGY

MEDLINE, CINAHL, PsycINFO, EMBASE, Emcare, AMED and Cochrane trial registries were searched (inception to 17 November 2023).

SELECTION CRITERIA

CPP Studies in women where the principal treatment modality was a biopsychosocial approach were included. Prospero registration: CRD42022374256.

DATA COLLECTION/ANALYSIS

Data extraction included study setting, population, study design, intervention characteristics and outcome measures and is described via a narrative synthesis.

RESULTS

The review included 14 RCTs (871 patients) and identified four broad intervention categories (Acceptance Commitment Therapy n = 2, Cognitive Behavioural Therapy n = 6, Mindfulness-based approaches n = 2, and Physiotherapy-based interventions n = 4). Pain science education (PSE) and, exposure/engagement with valued activity were recognised as important aspects of treatment regardless of intervention type. The most utilised outcomes were pain reduction and emotional functioning, with all studies reporting improvements in these domains. Heterogeneity in outcomes prevented efficacy comparison. High risk of bias was identified in six studies (1/4 physiotherapy-based approaches, 2/6 CBT, 1/2 ACT and 2/2 mindfulness-based interventions).

CONCLUSIONS

CBT and ACT-based biopsychosocial approaches were found effective in reducing pain and improving psychometric outcomes for CPP. Evaluation indicated PSE, and exposure/engagement in valued activity are important components of biopsychosocial management. Outcome heterogeneity needs to be addressed in future trials.

Femoral tunnel length does not impact outcomes following ACL reconstruction using a single-bundle quadriceps tendon autograft: A systematic review

PURPOSE

To determine whether femoral tunnel length (FTL) affects clinical or functional outcomes following primary Anterior cruciate ligament reconstruction (ACLR) with single-bundle quadriceps tendon autograft, both with and without a patellar bone block.

METHODS

An electronic search of MEDLINE, EMBASE, and Cochrane databases was carried out via OVID. Data pertaining to study characteristics, patient demographics, surgical techniques, femoral tunnel length, and subjective/objective clinical outcomes was abstracted. Studies were stratified into two groups based on FTL; a short femoral tunnel (S-FT) group of ≤25 mm, and a long femoral tunnel (L-FT) group of >25 mm. There was a high degree of heterogeneity between studies, prohibiting meta-analysis.

RESULTS

Seven studies comprising 368 total patients with a mean age of 30.3 years (range: 23.4-34 years) were included for analysis. The S-FT group included 126 patients and the L-FT group 242 patients. Both groups demonstrated statistically significant postoperative improvements across both subjective and objective clinical and functional outcomes. Average complication rates were 11.9% (range: 0%-29%) in the S-FT group and 4.5% (range: 1%-14%) in the L-FT group. Ranges of re-rupture rates were 0%-2% and 0%-3% for the S-FT and L-FT groups, respectively (n.s.).

CONCLUSION

Both S-FT and L-FT groups demonstrated comparable postoperative outcomes following primary ACLR with single bundle quadriceps tendon autograft. There were slightly superior, although non-significant, outcomes reported with short femoral tunnel length, however, this may have been confounded by the variation in surgical technique used.

LEVEL OF EVIDENCE

Level IV.