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

Injury risk profile for soccer players: identification of the risk factors for soccer-related injuries - an umbrella review

This review aimed to identify risk factors for soccer injuries and provide researchers the needed elements to build a soccer-player's injury risk profile. An umbrella review was conducted following the PRIOR criteria (OSF registration link: https://osf.io/jr7xe/). A literature search was run to identify studies investigating soccer-related injury risk factors. We included systematic reviews published between 2013 and 2023 related to soccer and analysed the identified risk factors to classify these in intrinsic and extrinsic, group in categories and identify relationships between risk factors and injury location. Among 240 risk factors, 181 (75.4%) were classified as intrinsic and 59 (24.6%) as extrinsic. We grouped risk factors in 14 categories. Finally, we found relationships between risk factors and injury locations for 159 factors, with the knee representing the body area most affected by risk factors (N = 101), followed by the ankle (N = 65) and the thigh (N = 65).

Digital Health Interventions to Improve Mental Health in Patients With Cancer: Umbrella Review

BACKGROUND

Mental health plays a key role across the cancer care continuum, from prognosis and active treatment to survivorship and palliative care. Digital health technologies offer an appealing, cost-effective tool to address psychological needs.

OBJECTIVE

This umbrella review aims to summarize and evaluate the available evidence on the efficacy of digital health interventions for improving mental health and psychosocial outcomes for populations with cancer.

METHODS

Literature searches were conducted in Embase, PsycINFO, PubMed, CINAHL, the Cochrane Library, and Web of Science from their inception to February 4, 2024. Systematic reviews (with or without meta-analysis) investigating the efficacy of digital health interventions for psychosocial variables in patients with cancer were included. Quality was assessed using the Assessing the Methodological Quality of Systematic Reviews-2 tool.

RESULTS

In total, 78 systematic reviews were included in this review. Among diverse delivery modalities and types of digital interventions, websites and smartphone apps were the most commonly used. Depression was the most frequently addressed, followed by quality of life, anxiety, fatigue, and distress. The qualities of the reviews ranged from critically low to high. Generally, despite great heterogeneity in the strength and credibility of the evidence, digital health interventions were shown to be effective for mental health in patients with cancer.

CONCLUSIONS

Taken together, digital health interventions show benefits for patients with cancer in improving mental health. Various gaps were identified, such as little research specifically focusing on older adult patients with cancer, a scarcity of reporting high-precision emotion management, and insufficient attention to other certain mood indicators. Further exploration of studies with standardized and rigorous approaches is required to inform practice.

TRIAL REGISTRATION

PROSPERO CRD42024565084; https://tinyurl.com/4cbxjeh9.

SGLT2 Inhibitors in COVID-19: Umbrella Review, Meta-Analysis, and Bayesian Sensitivity Assessment

BACKGROUND

Several studies have reported a reduced risk of COVID-19-related mortality in patients taking antidiabetic medications. This is an umbrella review, meta-analysis, and Bayesian sensitivity assessment of SGLT2 inhibitors (SGLT2is) in COVID-19 patients with type 2 diabetes mellitus (T2DM).

METHODS

A search was conducted on the MEDLINE (PubMed), EMBASE, Cochrane, and ClinicalTrials.gov databases on 5/12/2023. We performed an umbrella review of systematic reviews and meta-analyses on the effects of SGLT2is in T2DM patients with COVID-19 and critically appraised them using AMSTAR 2.0. Trials investigating SGLT2i use in COVID-19 patients post-hospitalisation and observational studies on prior SGLT2i use among COVID-19 patients were included in the meta-analysis, adhering to the PRISMA guidelines.

RESULTS

SGLT2is exhibited significantly lower odds of mortality (OR 0.67, 95% CI 0.53-0.84) and hospitalisation (OR 0.84, 0.75-0.94) in COVID-19 patients with T2DM. Bayesian sensitivity analyses corroborated most of the findings, with differences observed in hospitalisation and mortality outcomes. SGLT-2 inhibitors showed an OR of 1.20 (95% CI 0.64-2.27) for diabetic ketoacidosis. Publication bias was observed for hospitalisation, but not for mortality. The GRADE assessment indicated a low to very low quality of evidence because of the observational studies included.

CONCLUSIONS

The prophylactic use of SGLT2is reduces mortality and hospitalisation among COVID-19 patients, particularly in patients with diabetes. The utility of SGLT2is after hospitalisation is uncertain and warrants further investigation. A limited efficacy has been observed under critical conditions. Individualised assessment is crucial before integration into COVID-19 management.

Use and impact of digital technology in supporting health providers deliver care in low- and low-middle-income countries: A systematic review protocol

BACKGROUND

Healthcare providers are critical to the successful, sustainable and impactful implementation of digital health. Despite the growing interest, Digital Health Innovations (DHIs) are often implemented without sufficient evidence, leading to numerous short-lived projects and a limited understanding of their impact on health systems and outcomes. In 2023, the World Health Organization (WHO) introduced a new Classification of Digital Health Interventions, identifying four core DHI user groups. This review aims to synthesise evidence on the impact of DHIs designed for one of these user groups-healthcare providers-on delivering health services in low- and lower-middle-income countries (LLMICs).

METHODS

We will conduct an umbrella review, analysing systematic reviews on DHIs for healthcare providers. Data will be extracted using deductive coding before being thematically analysed according to the 11 DHIs for service providers outlined in the WHO's 2023 Classification.

DISCUSSION

This umbrella review will explore, synthesise, and evaluate the quality of evidence on how healthcare providers in LLMICs utilise DHIs to address service delivery challenges and their effectiveness. To our knowledge, this is the first comprehensive synthesis of evidence focused on DHIs designed for use by healthcare providers in LLMICs. It is also the first review to align with WHO's taxonomy for DHIs, as outlined in the WHO Classification of Digital Interventions, Services and Applications in Health.

SYSTEMATIC REVIEW REGISTRATION

The protocol is being registered in PROSPERO (ID: CRD42024586285).

Effects and parameterization of low-level laser therapy in diabetic ulcers: an umbrella review of systematic reviews and meta-umbrella

This study aimed to systematically verify the available systematic reviews and meta-analyses of Low-level laser therapy (LLLT) in diabetic foot ulcer (DFUs) to identify the effects and optimal parameters of LLLT in the management of DFUs. This umbrella review was written according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) report items and registered in the International Prospective Register of Systematic Review (PROSPERO). The search for articles was performed in the Pubmed, Scopus, Web of Science and Embase databases. The following terms were used: Diabetic Foot, Diabetic Neuropathies, Peripheral Vascular Diseases, Peripheral Neuropathy, Diabetic Foot Ulcer, LASER Therapy, Low-Level Light Therapy, LLLT, LASER Biostimulation, Low Intensity LASER Irradiation, Low Power LASER Irradiation, Low Intensity LASER Therapy, Low Power LASER Therapy. A search was performed in the references section of the included studies. The systematic review (SR) included studies that compared LLLT with non-therapeutic doses (parameters considered low to modify healing), sham irradiation, and conventional DFU treatment. The interventions were performed using red and infrared wavelengths. Although two studies included in the SR used wavelengths below 600 nm, these were combined with diodes with infrared wavelengths within the same device. Another study performed a comparative analysis of LLLT at different wavelengths (632 nm and 904 nm), with area reduction rates of 63.7% and 56.8%, respectively, with no statistically significant difference. This is study indicated that, compared with standard treatment and non-irradiation treatments, the use of photobiomodulation (PBM) with different parameters was effective in promoting UPD healing. Further studies are warranted to determine the ideal parameters for improving patient outcomes. (International Prospective Register of Systematic Review Registration number: CRD42022362447).

Risk factors for developing irritable bowel syndrome: systematic umbrella review of reviews

BACKGROUND

Irritable bowel syndrome (IBS) is a debilitating disorder affecting 4-9% of the global population. It is a multifaceted disorder with complex and varied causes. This review aims to consolidate the evidence regarding IBS risk factors by examining existing systematic reviews and meta-analyses, covering potential genetic, immunological, psychological, and dietary causes.

METHODS

Systematic literature searches were conducted in MEDLINE, Embase and Cochrane library databases. Study selection and data extraction were conducted independently by four authors, with discrepancies resolved by consensus with a senior author. Systematic reviews examining risk factors of IBS development were eligible for review. Results were narratively synthesized. Quality of reviews were analysed using AMSTAR 2, and evidence were appraised using GRADE methodology.

RESULTS

A total of 69 systematic reviews were included in this study. Most reviews were of "critically low" quality, while the remaining were "low" quality. Common shortcomings included the absence of a list of excluded studies with justifications for their exclusion and inadequate consideration of the risk of bias in individual studies. Eight major categories of risk factors for IBS identified were as follows: dietary, genetic, environmental, psychological, gut microbiome, socio-economic, physiological, and pathological, albeit overlaps exist. The most frequently reported risk factors for IBS development were female gender and anxiety disorders, with overall GRADE evaluation of "low"; depression and gastroenteritis, with overall GRADE evaluation of "moderate".

CONCLUSIONS

Clinical practice should prioritize recognition of these risk factors. Future reviews should improve their reporting of results based on the PRISMA guidelines, to enhance the quality of research in this field.

PROTOCOL REGISTRATION

PROSPERO CRD42023493739.

Epidemiology, literacy, risk factors, and clinical status of oral cancer in East Africa: A scoping review

BACKGROUND

Oral cancer (OC) is a topical public health issue in East Africa due to increasing incidence of the disease. Public health efforts to address the oral cancer burden depends largely on the available empirical evidence. Hence, this scoping review aims to map the existing empirical evidence on oral cancer in East African countries.

METHODS

The Preferred Reporting Items for Systematic Review and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR) was used as a guideline for reporting this scoping review. Additionally, we ensured quality assessment of the methodology and reporting process of this study using the AMSTAR 2 checklist. We conducted a systematic search of nine research databases on 17th November 2023, and reviewed studies published in English from year 2000 to 17th November 2023. The team developed data extraction form and data extraction was done by two reviewers. Thematic analyses were conducted manually and presented in texts, tables and flow chart.

RESULTS

Only 30 full manuscripts were included in this review. Twenty-nine out of 30 studies were either hospital- or clinic-based while two were community-based. Only four studies showed gaps and obvious disparities in awareness and knowledge levels across East Africa, however, higher levels of awareness were reported among dentists and dental patients relative to the general population. Most neoplasms were presented and diagnosed late. The review finding also highlighted the significant impact of Toombak use on the oral microbiome composition, potentially contributing to oral cancer risks. Further, this review elucidated the prognostic relevance of PD-L1 expression at the invasive tumor front and microbial composition, with Candida correlating with adverse prognosis and Malassezia showing associations with improved survival rates. Also, Toombak usage, tumor staging, and mucosal field alterations emerged as predictors of local recurrence, while lymph node involvement and extranodal extension were associated with regional recurrence among Sudanese cohorts. Finally, a few studies undertook an evaluation of instrument validity for OC detection, revealing promising outcomes concerning diagnostic accuracy and instrument reliability.

CONCLUSIONS

There is a dire need for targeted interventions and early detection strategies tailored to the unique epidemiological and clinical profiles of oral and maxillofacial tumors in East Africa. Public health interventions aimed at curbing the prevalence of Toombak use and promoting healthier lifestyle choices to reduce the oral diseases incidence in Sudan and other regions where these behaviors are prevalent remain germane.

An evidence mapping study based on systematic reviews of traditional Chinese medicine (TCM) for diabetic retinopathy

BACKGROUND

Diabetic retinopathy (DR) is a leading cause of vision impairment and blindness among individuals with diabetes. Traditional Chinese medicine (TCM) has been explored as an alternative treatment for DR, but the quality of evidence remains uncertain. A comprehensive evidence mapping study is necessary to synthesize existing SRs, identify gaps in the literature, and highlight areas requiring further research.

OBJECTIVE

This study aims to evaluate the reporting and methodological quality of SRs on TCM for DR and to assess the effectiveness of TCM interventions using an evidence-mapping approach.

METHODS

A comprehensive search of major biomedical databases to identify relevant SRs published up to November 2023. The reporting quality of the included SRs was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, while the methodological quality was evaluated using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) tool.

RESULTS

A total of 51 SRs involving 131,084 participants were included in the analysis. Evidence mapping indicated that TCM is relatively effective in treating DR. However, the methodological quality and reporting standards of these SRs were generally suboptimal. According to the AMSTAR 2 assessment, only one SR (2%) was rated as high quality, 29 SRs (56.9%) were of moderate quality, 20 SRs (39.2%) were of low quality, and one SR (2%) was of critically low quality. While all studies adequately reported the PICO components, risk of bias assessment, and statistical methods, none provided information on funding sources. Furthermore, only one study (2%) included a list of excluded studies with reasons, and eight SRs (15.7%) documented pre-specified protocols. Common reporting deficiencies included incomplete protocol and registration details, unclear review rationales, and insufficient presentation of relevant outcome data.

CONCLUSION

This evidence mapping study highlights the potential benefits of TCM for treating DR while identifying significant gaps in the existing literature. Although TCM interventions show potential benefits for treating DR, the overall quality of SRs is suboptimal. Future research should focus on addressing these gaps, particularly in areas such as funding disclosure and methodological rigor, to enhance the reliability of evidence on TCM interventions for DR.

Antrum Resection Versus Preservation Following Laparoscopic Sleeve Gastrectomy in the Treatment of Obesity: A Meta-Analysis of Randomized Controlled Trials and Systematic Review

BACKGROUND

Laparoscopic sleeve gastrectomy (LSG) has been proven to be an effective surgical method for managing morbid obesity. However, the extent of the antral excision remains controversial. In this meta-analysis, we evaluated the safety and efficacy of LSG with antral resection (AR) and antral preservation (AP).

MATERIALS AND METHODS

The PubMed, Embase, Cochrane Library, and Google Scholar databases were systematically searched for randomized clinical trials (RCTs) from their inception dates to March 2024. The main outcomes were the percentage of excess weight loss (%EWL), percentage of total weight loss (%TWL), and BMI at 3, 6, 12, and 24 months postsurgery.

RESULTS

Fourteen RCTs comprising 1222 patients were included in the study. The %EWL was significantly lower in the AP group at 6 (mean difference [MD]: -5.65 and p = 0.003), 12 (MD: -5.08 and p < 0.00001), and 24 (MD: -5.23 and p = 0.0004) months. The %TWL was significantly lower in the AP group at 3 (MD: -4.63 and p = 0.02), 6 (MD: -3.98 and p < 0.0001), and 12 (MD: -4.63 and p < 0.00001) months. BMI was lower in the AR group at 3 (MD: 1.81 and p = 0.007) and 6 (MD: 2.39 and p = 0.002) months. No significant difference was found in surgical time and de novo gastroesophageal reflux disease; however, the AP group demonstrated significantly longer hospital stays and a lower rate of late vomiting.

CONCLUSION

LSG with AR yields better weight loss than LSG with AP but may lead to a higher rate of late vomiting.

Perceptions, experiences, barriers, facilitators, learning outcomes, and modes of assessment of digital clinical placements for pre-registration physiotherapy students internationally: a systematic review protocol

INTRODUCTION

The shift to digital clinical placements for physiotherapy education due to COVID-19 prompts a need for evaluation of current evidence. Existing studies highlight benefits of digital technology in clinical placements, but lack of a systematic review focused on pre-registration physiotherapy students is a key gap. This systematic review will address this gap by synthesizing the evidence for digital clinical placements for pre-registration physiotherapy students internationally.

METHODS AND ANALYSIS

This systematic review is designed using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) statement and Cochrane Handbook - it is registered on PROSPERO (CRD42024571696). Search terms will be adapted to each database, including EMBASE, MEDLINE, PROSPERO, ERIC, and CINAHL. Key journals, forward citation tracking, references of included studies, and professional organization websites will also be searched. The search will include studies published since database inception to 31/05/24. There will be no limit to study design or language. Studies that report on perceptions, experiences, barriers, facilitators, learning outcomes, and modes of assessment of digital clinical placements for pre-registration physiotherapy students will be included. Meta-aggregation will be used to synthesize themes from findings which enables the generation of themes without the need to re-interpret data and the loss of study specific context.

ETHICS AND DISSEMINATION

Ethics approval is not required. The results of this study will be written up for publication in relevant peer-reviewed scientific journals and contribute to a developing area of research. Results will also be presented at national or international conferences, events for the physiotherapy profession, or education events.

Does transurethral resection of the prostate before robot-assisted radical prostatectomy have adverse effects on patients diagnosed with prostate cancer: a comparative evidence-based analysis?

In clinical practice, it is not uncommon for a history of trans-urethral resection of the prostate (TURP) to complicate a future robotic-assisted radical prostatectomy (RARP). This study aims to determine if prior TURP adversely affects outcomes in subsequent RARP, analyzing perioperative, functional, and oncological results between the procedures. Research published in English before September 2024 was systematically reviewed using Web of Science, PubMed, Cochrane Library, and the EMBASE. Review Manager 5.4 was used to do the meta-analysis, included 15 studies, with 869 patients who underwent RARP following TURP and 5,879 patients who underwent RARP alone. Compared to standard RARP, RARP following TURP was associated with extended operative time (OT) (WMD: 26.63 min, 95% CI: 16.79-36.48, P < 0.00001), increased estimated blood loss (EBL) (WMD: 19.85 ml, 95% CI: 9.22-30.48, P = 0.0003), longer hospital stay(LOS) (WMD: 0.52 days, 95% CI: 0.28-0.77, P < 0.0001), and extended catheter removal duration (WMD: 0.18 days, 95% CI: 0.02-0.35, P = 0.03). The overall nerve-sparing success rate was lower (OR: 0.53, 95% CI: 0.35-0.78, P = 0.001), with reduced bilateral nerve-sparing success rates (OR: 0.58, 95% CI: 0.39-0.84, P = 0.005). Patients in the TURP group had higher rates of bladder neck reconstruction (OR: 8.38, 95% CI: 5.80-12.10, P < 0.0001) and major complications (Clavien grade ≥ 3) (OR: 1.94, 95% CI: 1.10-3.41, P = 0.02). Furthermore, the positive surgical margin (PSM) rate was elevated in the prior-TURP group (OR: 1.25, 95% CI: 1.02-1.53, P = 0.03). Quality-of-life outcomes indicated that patients undergoing RARP after TURP experienced lower urinary incontinence recovery rates at one year (OR: 0.58, 95% CI: 0.34-0.97, P = 0.04) and reduced continence recovery rates (OR: 0.60, 95% CI: 0.44-0.81, P = 0.007). Nevertheless, there were no notable differences between the two groups in terms of the rates of transfusions, unilateral nerve-sparing, lymphadenectomy, minor complications (Clavien grade < 3), or biochemical recurrence (BCR) after a year. Although RARP after TURP is achievable, it is notably more complex. Findings suggest that while the surgical difficulty is increased, oncological and functional outcomes for the prior-TURP group remain comparable to the non-TURP group. This research aims to provide clinicians with data to support informed decision-making when treating individuals who have experienced TURP in the past.

Effectiveness of clinical healthcare interventions for enhancing the work participation of patients with various health conditions: a synthesis of systematic reviews

OBJECTIVES

This objectives of this study were to determine the effectiveness of clinical healthcare interventions designed for improving the work participation of patients with various health conditions and identify promising elements within these interventions.

DESIGN

A systematic literature search was conducted, and a synthesis of systematic reviews (SRs) was performed.

DATA SOURCES

MEDLINE, Embase, Cochrane Library and CINAHL were searched for articles published from January 2012 to December 2023.

ELIGIBILITY CRITERIA

SRs of randomised controlled trials evaluating the effectiveness of interventions that aimed at improving work participation initiated within clinical healthcare in patients being treated for various health conditions were included.

DATA EXTRACTION AND SYNTHESIS

Two authors independently used standardised methods to search and select SRs, and extract data. Our primary outcome was work participation, which could include return-to-work rate or sick leave duration. We were interested in both short-, medium-, as well as long-term outcomes. Risk of bias was assessed using the AMSTAR-2 tool. We used Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to evaluate the certainty of the evidence and findings were summarised in GRADE evidence profiles. We used a deductive synthesis to identify promising intervention elements.

RESULTS

The health conditions included in the selected SRs were cancer, chronic low back and musculoskeletal pain, coronary heart disease, inflammatory arthritis, complaints of the lumbopelvic region during pregnancy, stroke and traumatic brain injury. Across health conditions, many interventions trended towards small, favourable effects. Moderately certain evidence showed that multidisciplinary and physical interventions enhance work participation at 12 months for people with cancer (risk ratio (RR) 1.23, 95% CI 1.09 to 1.33 and RR 1.23, 95% CI 1.08 to 1.39, respectively), and that multidisciplinary interventions reduce the days of return to work compared with usual care for people with coronary heart disease (40.77 days lower than control, 95% CI -67.19 to -14.35). Low-certainty evidence suggested that multidisciplinary interventions may enhance work participation at 12 months for people with coronary heart disease (RR 1.56, 95% CI 1.23 to 1.98) and reduce the number of sick leave days at 12 months for people with chronic low back pain (82, IQR 51 to 164 vs 175, IQR 91 to 365; p=0.003). Promising elements included (psycho)education, cognitive-behavioural therapy, psychosocial support, group and vocational counselling and physical training.

CONCLUSIONS

There is considerable overlap in clinical healthcare interventions that aim to enhance work participation for patients across health conditions. Although their effects on work participation vary, some conditions show favourable response to multidisciplinary interventions. More evidence is needed on developing tailored interventions and evaluating their cost-effectiveness.

PROSPERO REGISTRATION NUMBER

CRD42022346552.

Digital health interventions to treat overweight and obesity in children and adolescents: An umbrella review

Digital health interventions can support the treatment of overweight and obesity in children and adolescents, yet primary research and systematic reviews leave uncertain evidence. In this umbrella review of reviews and meta-analyses, we methodologically appraise and investigate the effects of digital health interventions used to manage overweight and obesity in children. Systematic searches were conducted in July 2023 in Medline (Ovid), CINAHL (EBSCOhost), Cochrane, EMBASE (Ovid), PsycINFO (Ovid), Epistemonikos and Web of Science (Core Collection). Reports on experiences and/or effectiveness of digital health interventions aimed at treating children with overweight or obesity aged 0 to 19 years and/or their parents were eligible for inclusion. Screening, data extraction, and methodological appraisal were conducted in blinded pairs of researchers. In total, the searches identified 2927 citations, of which 16 reviews and 10 meta-analyses, reporting on 162 distinct primary studies, were included. Effects on anthropometric measures of all digital health interventions were small when analyzing BMI and BMI-z-scores combined. Future research should strive to conduct more homogeneous and solid research, employing robust designs, standardized outcomes, and a longer follow-up time. Designing digital health interventions for the future should to a larger extent include end-users to ensure usability and relevance for the population, adding significance to the interventions that are evaluated.

Efficacy and safety of regorafenib in the treatment of bone sarcomas: systematic review and meta-analysis

BACKGROUND

Metastatic or recurrent bone sarcomas are often associated with an unfavorable prognosis, posing a formidable challenge in extending patients' survival. Currently, regorafenib has shown promise in treating metastatic and recurrent bone sarcomas. However, there is a lack of consensus on its efficacy and safety. This systematic review and meta-analysis aims to consolidate existing data to assess the efficacy and safety of regorafenib in bone sarcomas.

METHODS

A comprehensive search strategy utilizing MeSH terms and free-text keywords was employed to systematically search the Embase, PubMed, Web of Science, and Cochrane databases up to May 26, 2024. Randomized controlled trials investigating regorafenib monotherapy for metastatic or recurrent bone sarcomas were included. The primary outcomes of interest were progression-free survival (PFS), overall survival(OS) and adverse events (AEs).

RESULTS

We retrieved 335 articles and included 5 of them. Regorafenib significantly extended PFS-3 months and PFS-6 months in patients with metastatic or recurrent bone sarcomas compared to the control group, exhibiting a favorable odds ratio (OR) of 2.04 (95% CI: 1.21-2.86, P < 0.01) and 1.03 (95% CI: 0.08-1.99, P < 0.05), respectively. However, regorafenib did not improve OS at any observation point compared with the control group(P > 0.05), and the frequency of AEs was higher, with an odds ratio of 1.35 (95% CI: 0.63-2.07, P < 0.01).

CONCLUSION

Regorafenib emerges as a promising therapeutic option for metastatic or recurrent bone sarcomas, demonstrating certain clinical benefits alongside manageable adverse reactions. Nevertheless, further research is warranted to refine the efficacy and safety profile of regorafenib, particularly in exploring safe dosage ranges or alternative treatment modalities.

REGISTRATION NUMBER

CRD42024551705.

Outcomes of Metabolic and Bariatric Surgery in Populations with Obesity and Their Risk of Developing Colorectal Cancer: Where Do We Stand? An Umbrella Review on Behalf of TROGSS-The Robotic Global Surgical Society

Introduction: Obesity is a chronic disease associated with increased risk for several cancers, including colorectal cancer (CRC), a leading cause of cancer-related mortality. The majority of CRC cases are associated with modifiable risk factors. Metabolic and bariatric surgery (MBS) is a proven, durable, and successful intervention for obesity. This study aimed to evaluate the impact of MBS on CRC risk through measures of association, such as relative risk (RR) and odds ratio (OR). Methods: A systematic search of PubMed, Scopus, Web of Science, ScienceDirect, and Embase was conducted to identify systematic reviews (SR) and meta-analyses examining the relationship between obesity treated with MBS and CRC incidence. The PICO framework guided inclusion criteria, and three independent reviewers screened articles using Rayyan software. Quality assessment was performed using AMSTAR2. Results: Of 1336 screened articles, 10 SR met inclusion criteria, encompassing 53,452,658 patients. Meta-analyses consistently showed a significant reduction in CRC risk following MBS in patients with severe obesity. Risk reductions were reported by Liu et al. (RR: 0.46, 95% CI: 0.32-0.67, p < 0.01), Chierici et al. (RR: 0.46, 95% CI: 0.28-0.75, p = 0.018), Wilson et al. (RR: 0.69, 95% CI: 0.53-0.88, p = 0.003), and Pararas et al. (RR: 0.56, 95% CI: 0.40-0.80, p < 0.001). Sensitivity analyses supported these findings. For colon cancer, Liu and Chierici both reported an RR of 0.75 (95% CI: 0.46-1.21, p = 0.2444) with significant heterogeneity (I2 = 89%). A trend towards reduced rectal cancer risk (RR: 0.74, 95% CI: 0.40-1.39, p = 0.3523) was noted but limited by fewer studies. Sex-specific analyses revealed protective effects in both sexes, with a more pronounced impact in females (RR: 0.54, 95% CI: 0.37-0.79, p = 0.0014). Conclusions: This umbrella review synthesizes current evidence on the impact of MBS on CRC risk, highlighting a consistent protective association. The findings also indicate a potential risk reduction for both colon and rectal cancer, with a more pronounced effect observed among females compared to males. Given the profound implications of MBS on cancer incidence, morbidity, and mortality, further high-quality, long-term studies are essential to deepen our understanding and optimize its role in cancer prevention and patient care.

Genicular artery embolization for knee osteoarthritis: a systematic review with meta-analysis and cost-analysis

OBJECTIVE

To assess the effectiveness, safety, and cost-effectiveness of genicular artery embolization (GAE) for the treatment of mild or moderate knee osteoarthritis (KO) refractory to standard treatment, and/or severe KO in individuals not eligible for surgery.

METHOD

We conducted a systematic review with meta-analysis, supplemented by a cost-analysis, comparing GAE and standard treatment, from the perspective of the Spanish National Health System (NHS) over a one-year time horizon. The health improvement required for GAE to be deemed cost-effective was quantified, considering a willingness-to-pay threshold of 25 000 €/quality-adjusted life year (QALY).

RESULTS

We included two randomized controlled trials in our analysis. Pain estimates showed inconsistent results, and no significant effects were observed for overall function, health-related quality of life, or changes in the need for pain management medication. No serious complications or major adverse events were observed. GRADE quality of evidence ranged from moderate to low. No economic evaluations were identified. Our cost-analysis revealed that GAE would result in an incremental cost of € 3432.37 per patient, requiring a health improvement of 0.137 QALY per patient to be deemed a cost-effective technology.

CONCLUSIONS

In summary, based on moderate to low-certainty evidence, it remains inconclusive whether there is any difference between GAE and standard treatment for KO. However, the use of GAE would increase the costs. Larger randomized controlled trials are needed to determine the effects of using GAE for chronic pain secondary to KO and, consequently, to ascertain whether this technology could potentially become cost-effective from the NHS perspective.

Effect of semaglutide with obesity or overweight individuals without diabetes: an Umbrella review of systematic reviews

OBJECTIVE

Summarize the effectiveness and safety of Semaglutide for non-diabetic obese patients through umbrella analysis.

METHODS

From inception to May 2024, we searched PubMed, EMbase, Web of Science, and The Cochrane Library for a systematic review and meta-analysis of semaglutide in non-diabetic obesity. AMSTAR-2 assessed review quality, ROB scrutinized RCT quality, and RCTs were selected based on overlap. Random-effects meta-analysis synthesized data on weight, waist, BMI, ect.

RESULTS

The study encompassed 7 reviews and 10 RCTs, revealing that semaglutide induced average weight loss 11.71 kg [-13.16, -10.26] in non-diabetic obese patients, a 12.79% reduction [-14.4, -11.18]. Notably, ≥5, ≥10, ≥15, and ≥20% weight-loss rates significantly increased. Semaglutide also reduced waist by 9.39 cm [-10, -8.79], BMI by 4.27 kg/m^2 [-4.78, -3.75], SBP by 4.78 mmHg [-5.63, -3.93], DBP by 2.56 mmHg [-3.96, -1.17], and lipids by 3.2 mmol/l [-5.65, -0.75]. FBG significantly dropped by 5.46 mmol/l [-8.99, -1.93], and SF-36 scores improved by 1.7 points [0.78, 2.63]. However, common adverse reactions included nausea [RR: 2.59], diarrhea [RR: 1.77], and constipation [RR: 2.07].

CONCLUSIONS

Semaglutide shows significant weight loss and health benefits in non-diabetic obesity. However, Recent studies show semaglutide can cause NAION and erectile dysfunction, beyond previously reported adverse reactions. Besides, High overlap in current research highlights a lack of RCTs. And there is a high degree of heterogeneity across included studies. More large-scale, rigorous RCTs are needed to assess safety and support clinical use.

REGISTER

The study was registered at PROSPERO on 24 December 2023 (registration number:CRD42023493235).

Gender, race and ethnicity biases experienced by hospital physicians: an umbrella review to explore emerging biases in the evidence base

OBJECTIVES

To examine the authorship and content of systematic reviews (SRs) of biases experienced by medical professionals through a gender lens.

DESIGN

Review of SRs.

DATA SOURCES

We searched PubMed, Embase, PsycINFO and CINAHL from inception. Searches were conducted in May 2022 and updated in October 2023.

ELIGIBILITY CRITERIA

Reviews of studies reporting biases experienced by hospital physicians at any stage of their careers and in any country. Reviews were included if they used systematic methods to search the literature and synthesise the data. Non-English language publications were excluded.

DATA EXTRACTION AND SYNTHESIS

The main theme of each eligible review was identified through qualitative thematic analysis. We used NamSor to determine the first/last authors' gender and computed the proportion of female authors for each review theme.

RESULTS

56 articles were included in the review. These covered 12 themes related to gender, race and ethnicity bias experienced by physicians at any stage of their careers. The overall proportion of female authors was 70% for first authors and 51% for last authors. However, the gender of authors by theme varied widely. Female authors dominated reviews of research on discrimination and motherhood, while male authors dominated reviews on burnout, mental health and earnings. Only six reviews were identified that included race and ethnicity; 9 out of the 12 first and last authors were female.

CONCLUSIONS

Understanding the potential for a gendered evidence base on biases experienced by hospital physicians is important. Our findings highlight apparent differences in the issues being prioritised internationally by male and female authors, and a lack of evidence on interventions to tackle biases. Going forward, a more collaborative and comprehensive framework is required to develop an evidence base that is fit for purpose. By providing a point of reference, the present study can help this future development.

PROSPERO REGISTRATION NUMBER

CRD42021259409; Pre-results.

Global lens of Willems' method for dental age estimation: where we are and where we are going - umbrella review

This umbrella review aimed to evaluate the evidence behind the Willems method for dental age estimation and detect methodological limitations in the existing systematic reviews. The study followed the Preferred Reporting Items for Overviews of Reviews (PRIOR), with the protocol registered in PROSPERO (CRD42023487745). Seven databases, including grey literature sources, were searched (Medline/PubMed, Scopus, LILACS, SciELO, Web of Science, Open Grey and Open Access Theses and Dissertations). Systematic reviews of cross-sectional studies on the Willems method were included. Two calibrated reviewers independently conducted study selection, data extraction, quality assessment (AMSTAR-2) and risk of bias (ROBIS). Five systematic reviews published between 2017 and 2022 were included. Combined sample sizes ranged from 9347 to 17,741 individuals aged 2.2 to 18 years. Meta-analyses reported minor overestimations in dental age, with differences varying by sex and ethnicity. However, significant methodological shortcomings were identified, such as lack of protocol registration, limited search strategies, and inadequate assessment of the risk of bias. All systematic reviews were rated as critically low quality and with a high risk of bias. The Willems method was deemed appropriate for dental age estimation by most studies, but methodological limitations of existing systematic reviews underscore the need for more rigorous research and improved standards.

Preventing psychosis in people at clinical high risk: an updated meta-analysis by the World Psychiatric Association Preventive Psychiatry section

Recently published large-scale randomised controlled trials (RCTs) have questioned the efficacy of preventive interventions in individuals at clinical high risk for psychosis (CHR-P). We conducted a systematic review and meta-analysis to include this new evidence and provide future directions for the field. We followed the PRISMA guidelines and a pre-registered protocol, with a literature search conducted from inception to November 2023. We included RCTs that collected data on psychosis transition (the primary outcome) in CHR-P. Secondary outcomes were symptoms severity and functioning. Investigated time points were 6,12,24,36, and +36 months. We used odd ratios (ORs) and standardised mean differences (SMD) as summary outcomes. Heterogeneity was estimated with the Higgins I2. Twenty-four RCTs, involving 3236 CHR-P individuals, were included. Active interventions were Cognitive Behavioural Therapy (CBT), family-focused therapy, Integrated Psychological Therapy, antipsychotics, omega-3 fatty acids, CBT plus risperidone, minocycline, and other non-pharmacological approaches (cognitive remediation, sleep-targeted therapy, brain stimulation). Results showed no evidence that any of the investigated active interventions had a sustained and robust effect on any of the investigated outcomes in CHR-P, when compared to control interventions, including CBT on transition to psychosis at 12 months (9 RCTs; OR: 0.64; 95% CI: 0.39-1.06; I2: 21%; P = 0.08). These results highlight the need for novel treatment approaches in CHR-P. Future studies should consider the heterogeneity of this clinical population and prioritise stratification strategies and bespoke treatments.

Laparoscopic radical antegrade modular pancreatosplenectomy vesus laparoscopic distal pancreatosplenectomy for left-sided pancreatic cancer: a systematic review and meta-analysis

Objective

We aimed to compare the perioperative outcomes and postoperative complications of laparoscopic radical antegrade modular pancreatosplenectomy (L-RAMPS) versus laparoscopic distal pancreatosplenectomy (L-DPS) for left-sided pancreatic cancer through a meta-analysis.

Methods

A systematic review and meta-analysis, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, were performed. Literature searches were conducted in PubMed, Web of Science, Cochrane Library, and Embase for studies published from their inception up to June 14th, 2024.

Results

A total of three retrospective studies involving 242 patients were included in this meta-analysis, with 116 patients in the L-RAMPS group and 126 in the L-DPS group. The meta-analysis results indicated that L-RAMPS was associated with the retrieval of more lymph nodes (MD: 3.06; 95% CI: 2.51 to 3.62, p < 0.00001) and longer operative time (MD: 20.05; 95% CI: 13.97 to 26.12, p < 0.00001) compared to L-DPS for left-sided pancreatic cancer patients. However, no significant differences were observed between the two groups in terms of R0 resection margins, the incidence of pancreatic fistula (Grade B and C), postpancreatectomy hemorrhage, or postoperative complications (Clavien-Dindo Grades II and III).

Conclusions

In patients with left-sided pancreatic cancer, L-RAMPS resulted in the retrieval of more lymph nodes, a longer operative time, and a similar incidence of postoperative complications compared to L-DPS. Larger sample sizes, extended follow-up periods, and well-conducted randomized controlled trials are needed to further validate these findings.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=558977, identifier CRD42024558977.

Maternal Phenylketonuria and Offspring Outcome: A Retrospective Study with a Systematic Review of the Literature

Background: Phenylketonuria (PKU) poses significant challenges for maternal and neonatal outcomes, requiring strict adherence to dietary protocols to maintain optimal maternal phenylalanine (Phe) levels during pregnancy. This study retrospectively analyzed outcomes of pregnancies in PKU-affected women and conducted a systematic review on the timing of dietary management and its impact on outcomes. Methods: This retrospective study included data from nine PKU-affected women and 14 pregnancies followed at the Regional Reference Center for Metabolic Diseases in Catania. Women were categorized based on the timing of dietary intervention: preconception (pcD), during pregnancy (pD), or never (nD). Maternal Phe levels were classified as in-target (tP+) or non-target (tP-). A systematic review of the literature was conducted using PRISMA methodology, including 77 studies reporting maternal Phe levels, dietary timing, and clinical/auxological offspring outcomes. Results: In the retrospective study, pcD and tP+ groups had significantly better neonatal outcomes, with lower rates of congenital heart disease (CHD), facial dysmorphisms, intrauterine growth restriction (IUGR), and microcephaly. Systematic review data from 1068 PKU-affected women and 2094 pregnancies revealed that pcD with tP+ resulted in the lowest rates of miscarriage (0.14%) and adverse neonatal outcomes, while tP- and nD groups showed the highest rates of CHD, microcephaly, and intellectual disability. Conclusions: Early dietary intervention, ideally preconceptionally, and achieving target maternal Phe levels are critical in reducing adverse outcomes in pregnancies of PKU-affected women. These findings emphasize the importance of metabolic control and adherence to dietary protocols in maternal PKU management.

Creating and Publishing Systematic Reviews, Meta-analyses, and Scoping Reviews: A 10-step Guide for Students and Trainees

This article serves as a step-by-step guide for students and trainees who wish to conduct a systematic review, meta-analysis, or scoping review. As the field of evidence synthesis progresses, more students and trainees are attempting to conduct reviews, and it can be unclear how to approach such a project. In 10 organized steps, we describe different types of reviews, explain how to choose the most appropriate one, detail the steps involved in conducting a review, and list resources that are available to support authors of reviews. We describe the steps involved in 1) forming an appropriate research team; 2) developing a compelling research question; 3) writing a review; and 4) reporting the findings with clarity.

Interventions for Digital Addiction: Umbrella Review of Meta-Analyses

BACKGROUND

Numerous studies have explored interventions to reduce digital addiction outcomes, but inconclusive evidence makes it difficult for decision-makers, managers, and clinicians to become familiar with all available literature and find appropriate interventions.

OBJECTIVE

This study aims to summarize and assess the certainty of evidence of interventions proposed to decrease digital addiction from published meta-analyses.

METHODS

An umbrella review of published meta-analyses was performed. We searched PubMed, Cochrane Library, Web of Science, and Embase for meta-analyses published up to February 2024. Eligible studies evaluated interventions using randomized controlled trials, nonrandomized controlled trials, or quasi-experimental studies and were assessed for methodological quality using Assessment of Multiple Systematic Reviews version 2. A random effects model was used to analyze data, considering heterogeneity and publication bias. Grading of Recommendations, Assessment, Development, and Evaluations was applied to assess evidence with certainty.

RESULTS

A total of 5 studies assessing 21 associations were included in the umbrella review, of which 4 (80%) were high-quality meta-analyses. Weak evidence was observed in 19 associations, whereas null associations appeared in the remaining 2 associations. These associations pertained to 8 interventions (group counseling, integrated internet addiction [IA] prevention programs, psychosocial interventions, reality therapy, self-control training programs, cognitive behavioral therapy, interventions to reduce screen time in children, and exercise) and 9 outcomes (self-control, self-esteem, internet gaming disorder symptoms, time spent gaming, IA scores, screen use time, interpersonal sensitivity longlines, anxiety, and depression). Cognitive behavioral therapy reduces anxiety (standardized mean difference [SMD] 0.939, 95% CI 0.311 to 1.586), internet gaming disorder symptoms (SMD 1.394, 95% CI 0.664 to 2.214), time spent gaming (SMD 1.259, 95% CI, 0.311 to 2.206), and IA scores (SMD -2.097, 95% CI -2.814 to -1.381). Group counseling had a large effect on improving self-control (SMD 1.296, 95% CI 0.269 to 2.322) and reducing IA levels (SMD -1.417, 95% CI -1.836 to -0.997). Exercise intervention reduced IA scores (SMD -2.322, 95% CI -3.212 to -1.431), depression scores (SMD -1.421, 95% CI -2.046 to -797), and interpersonal sensitivity scores (SMD -1.433, 95% CI -2.239 to -0.627).

CONCLUSIONS

The evidence indicates that current interventions to reduce digital addiction are weak. Data from more and better-designed studies with larger sample sizes are needed to establish robust evidence.

TRIAL REGISTRATION

PROSPERO CRD42024528173; crd.york.ac.uk/PROSPERO/display_record.php?RecordID=528173.

Treatments of Interest in Male Breast Cancer: An Umbrella Review

Background: Male breast cancer (MaBC) is a rare disease and due to its rarity and the lack of specific protocols for its management, treatment algorithms are extrapolated from female breast cancer (FBC). To optimize MaBC treatment, we conceived an umbrella review with the aim of supplying an evidence-based summary of systematic reviews published about this topic in the last twenty years. Methods: This umbrella review was performed according to a predefined protocol (PROSPERO number CRD42024574299). We performed a literature search of the PubMed and Cochrane Libraries databases and we considered systematic reviews on MaBC treatment published from 2004 to 2024. We evaluated relevant treatments in the management of MaBC, including surgery, radiotherapy, and systemic treatments. We conducted the quality assessment according to A MeaSurement Tool to Assess systematic Reviews version 2 (AMSTAR-2), and the description of the main findings of eligible articles. Results: Seven systematic reviews were selected and the main findings were compiled. Breast-conserving surgery is a reasonable treatment approach and, in selected cases, equivalent in terms of safety and survival outcomes compared to mastectomy. Sentinel lymph node biopsy represents a successful surgical practice with similar accuracy compared to female cases. Adjuvant radiotherapy improves overall survival in MaBC patients following partial mastectomy and after radical mastectomy, in case of involved nodes. Finally, Tamoxifen is associated with an improvement of survival outcomes; aromatase inhibitor and gonadotrophin-releasing hormone should be used only in case of contraindications to tamoxifen. Conclusions: Further research and improved guidelines for MaBC treatment should consider these evidence-based data.

Comparison of tenofovir versus entecavir for preventing hepatocellular carcinoma in chronic hepatitis B patients: an umbrella review and meta-analysis

There are several meta-analyses about the comparison of tenofovir disoproxil fumarate (TDF) versus entecavir (ETV) for preventing hepatocellular carcinoma in patients with chronic HBV infection published in recent years. However, the conclusions vary considerably. This umbrella review aims to consolidate evidence from various systematic reviews to evaluate differences in hepatocellular carcinoma prevention between two drugs. Systematic searches were conducted using PubMed, Embase, and Web of Science to identify original meta-analyses. Finally, twelve studies were included for quantitative analyses. We found that TDF treatment was associated with a significantly lower risk of HCC than ETV (hazard ratio, 0.80; 95% CI 0.75-0.86, p < 0.05). The lower risk of HCC in patients given TDF compared with ETV persisted in subgroup analyses performed with propensity score-matched cohorts, cirrhosis cohorts, nucleos(t)ide naïve cohorts and Asian cohorts. In the cohorts of non-Asia and patients without cirrhosis, there was no difference exhibited between these two drugs. Subsequent analyses showed TDF treatment was also associated with a lower incidence of death or transplantation than patients receiving ETV. Overall, the preventive effect of these two drugs on HCC has been studied in several published meta-analyses, but few were graded as high-quality evidence, meanwhile, most of which had high overlap. Thus, future researchers should include updated cohorts or conduct prospective RCTs to further explore this issue.

The Future of Breast Cancer Organized Screening Program Through Artificial Intelligence: A Scoping Review

Objective: The aim of this scoping review was to evaluate whether artificial intelligence integrated into breast cancer screening work strategies could help resolve some diagnostic issues that still remain. Methods: PubMed, Web of Science, and Scopus were consulted. The literature research was updated to 28 May 2024. The PRISMA method of selecting articles was used. The articles were classified according to the type of publication (meta-analysis, trial, prospective, and retrospective studies); moreover, retrospective studies were based on citizen recruitment (organized screening vs. spontaneous screening and a combination of both). Results: Meta-analyses showed that AI had an effective reduction in the radiologists' reading time of radiological images, with a variation from 17 to 91%. Furthermore, they highlighted how the use of artificial intelligence software improved the diagnostic accuracy. Systematic review speculated that AI could reduce false negatives and positives and detect subtle abnormalities missed by human observers. DR with AI results from organized screening showed a higher recall rate, specificity, and PPV. Data from opportunistic screening found that AI could reduce interval cancer with a corresponding reduction in serious outcome. Nevertheless, the analysis of this review suggests that the study of breast density and interval cancer still requires numerous applications. Conclusions: Artificial intelligence appears to be a promising technology for health, with consequences that can have a major impact on healthcare systems. Where screening is opportunistic and involves only one human reader, the use of AI can increase diagnostic performance enough to equal that of double human reading.

Dissemination strategies of clinical practice guidelines-mixed methods evidence synthesis protocol

Clinical practice guidelines (CPGs) are shared through various dissemination strategies using a range of dissemination products and channels. However, users may have different needs for accessing and understanding them. Patients and carers from low- and middle-income countries might face challenges in accessing CPGs such as inadequate systems for printed book distribution and insufficient and substandard photocopies. Many organizations offer lengthy documents, but busy healthcare workers may prefer shorter, digital versions. Digital CPGs can be sent through different channels such as email, newsletters, or social media. How users feel about these products (e.g., clinical protocol, educational material or decision aids) and how it affects the usage of CPGs is not well understood. In addition to these issues, most of the previous systematic reviews on this topic have clubbed the dissemination strategies along with the adoption of recommendations or implementation aspects. There is a need for evidence on the existing dissemination strategies disentangled from the implementation aspects. We aim to conduct a mixed-methods systematic review to identify documented dissemination strategies for CPGs, barriers and facilitators to access such strategies and the expectations and needs of end users regarding dissemination needs. We will search literature from MEDLINE, Embase, CINAHL, Web of Science, Scopus, Epistemonikos, Agency for Healthcare Research and Quality and Medical Guidelines Clearing house. We will critically appraise all the included studies using appropriate tools based on the study design. We will use manifest content analysis to identify documented dissemination strategies and latent content analysis to understand the barriers, facilitators, preferences of end-users. We intend to follow the convergent matrix model approach for this mixed methods evidence synthesis. We anticipate that this mixed-methods systematic review will highlight the various strategies of dissemination of CPGs and the associated barriers and facilitators.

Implications of five endoscopic and conventional open surgery on lateral neck dissection outcomes in patients with papillary thyroid carcinoma: a network meta-analysis and systematic review

OBJECTIVES

The efficacy and safety of different surgical approaches to thyroidectomy with lateral neck dissection remain unclear. This study aims to evaluate five endoscopic and open techniques for thyroidectomy with lateral neck dissection and identify the most effective method.

METHODS

A systematic search was conducted in PubMed, Web of Science, Embase, and the Cochrane Library for studies comparing different surgical approaches across multiple outcome indicators. The risk of bias was analyzed, and publication bias was assessed using funnel plot asymmetry tests. Both global and local inconsistency tests were performed to evaluate the agreement between direct and indirect comparisons. Pairwise and network meta-analyses were conducted for each outcome, with approaches ranked using Surface Under the Cumulative Ranking (SUCRA) values and curves.

RESULTS

A total of 1251 patients across 13 clinical studies were included in the analysis. No significant statistical differences were found among the approaches for lymph node dissection and postoperative recurrence rates. The bilateral axillary breast approach yielded the highest number of lymph nodes (SUCRA value: 0.762). The suprasternal fossa approach had the lowest postoperative recurrence rate (SUCRA: 0.657) and performed well in metastatic lymph node dissection (SUCRA: 0.679). The bilateral axillary breast approach significantly reduced postoperative complication rates compared to the open and transaxillary approaches (mean differences: - 1.88 and - 0.23; 95% confidence intervals: - 3.87 to - 0.46 and - 0.62 to 0.29, respectively) and was the most effective in minimizing complications (SUCRA: 0.910). Open surgery demonstrated a significantly shorter operative duration.

CONCLUSION

Endoscopic approaches are viable and safe alternatives to open surgery, with fewer postoperative complications, albeit at the cost of longer operative durations.

A foundation systematic review of natural language processing applied to gastroenterology & hepatology

OBJECTIVE

This review assesses the progress of NLP in gastroenterology to date, grades the robustness of the methodology, exposes the field to a new generation of authors, and highlights opportunities for future research.

DESIGN

Seven scholarly databases (ACM Digital Library, Arxiv, Embase, IEEE Explore, Pubmed, Scopus and Google Scholar) were searched for studies published between 2015 and 2023 that met the inclusion criteria. Studies lacking a description of appropriate validation or NLP methods were excluded, as were studies ufinavailable in English, those focused on non-gastrointestinal diseases and those that were duplicates. Two independent reviewers extracted study information, clinical/algorithm details, and relevant outcome data. Methodological quality and bias risks were appraised using a checklist of quality indicators for NLP studies.

RESULTS

Fifty-three studies were identified utilising NLP in endoscopy, inflammatory bowel disease, gastrointestinal bleeding, liver and pancreatic disease. Colonoscopy was the focus of 21 (38.9%) studies; 13 (24.1%) focused on liver disease, 7 (13.0%) on inflammatory bowel disease, 4 (7.4%) on gastroscopy, 4 (7.4%) on pancreatic disease and 2 (3.7%) on endoscopic sedation/ERCP and gastrointestinal bleeding. Only 30 (56.6%) of the studies reported patient demographics, and only 13 (24.5%) had a low risk of validation bias. Thirty-five (66%) studies mentioned generalisability, but only 5 (9.4%) mentioned explainability or shared code/models.

CONCLUSION

NLP can unlock substantial clinical information from free-text notes stored in EPRs and is already being used, particularly to interpret colonoscopy and radiology reports. However, the models we have thus far lack transparency, leading to duplication, bias, and doubts about generalisability. Therefore, greater clinical engagement, collaboration, and open sharing of appropriate datasets and code are needed.

The efficacy and safety of current treatment of vulvovaginal candidiasis: An umbrella review of systematic reviews and meta-analyses

Vulvovaginal candidiasis (VVC) is one of the most common infections of the genital tract in women of reproductive age. In this umbrella review, we aim to summarize all the existing literature about different treatment strategies for vulvovaginal candidiasis. This umbrella review adhered to the PRISMA guidelines, systematically searching databases including Scopus, PubMed, and Web of Science for meta-analyses for assessing different treatment methods for vaginal candidiasis until September 2024. Data extraction focused on outcome metrics, and methodological quality assessed via the AMSTAR-2 checklist. In our study, we have included a total of five articles. Within pharmacological interventions, treating individuals with fluconazole, ketoconazole, clotrimazole, and oteseconazole has demonstrated a significant reduction in the risk of mycological recurrence at the 12-month mark. Moreover, women who were treated with fluconazole experienced fewer episodes of VVC recurrence immediately after treatment, as well as at the 3- and 6-month follow-up periods when compared to those who received a placebo. In terms of non-pharmacological interventions, the combination therapy involving Redcore lotion alongside miconazole exhibited more substantial results in decreasing episodes of VVC compared to miconazole used alone. Furthermore, our results revealed a negative correlation between probiotic consumption and the rate of recurrence. In the end, we examined the primary treatment methods for vulvovaginal candidiasis and highlighted that, apart from azoles and antibiotics, emerging treatments such as probiotics and Redcore, along with certain established antibiotics, can also be considered viable options. More studies are needed to find more effective treatments as well as treatments for specific conditions such as pregnancy or immunodeficiency.

Association Between Vitamin D and COVID-19-Related Outcomes: An Umbrella Review of Meta-Analyses

CONTEXT

COVID-19 remains globally pandemic, and although several meta-analyses have explored the association between vitamin D and COVID-19 relative to clinical outcomes, a unified view has not yet emerged.

OBJECTIVE

To summarize the evidence for associations between vitamin D levels and COVID-19-related clinical outcomes and to assess the strength and validity of these associations.

DATA SOURCES

PubMed, Embase, Web of Science, Scopus, and the Cochrane Database of Systematic Reviews databases were searched from January 1, 2020, to June 15, 2024.

DATA EXTRACTION

Two reviewers independently extracted data and assessed study quality.

DATA ANALYSIS

Low vitamin D levels increased the risk of infection by 1.26- to 2.18-fold, the risk of severe illness by 1.50- to 5.57-fold, the risk of intensive care unit (ICU) admission by more than 2-fold, and the risk of death by 1.22- to 4.15-fold. In addition, patients with vitamin D deficiency had an average increase in length of hospital stay of 0.54 days compared with patients with high vitamin D levels. Overall, vitamin D supplementation may reduce severity (eg, ICU admissions, need for mechanical ventilation) and shorter length of hospital stay but has a nonsignificant effect on infection and mortality rates. In addition, there were significant differences in vitamin D levels between individuals testing positive for COVID-19 and those testing negative (mean difference [MD] = -3.22 ng mL-1; 95% CI, -5.18 to -1.25), those with severe cases and those with mild cases (MD = -4.60 ng mL-1; 95% CI, -5.49 to -3.71), and nonsurvivors and survivors of COVID-19 infection (MD = -6.59 ng mL-1; 95% CI: -8.94 to -4.24).

CONCLUSIONS

Low vitamin D levels are associated with higher infection rates, more severe disease, and higher mortality rates among individuals with COVID-19, whereas vitamin D supplementation may reduce patients' disease severity. The beneficial effects on infection rates and mortality remain to be further explored, however, in higher-quality, randomized controlled studies. Nonetheless, caution is warranted because the methodological quality of most meta-analyses and the level of evidence for most outcomes are very low.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration No. CRD42022385036.

Heart disease in pregnancy and adverse outcomes: an umbrella review

Background

Heart disease in pregnancy encompasses both congenital heart disease and maternal-acquired heart disease, both of which are associated with an increased risk of various adverse outcomes for mothers and their offspring.

Objective

The objective of the study was to review and summarize the evidence regarding the association between heart disease in pregnancy and adverse outcomes in mothers and their offspring.

Data sources

A comprehensive search was conducted in Embase, PubMed, Web of Science, and the Cochrane Database of Systematic Reviews from inception to March 2024. The protocol for this review was registered in PROSPERO (CRD42024519144).

Study eligibility criteria

This review included systematic reviews and meta-analyses that examined the association between heart disease in pregnancy and adverse outcomes for mothers and their offspring.

Study appraisal and synthesis methods

Data were independently extracted by two reviewers. The quality of the systematic reviews and meta-analyses was assessed using the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR2), while Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to evaluate the strength of the evidence for each outcome.

Results

A total of 12 meta-analyses and systematic reviews were included, which documented 156 adverse outcomes for mothers and 65 adverse outcomes for offspring. Evidence was found for both primary and secondary adverse outcomes. Adverse outcomes for mothers were death, cardiac events (cardiac arrest, heart failure, surgery, arrhythmia, anesthesia or sedation, endocarditis, mitral regurgitation, myocardial infarction, NYHA III-IV, restenosis, syncope, and others), pulmonary events (respiratory failure, pulmonary edema, and respiratory support), embolism, cerebrovascular events, postpartum hemorrhage, arterial events, delivery mode, and hospital stay. Adverse outcomes for offspring were death, pregnancy loss, growth restriction, low birth weight, preterm birth, recurrence, and uncertainty. No publication bias was detected using Egger's test. The overall AMSTAR 2 confidence rating for the included meta-analyses and systematic reviews was moderate. The majority (55.3%) of the evidence evaluated by GRADE was of low quality, while the remaining outcomes were categorized as having "very low"-quality evidence.

Conclusion

Current evidence links heart disease during pregnancy to adverse maternal outcomes, including death and cardiac, pulmonary, and cerebrovascular events, as well as increased mortality risk for offspring. Many meta-analyses in this field have limitations that raise concerns about their validity, highlighting the need for high-quality prospective studies.

Efficacy of non-invasive brain stimulation interventions on cognitive impairment: an umbrella review of meta-analyses of randomized controlled trials

BACKGROUND

The impact of noninvasive brain stimulation (NIBS) on cognitive and mental outcomes in Alzheimer's disease (AD) and mild cognitive impairment (MCI) remains under debate due to contradictory findings from systematic reviews and meta-analyses (SRMAs). To synthesize evidence from SRMAs assessing the effectiveness of NIBS techniques on cognitive and mental outcomes in AD and MCI populations. By comparing our findings to recent reviews and clinical guidelines, we highlight how this study addresses current limitations in the literature, provides a more holistic perspective on NIBS interventions, and guides future research and clinical practice.

METHODS

We searched four databases from inception to May 15, 2024, reviewing SRMAs that analyzed the effects of NIBS. Effect sizes, 95% confidence intervals (CIs), and prediction intervals were computed for each meta-analysis. The methodological quality of the SRMAs was evaluated using the Measurement Tool to Assess Systematic Reviews 2, and the quality of evidence was assessed through the Grading of Recommendations, Assessment, Development, and Evaluation criteria.

FINDINGS

Ten SRMAs detailing 22 associations were analyzed, focusing on two NIBS techniques across 12 unique outcomes. Significant improvements were observed in global cognition, language, executive function, and memory. Repetitive transcranial magnetic stimulation (rTMS) significantly enhanced short-term global cognition (standardized mean difference [SMD], 0.44; 95% CI 0.02-0.86), language (SMD, 1.64; 95% CI 1.22-2.06), executive function (SMD, 1.64; 95% CI 0.18-0.83), and long-term global cognition (SMD, 0.29; 95% CI 0.07-0.50). Transcranial direct current stimulation (tDCS) was effective in improving memory (SMD, 0.60; 95% CI 0.32-0.89) and executive function (SMD, 0.39; 95% CI 0.08-0.71). NIBS interventions showed no significant correlation with neuropsychiatric symptoms but demonstrated good tolerability in terms of safety and acceptability.

INTERPRETATION

This umbrella review indicates that NIBS techniques, particularly rTMS and tDCS, can significantly improve cognitive functions such as global cognition, language, executive functions, and memory in patients with AD and MCI. Despite potential benefits, results should be interpreted cautiously due to study heterogeneity and methodological limitations. Future studies should investigate their long-term effects and applicability across dementia types.

Systematic reviews of the literature: an introduction to current methods

Systematic reviews are a type of evidence synthesis in which authors develop explicit eligibility criteria, collect all the available studies that meet these criteria, and summarize results using reproducible methods that minimize biases and errors. Systematic reviews serve different purposes and use a different methodology than other types of evidence synthesis such as narrative reviews, scoping reviews, and overviews of reviews. Systematic reviews can address questions regarding effects of interventions or exposures, diagnostic properties of tests, and prevalence or prognosis of diseases. All rigorous systematic reviews have common processes that include (1) determining the question and eligibility criteria, including a priori specification of subgroup hypotheses, (2) searching for evidence and selecting studies, (3) abstracting data and assessing risk of bias of the included studies, (4) summarizing the data for each outcome of interest, whenever possible using meta-analyses, and (5) assessing the certainty of the evidence and drawing conclusions. There are several tools that can guide and facilitate the systematic review process, but methodological and content expertise are always necessary.

Effectiveness and safety of percutaneous endoscopic debridement and drainage for spinal infections: a systematic review and meta-analysis

BACKGROUND

Spinal infections (SI) typically manifest with and pose a growing medical challenge. However, current evidence for treating SI is limited and inconclusive. Our aim was to assess the effectiveness and safety of percutaneous endoscopic disc decompression (PEDD) for SI.

METHODS

On 20 October 2023, we searched the EMBASE, PubMed, Cochrane Library, China Biology Medicine Disc, China National Knowledge Infrastructure, and Wanfang databases for eligible studies. Cohort studies on SI treated with PEDD, reporting relevant effectiveness or safety outcomes. We assessed study quality using a modified Newcastle-Ottawa Scale and conducted a random-effects meta-analysis to calculate pooled results.

RESULTS

Overall, 36 studies involving 925 patients were included. Erythrocyte sedimentation rate levels decreased significantly at 1-week postoperatively compared with preoperative levels (mean difference [MD] = - 13.48 [95% CI - 15.65 to - 11.31]) and continued to decrease over 3 months. Similarly, the c-reactive protein (CRP), visual analogue scale, and oswestry disability index scores significantly reduced postoperatively. The rates of excellent or good MacNab classification were 92.6% (95% CI 84.1-98.1%). Microbiological diagnostics revealed a 71.7% (95% CI 65.5-77.6%) positive rate in tissue cultures, surpassing blood cultures (odds ratio [OR] 2.72 [95% CI 1.01-7.30]). The rates of complication, reoperation, and mortality were 4.1% (95% CI 1.5-8.0%), 8.6% (95% CI 4.3-14.3%), and 1.7% (95% CI 0.4-4.1%), respectively. Subgroup analyses demonstrated a significantly lower reoperation rate in the group that discontinued antibiotics based on a normal CRP than in the fixed-duration group (2.7% [95% CI 0.3-7.7%] vs 20.1% [95% CI 14.5-26.3%], p = 0.0002). Conversely, ambulation 1 day postoperatively was associated with a higher reoperation rate than ambulation within 5-14 days (16.2% [95% CI 9.3-24.6%] vs 1.1% [95% CI 0.0-6.0%], p = 0.0060).

CONCLUSION

Our meta-analysis suggests that PEDD is a potentially effective and safe intervention for SI. Optimizing antibiotic discontinuation and postoperative care strategies may contribute to reducing reoperation rate. However, these findings require further validation from controlled studies.

Enteral Nutrition Versus a Combination of Enteral and Parenteral Nutrition in Critically Ill Adult Patients in the Intensive Care Unit: An Overview of Systematic Reviews and Meta-Analysis

Background/Objectives: Uncertainty persists about the best methods and timing for providing medical nutrition therapy (MNT) in the acute phase of critical illness. We conducted an overview of systematic reviews to examine and appraise the findings of the current systematic reviews and performed an updated meta-analysis incorporating newly published randomized controlled trials (RCTs) to investigate whether enteral nutrition (EN) is superior to the combination of EN and parenteral nutrition (PN) in patients admitted to the intensive care unit (ICU). Methods: We systematically searched three databases to retrieve systematic reviews and RCTs. Two independent reviewers performed the screening, data extraction, and quality assessment processes. The random effects model was utilized to synthesize the data regarding primary and secondary outcomes. Results: There was no difference between the two interventions regarding the efficacy and safety endpoints, apart from the bloodstream infections, which were found to be increased in the group that received the combination of EN+PN (RR = 1.27, 95%CI = 1.03 to 1.56, PI = 0.91 to 1.77, I2 = 0%). Conclusions: According to the present overview of systematic reviews and meta-analyses, there was no observed benefit on mortality, length of ICU stay or hospitalization, and duration of mechanical ventilation in critically ill patients receiving a combination of EN and PN in comparison to those receiving sole enteral nutrition in the ICU. Furthermore, no difference was observed in the rates of respiratory infections as well as the appearance of adverse events, such as vomiting and diarrhea. On the other hand, there was an increase in bloodstream infection rates in patients who received EN+PN compared to EN alone. Due to the limited implications of the results in clinical practice, further research is needed.

The effect of non-pharmacological interventions on cognitive function in cancer: an overview of systematic reviews

PURPOSE

A significant number of cancer survivors experience cancer-related cognitive impairment (CRCI), which can impact their ability to think, reason, make decisions, and perform daily actions. In recent years, non-pharmacological interventions for CRCI have gained significant attention. These interventions include exercise, cognitive behavioural therapy, cognitive training/remediation, dietary, mind-body, and multi-modal/complex interventions. This umbrella review provides a critical overview to inform guidelines and current practice, identify the most promising interventions, and uncover gaps in the research literature.

METHODS

This umbrella review of systematic reviews was pre-registered on Open Science Framework and PROSPERO. Six databases were searched. Systematic reviews (SR) assessing any non-pharmacological interventions to improve cognition in cancer (any type) were included. The overview followed gold-standard guidelines and recommendations. The results were narratively synthesised, and descriptive statistics and effect size ranges were calculated.

RESULTS

Sixty-four (n = 64) SRs were included. Results were synthesised into four non-pharmacological domains. Cognitive training/rehabilitation had the strongest evidence for efficacy. Physical activity/exercise showed promising efficacy; however, the variability of findings was considerable. Mind-body and psychological/behavioural therapy interventions were limited, but there was evidence for short-term effectiveness. Multi-modal/complex interventions showed potential for improving cognition in cancer but were poorly defined.

CONCLUSIONS

Overall, non-pharmacological interventions demonstrated efficacy for improving cognition in cancer. There were limited intervention characteristics within domains which were consistently related to efficacy. Three key recommendations are provided for future research: (1) adopt harmonisation and reporting guidelines; (2) develop definitional guidelines of cognitive domains for CRCI research; and (3) assess intervention and participant characteristics associated with positive versus null/negative findings.

Critiques of the Cass Review: Fact-Checking the Peer-Reviewed and Grey Literature

The Cass Review's final report, published in April 2024, made recommendations to the UK's National Health Service regarding structuring of services for minors with gender-related distress. It recommended cautious use of hormonal interventions in this population and use of research protocols. Some clinician-researchers disagree with the Cass Review's recommendations and have written critiques. A critique of the Cass Review posted on Yale Law School's website in July 2024 has received extensive media coverage. Its references identified three other critiques. In these papers, there were multiple claims that were incorrect or that lacked essential clarification/contextualization. These claims involved (1) the Cass Review's contents and processes; (2) the pediatric transgender healthcare evidence base; (3) existing clinical practice guidelines, including claims that there is international medical consensus; (4) evidence-based medical practice and guideline development; and (5) conclusions regarding the validity of the Cass Review's findings. The Cass Review's careful, balanced investigations and judgments were a comprehensive, evidence-based response to the controversies in this pediatric clinical arena. Recently-published critiques of the Review have contained incorrect or inadequately contextualized claims. Because accurate information about medical interventions is essential to informed consent, it is important to correct errors in potentially influential publications.

Prise en charge du trouble lié à l’usage d’opioïdes : mise à jour 2024 du guide de pratique clinique nationale

Contexte:

Dans un contexte où les pratiques et les politiques évoluent constamment, il est essentiel d’être à l’affût des plus récentes données scientifiques et de les intégrer afin d’optimiser la prise en charge des personnes atteintes d’un trouble lié à l’usage d’opioïdes. Cet article résume le nouveau guide de pratique clinique nationale de l’Initiative canadienne de recherche sur les impacts des substances psychoactives (ICRIS) sur la prise en charge clinique du trouble lié à l’usage d’opioïdes qui révise les recommandations de 2018.

Méthodes:

Aux fins de la mise à jour, nous avons suivi l’Institute of Medicine Standards for Developing Trustworthy Clinical Practice Guidelines et utilisé l’outil AGREE-REX (Appraisal of Guidelines REsearch and Evaluation—Recommendations EXcellence) pour assurer la qualité. Au terme d’une revue systématique de la littérature scientifique pertinente publiée entre le 1er janvier 2017 et le 14 septembre 2023, nous avons formulé et classé les nouvelles recommandations selon l’approche GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Un comité multidisciplinaire national externe — auquel siégeaient notamment des personnes ayant un savoir expérientiel avec le trouble lié à l’usage d’opioïdes — a procédé à une évaluation, dont les résultats ont été pris en compte dans ce guide.

Recommandations:

Sur les 11 recommandations présentées dans le guide de 2018, 3 sont restées inchangées, et les 8 autres ont été mises à jour. Quatre d’entre elles ont été combinées en 1 seule, 1 a été scindée en 2, 1 est devenue une considération particulière et 2 ont fait l’objet d’une simple révision. Les principales modifications découlent de données probantes substantielles attestant que la méthadone et la buprénorphine ont une efficacité équivalente, notamment pour diminuer l’usage d’opioïdes et les effets indésirables, et sont donc maintenant toutes deux les options thérapeutiques privilégiées de première intention. La morphine orale à libération prolongée est recommandée comme une option de deuxième intention. Il est possible d’offrir des interventions psychosociales comme traitement complémentaire, mais cela ne devrait pas être obligatoire. Le présent guide de pratique clinique réitère l’importance d’éviter de prendre en charge le sevrage comme unique intervention et d’inclure des services de réduction des méfaits fondés sur des données probantes dans le continuum de soins.

Interprétation:

La mise à jour propose de nouvelles recommandations fondées sur les dernières données probantes en vue de normaliser la prise en charge du trouble lié à l’usage d’opioïdes. L’objectif est d’établir une assise solide sur laquelle les organismes provinciaux et territoriaux pourront bâtir leurs directives sur l’optimisation des soins.

Umbrella review of adjuvant photodynamic therapy for cholangiocarcinoma palliative treatment

BACKGROUND

Cholangiocarcinoma is a rare and often fatal malignancy. Numerous studies have demonstrated promising outcomes and survival rates associated with adjuvant photodynamic therapy (PDT) in the palliative treatment of cholangiocarcinoma.

OBJECTIVE

To systematically evaluate the existing meta-analyses on PDT for cholangiocarcinoma, assessing evidence quality and strength while performing updated meta-analyses to refine survival outcomes.

METHODS

PubMed, EMBASE, Cochrane Library, and Web of Science were systematically searched up to September 18, 2024, to identify meta-analyses and clinical studies on PDT in patients with cholangiocarcinoma. The random-effects model was employed to re-synthesize existing meta-analyses, with a comprehensive evaluation of methodological quality. Updated meta-analyses of survival data were conducted, including subgroup analyses stratified by cholangiocarcinoma type and intervention modality.

RESULTS

A total of 5 meta-analyses and 21 clinical studies were included. The findings indicated that combining PDT with stenting or chemotherapy can significantly improve overall survival in patients with cholangiocarcinoma and reduce mortality rate, without increasing the risk of adverse events (AEs) such as cholangitis or abscess formation. For extrahepatic cholangiocarcinoma, adding PDT to stenting demonstrated a notable improvement in the 2-year survival rate. Meanwhile, for hilar cholangiocarcinoma, the addition of chemotherapy to PDT showed a more pronounced enhancement in the 1-year survival rate.

CONCLUSION

Current evidence indicates that PDT combined with stenting or chemotherapy in the palliative treatment of cholangiocarcinoma decreases overall mortality and enhances OS without increasing the incidence of AEs. Adding PDT to stenting or chemotherapy may be more beneficial for long-term efficacy.

The effect of propranolol on cesarean section rate in prolonged labor: a systematic review and meta-analysis

Background

Propranolol is widely recognized as a nonselective β-adrenergic receptor blocker known to enhance uterine activity in both pregnant and non-pregnant women. Prolonged labor and serious concerns about maternal and neonatal health prompted us to investigate medical issues. The aim of this systematic review and meta-analysis was to assess the effect of propranolol on cesarean deliveries during prolonged labor.

Methods

A systematic search was conducted in databases including PubMed, Cochrane CENTRAL, Science Direct, Google Scholar, Embase, and Web of Science from inception to 1 November 2023. We included randomized clinical trials that evaluated maternal and neonatal outcomes in patients receiving intrapartum propranolol during prolonged labor. Unadjusted risk ratios with 95% confidence intervals were calculated using a fixed-effects model. The I2 statistic was used to measure and assess heterogeneity. The primary outcome was cesarean delivery rate, and secondary outcomes included Apgar score, cord arterial pH, neonatal birth weight, neonatal intensive care unit admission, postpartum hemorrhage, and composite maternal and neonatal morbidity.

Results

Of the 704 identified articles, six were included in the meta-analyses. There was a significant difference in cesarean deliveries between propranolol and placebo (RR 0.80, 95% confidence interval 0.59-1.09, P = 0.02). In addition, there was no significant difference between study groups in secondary outcomes.

Conclusion

In this meta-analysis, a notable reduction in cesarean rates was observed when propranolol was given to women in prolonged labor. The results of this meta-analysis show that the use of propranolol safely reduces the need for cesarean deliveries due to labor arrest disorders.

Efficacy of telerehabilitation for patients after hip fracture surgery: A systematic review and meta-analysis

INTRODUCTION

This study aimed to determine the efficacy of telerehabilitation for patients after hip fracture surgery through a systematic review and meta-analysis.

METHODS

Eight electronic databases were searched in August 2022. The primary outcomes were mobility outcomes, activities of daily living (ADL) outcomes, and all adverse events, whereas the secondary outcomes were pain, health-related quality of life, and fall efficacy scale score.

RESULTS

Seven randomized controlled trials were eligible for this study. The evidence regarding the effect of telerehabilitation on mobility outcomes (standardized mean difference (SMD): 0.05, 95% confidence interval (CI): -0.39 to 0.48) and all adverse events (risk ratio: 1.14, 95% CI: 0.62 to 2.21) was very uncertain. A clinically irrelevant but significant mean difference (MD) in ADL outcomes was found (MD: 4.82, 95% CI: 2.63 to 7.01). Telerehabilitation may result in a slight increase in fall efficacy scale score (SMD: 0.26, 95% CI: -0.02 to 0.54) and little to no difference in pain (MD: -1.0, 95% CI: -18.31 to 16.31).

CONCLUSIONS

The efficacy of telerehabilitation for patients after hip fracture surgery was uncertain with respect to the mobility outcomes, all adverse events, and pain, with no clinically meaningful differences in ADL outcomes. Telerehabilitation may be necessary to be considered for patients after hip fracture surgery to improve their confidence in their ability to perform daily activities without falling. Therefore, medical staff may consider telerehabilitation for hip fractures.

Ergogenic Benefits of β-Hydroxy-β-Methyl Butyrate (HMB) Supplementation on Body Composition and Muscle Strength: An Umbrella Review of Meta-Analyses

BACKGROUND

β-Hydroxy-β-methyl butyrate (HMB) is a metabolite of the amino acid leucine, known for its ergogenic effects on body composition and strength. Despite these benefits, the magnitude of these effects remains unclear due to variability among studies. This umbrella review aims to synthesize meta-analyses investigating the effects of HMB on body composition and muscle strength in adults.

METHODS

A comprehensive literature search was conducted in Scopus, PubMed and Web of Science without date or language restrictions until August 2024. The study protocol was registered at Prospero (No. CRD42023402740). Included studies evaluated the effects of HMB supplementation on body mass, fat mass (FM), fat-free mass (FFM), muscle mass and performance outcomes. Effect sizes (ESs) and 95% confidence intervals (CIs) were calculated, and a random-effects model was used for meta-analysis. Standard methods assessed heterogeneity, sensitivity and publication bias. The methodological quality of included studies was assessed using the AMSTAR2 tool.

RESULTS

Eleven studies comprising 41 data sets were included, with participants aged 23-79 years. HMB supplementation significantly increased muscle mass (ES: 0.21; 95% CI: 0.06-0.35; p = 0.004), muscle strength index (ES: 0.27; 95% CI: 0.19-0.35; p < 0.001) and FFM (ES: 0.22; 95% CI: 0.11-0.34; p < 0.001). No significant changes were observed in FM (ES: 0.03; 95% CI: -0.04 to 0.35; p = 0.09) or body mass (ES: 0.09; 95% CI: -0.06 to 0.24; p = 0.22). The quality assessment revealed that five studies were of high quality, three were of low quality and three were of critically low quality.

CONCLUSIONS

HMB supplementation may benefit individuals experiencing muscular atrophy due to physiological conditions, particularly enhancing muscle mass and strength without significant changes in fat mass or body weight.

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.

Intermittent fasting for weight management and metabolic health: An updated comprehensive umbrella review of health outcomes

AIMS

To provide an updated comprehensive evaluation of the quality and evidence association of existing studies on health outcomes related to intermittent fasting (IF).

MATERIALS AND METHODS

We conducted a systematic search of PubMed, Web of Science, Cochrane Library, and Embase databases, covering literature up to June 2024. Meta-analyses and systematic reviews that include adult populations and quantitatively analyse health outcomes related to IF interventional studies are included. For evidence with complete data, we reanalyzed health evidence effect sizes and 95% confidence intervals using random-effects models. Article quality and the certainty of the evidence were graded using A Measurement Tool to Assess Systematic Reviews (AMSTAR-2), Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, and a standardized credibility grading system.

RESULTS

Twelve meta-analysis studies and 122 health outcome associations with IF were identified. High-quality evidence indicated significant associations between time-restricted eating (TRE) and weight loss, fat mass reduction, decreased fasting insulin and glycosylated haemoglobin levels in overweight or obese adults, as well as between the 5:2 diet and reduced low-density lipoprotein cholesterol levels. Moderate-to-low-quality evidence suggested associations between modified alternate-day fasting and improvements in body weight, lipid profile and blood pressure. Additionally, high-to-low-quality evidence showed that IF regimens effectively improved liver health in non-alcoholic fatty liver disease.

CONCLUSIONS

This umbrella review highlights IF, especially TRE, as a promising intervention for weight and metabolic health, particularly beneficial for overweight or obese adults. We also highlight the need for further extensive research to understand the long-term effects, individualized IF plans and potential adverse effects of IF in different populations.

Advancing occupational therapy scoping reviews: Recommendations to enhance quality and methodological rigour

INTRODUCTION

Scoping reviews are an increasingly popular methodological approach to collate evidence and synthesise knowledge in many fields including occupational therapy. However, many are published with potential methodological weaknesses. To address this issue, nine methodological recommendations that authors could adopt to improve the quality and rigour of published scoping reviews are proposed based on the authors' opinions and the published evidence.

OVERVIEW

It is suggested that when authors are completing a scoping review, they can consider completing one or more of the following methodological guidelines: (1) refer to the Levac et al.'s (2010) scoping review recommendations, the JBI Scoping Review Protocol, and the PRISMA Extension for Scoping Reviews (PRISMA-ScR) Checklist as methodological guides; (2) include grey literature as a standard component search strategy approach; (3) include thesis and dissertations as recognised sources of evidence; (4) apply a recognised research methodology critical appraisal/quality assessment tools and scales to evidence selected for inclusion in scoping reviews; (5) assign a level of evidence (LoE) framework to the selected evidence; (6) apply a recognised qualitative knowledge syntheses approach to the data extracted; (7) report the steps taken to ensure the trustworthiness of the qualitative knowledge synthesis approach used; (8) include consumer, stakeholder and community consultation; and (9) apply a scoping review-specific critical appraisal/quality assessment tool as a quality assurance activity. The authors are not proposing that the nine recommendations are mandatory, but instead they are methodological guidelines that scoping review authors can incorporate if they choose.

CONSUMER AND COMMUNITY INVOLVEMENT

Consumers and community members were not involved in the writing of the manuscript.

CONCLUSION

Adopting the suggested methodological recommendations as a regular part of completing occupational therapy-related scoping reviews will increase their quality, precision, and rigour.

The benefits and drawbacks of music in the operating room

INTRODUCTION

A significant proportion of surgeons listen to music in the operating room (MOR) during a surgical procedure. Over the last twenty years, this practice has been widely studied. The aim of this article is to analyze the effects of MOR on surgical performance, postoperative history and, more generally, on communication in the operating theater.

METHOD

A comprehensive review of the factual literature (randomized trials and systematic reviews) was carried out.

RESULTS

Given the heterogeneity of the published studies, it was not possible to achieve results with a high level of evidence. Above and beyond a probably lightened mental load ascribable to MOR, our review did not demonstrate significant benefits of music (a "Mozart effect") regarding enhanced surgical performance in a clinical setting or a reduced number of perioperative or postoperative adverse events. The major drawbacks of MOR include team communication impediments, surgeon distraction, and frustration felt by team members.

CONCLUSION

MOR implementation should presuppose dialogue and agreement among all members of a caregiving team. Do the advantageous aspects of MOR indeed (finally) consist in lessened mental load and heightened surgeon well-being?