PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis

The benefits, barriers, and specific needs of palliative care for adults with cancer in sub-Saharan Africa: a systematic review

People living in low - and middle-income countries are less likely to receive palliative care. Early delivery of palliative care reduces unnecessary hospital admissions and improves patients' and their families' quality of life. This systematic review has compiled and scrutinized adult cancer patients' benefits, barriers, and specific palliative care needs in sub-Saharan Africa (SSA) to provide stakeholders with vital information that can improve the support and care provided to this expanding patient population. A systematic literature search was conducted using PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, Medline, and ProQuest under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies included in the review focused on the utilization of palliative care among adult cancer patients in sub-Saharan Africa. The Joanna Briggs Institute (JBI) Critical Appraisal tools assessed study quality. This review synthesized findings from 16 studies and highlights that access to palliative care improves cancer patients' quality of life, satisfaction, and outlook on diagnosis. However, limited knowledge, financial constraints, and systemic obstacles impede access. Patients' needs were categorized into four themes: physical comfort, psychosocial support, spiritual well-being, and socioeconomic assistance. Palliative care improves adult cancer patients' quality of life in sub-Saharan Africa, but barriers hinder access. To address the challenges and meet patients' needs, enhancing literacy about palliative care, providing financial support, and implementing structured and sustainable palliative care models are essential for strengthening services and improving regional healthcare.

Side effects of microdosing lysergic acid diethylamide and psilocybin: A systematic review of potential physiological and psychiatric outcomes

OBJECTIVE

Psychedelics are gaining renewed attention, especially through the practice of microdosing, where low doses are taken regularly. Microdosing lysergic acid diethylamide (LSD) and psilocybin is used by both healthy individuals and those with mental health conditions to improve daily functioning, reduce anxiety, and enhance mood and cognition. However, there is limited information about the side effects of this practice. This review aimed to collect and characterize the side effects of psychedelic microdosing.

METHODS

We conducted a systematic review of original papers from PubMed, Web of Science, and Scopus (accessed August 03, 2024) that reported side effects of microdosing LSD and psilocybin. Non-English papers, non-original studies, studies without typical microdosing doses, or those lacking descriptions of side effects were excluded. Our methodology has been developed in accordance with PRISMA guidelines. Because side effects were assessed heterogeneously in these papers, we did not perform a bias evaluation.

RESULTS

We included 31 studies, 15 of which we classified as laboratory studies with higher quality evidence, and 14 studies with lower quality evidence, as well as 2 clinical cases. Side effects were typically dose-dependent, mild, and short-lived. Common adverse effects included increased blood pressure, anxiety, and cognitive impairment.

DISCUSSION

This review is limited by the heterogeneity in reporting side effects and the short duration of many studies. Future studies should transparently and systematically present a description of side effects.

Interventions for Improving Informal Social Support for Victim-Survivors of Domestic Violence and Abuse: An Evidence and Gap Map

Background

Domestic Violence and Abuse (DVA) is a significant global problem that warrants a robust, multi-sectoral response. The Covid-19 pandemic highlighted that informal and social networks play a critical role in responding to victim-survivors, alongside formal agencies and specialist services. Friends, relatives, neighbours and colleagues are uniquely placed to recognise abuse, respond and refer to wider services, where appropriate. Seeking to harness this potential, interventions tailored towards such informal supporters are being developed and implemented around the world. Yet little is known about such interventions. By pulling together the research on such programmes, this evidence and gap map begins to advance the understanding of informal support interventions, pinpointing the range and type of interventions implemented around the world, and the extent of the available evidence. This provides valuable insights for policy makers and practitioners seeking to commission or develop interventions and research in this area, with a view to facilitating a holistic, societal-wide response to domestic abuse. The evidence and gap map was a collaboration of academics and specialists, as well as domestic abuse researchers, with input and guidance from an Advisory Group.

Objectives

This evidence and gap map aims to establish the nature and extent of the empirical primary research on interventions aiming to create or enhance informal support for victim-survivors of domestic abuse, identifying clusters of evidence potentially suitable for synthesis, and gaps in the research base.

Search Methods

The following bibliographic databases were searched for published studies from inception to 31st October 2022: APA PsycINFO, Social Policy and Practice, ASSIA, PubMed, and Social Science Citation Index. Identifying grey literature was an important pillar of the search strategy and so websites of domestic abuse organisations, predominantly in the United Kingdom, were also searched. Similarly, a targeted search of specialist systematic review, policy and domestic abuse databases was undertaken from inception to 10th July 2023.

Selection Criteria

The evidence and gap map focused on any interventions that explicitly aimed to create or enhance informal social support for victim-survivors of domestic abuse. Eligible interventions targeted the providers of the support (i.e., friends, relatives, neighbours or colleagues), the victim-survivor, the relationship between them, and/or the wider community within which the informal support was provided. All study designs were included, reporting qualitative or quantitative data for samples or victim-survivors (adults who were/had been experiencing abuse in an intimate relationship) or informal supporters. Outcomes were not used as part of the eligibility criteria. Eligible studies needed to be published in English.

Data Collection and Analysis

All studies included in the evidence and gap map were coded by two independent reviewers, using specialist systematic review software EPPI Reviewer. Details were collected about the study sample, study design, intervention and outcomes. Quality appraisal was not undertaken.

Main Results

The EGM identified 47 primary studies of interventions that aimed to create, enhance or facilitate informal support for victim-survivors of domestic violence and abuse. The overwhelming majority of evidence is drawn from the Global North, and there is dissonance between the small evidence base and the relatively larger number of informal support interventions implemented around the world. The EGM highlights the importance of diverse study designs and grey literature in this field. The body of research is unevenly distributed, with the greatest concentration of studies around interventions directed towards victim-survivors, such as support groups or mentoring, and those tailored towards informal supporters, such as education and training. Most research reported on female, adult victim-survivors with a particular emphasis on their mental health and wellbeing, and their help-seeking behaviours. The reporting of such outcomes aligns with wider service user/provider priorities and highlights the imperative of DVA research to improve the lives of victim-survivors. The EGM found little research focused on interventions targeting structural factors that shape informal support, such as social relationships or community norms, and a lack of data on specific population groups including victim-survivors in the longer term, ethnic minority groups and men. There are major gaps in the research for informal supporters with limited data or outcomes for this group, and specific types of informal supporters (namely friends and family members) are notably absent from samples. The EGM also highlights a gap in the research on community-level outcomes.

Authors' Conclusions

To our knowledge, this EGM is the first to provide a comprehensive and rigorous overview of the evidence on informal support interventions in domestic abuse. The EGM provides a valuable tool for policymakers, practitioners and researchers seeking to navigate the evidence around such interventions. Whilst the EGM provides a partial picture of interventions around the world, the studies offer insight into informal support for victim-survivors of DVA and the potential effects of intervening. The suite of interventions covered by the EGM can inspire policymakers to broaden the response to domestic abuse beyond frontline services, identify stakeholders and commission pilot studies to further understanding of informal support interventions. The evidence base can be strengthened with additional studies examining interventions that target relationships and communities, as well as individuals, and assessing a wider range of population groups. At the same time, the EGM offers pockets of rich data, such as outcomes on victim-survivor mental health or interventions in faith-based organisations, which can be utilised to inform current and future service provision.

Evaluation of the relationship between bruxism and/or temporomandibular disorders and stress, anxiety, depression in adults: A systematic review and qualitative analysis

OBJECTIVE

The objective of this study was to map and systematically review the available evidence regarding the relationship between bruxism and/or temporomandibular disorders, psychological factors (stress, anxiety, depression) in adults.

MATERIAL AND METHOD

A systematic review has been conducted following the criteria described in Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020). A systematic search was performed in the Web of Science database with the last search updated as of November 2024. Observational studies in adults in which bruxism is assessed by questionnaires or clinical examination were included in the search. 10 of the 92 articles met the inclusion and exclusion requirements and were subject to a qualitative analysis.

RESULTS

There seems to be an association between bruxism, temporomandibular disorders and psychological factors. Clenching and grinding may be associated with overload of the chewing structures and give rise to symptoms typical of temporomandibular disorders, all under the probable influence of psychological factors.

CONCLUSIONS

Bruxism, associated with psychological factors, leads to the appearance of symptoms typical of temporomandibular disorders. More research is needed to understand how the factors interact.

CLINICAL SIGNIFICANCE

Clinicians should be aware of the psychological factors associated with bruxism and the relationship with temporomandibular disorders.

Structural Variations of Tendons: A Systematic Search and Narrative Review of Histological Differences Between Tendons, Tendon Regions, Sex, and Age

Tendons are force-transmitting structures which facilitate musculoskeletal functioning. Characterizing variations between different anatomical tendons, regions within tendons, as well as between the sexes and with age can improve understanding of tendon physiology and pathology. A systematic search of the literature was conducted to identify and summarize microscopic structural (histological) variations in normal/healthy tendons in relation to these variables (Tendon, Region, Age, Sex, and Other). Regional differences within individual tendons have been investigated in numerous studies, however investigations comparing histological variations between a range of different tendons are sparse, with most focusing on a few select tendons. When injured, ageing tendons typically have a greater degree of pathological changes than younger tendons, but few studies have documented variations in tendon histology throughout typical (uninjured) ageing or across large age spans. Similarly, sex-related observations of tendon structure are underreported. This narrative review summarizes studies on these topics and explores interactions between these variables, as well as the implications of these in the context of selecting control samples for studies of tendon pathology. Future studies should endeavour to improve knowledge of tendon structural variations-specifically focusing on normal tendons-to facilitate understanding of tendon structure-function relationships, physiological mechanisms involved in tendon damage/healing, and to aid clinical research and practice.

What are the experiences of women and midwives of non-severe perineal trauma assessment? A meta-synthesis

BACKGROUND

In the UK, most women giving birth vaginally experience perineal trauma, predominantly non-severe, yet there is no validated assessment tool to evaluate wound healing postnatally. Current NICE guidelines provide only generic advice on how to complete this assessment, exposing the potential for a variety of non-standardised practices. Criticism of UK postnatal care is widespread, and inadequate perineal trauma assessment might contribute to this.

QUESTION

What are the experiences of women and midwives of non-severe perineal trauma assessment?

METHODS

Systematic literature review with meta-synthesis using three online databases. Data was synthesised using constant comparative analysis.

DATABASES

CINAHL, PubMed, and Web of Science.

FINDINGS

Nine studies exploring the experiences of women (8/9) and midwives (1/9) on non-severe perineal trauma were included. Three themes emerged: 'How society and healthcare professionals are silencing women's experiences', 'The inadequate provision of perineal care', and 'A glimmer of hope, examples of positive experiences'.

DISCUSSION

Women report being underprepared about the extent of their perineal trauma, the potential impact on their lives and the services available if concerns. Some women are not offered perineal assessment and feel their concerns are trivialised by clinicians. These issues are not unique to the UK, as similar challenges exist globally. Improving postnatal care requires better communication, a therapeutic woman-midwife relationship, and societal change to reduce stigma around perineal trauma, which impacts women's psycho-physical health.

CONCLUSION

Improving postnatal perineal trauma care is crucial, with research needed on assessment practices and tools. Therapeutic relationships and women-centred clinical pathways can enhance experiences.

Therapeutic effects of dry needling for patellofemoral pain syndrome: a systematic review and meta-analysis

BACKGROUND AND PURPOSE

Dry needling has been increasingly used as an adjunctive therapy for patellofemoral pain syndrome in clinical practice. This study aimed to summarize the available evidence about the effects of dry needling in managing patellofemoral pain syndrome.

METHODS

Seven English-language databases and three Chinese-language databases were searched. Two researchers independently screened the literature, extracted data, and assessed the risk of bias using the PEDro scale and the Cochrane Risk of Bias Assessment Tool. The quality of evidence was evaluated using the GRADE approach.

RESULTS

A total of 12 studies were included, involving 624 participants. Dry needling significantly improved knee pain (MD = -0.86, 95%CI -1.17 to -0.55) and physical function (MD = 5.33, 95%CI 3.88 to 6.78) compared to comparative groups. When combined with exercise therapy, dry needling resulted in large reduction in knee pain(MD = -2.02, 95%CI -2.36 to -1.67) and small improvement in physical function (MD = 9.56, 95%CI 7.84 to 11.27) compared to exercise therapy alone. However, negligible or no additional benefits were observed when dry needling was added to extracorporeal shock wave therapy or multimodal interventions. Furthermore, dry needling showed no significant advantage over other trigger point therapies in terms of pain reduction and functional improvement.

CONCLUSION

Dry needling is effective in reducing pain and improving function for patients with patellofemoral pain syndrome, particularly when combined with exercise therapy. However, more high-quality studies are required to draw a definitive conclusion.

CLINICAL TRIAL REGISTRATION NUMBER

CRD42023490627 on PROSPERO.

Effectiveness and Safety of Ticagrelor Monotherapy After Short-Duration Dual Antiplatelet Therapy in PCI Patients: A Systematic Review and Meta-Analysis

Dual antiplatelet therapy (DAPT), consisting of aspirin and a P2Y12 inhibitor, is the standard treatment for patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES). However, the optimal duration of DAPT remains debated due to the need to balance ischemic event reduction with bleeding risks. This study evaluates the efficacy and safety of ticagrelor monotherapy after short-duration DAPT (1 to 3 months) compared to extended DAPT, focusing on major bleeding and cardiovascular outcomes. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Randomized controlled trials (RCTs) comparing ticagrelor monotherapy after short-duration DAPT to extended DAPT were identified from PubMed, Embase, and the Cochrane Library. Data on major bleeding, major adverse cardiovascular and cerebrovascular events (MACCE), myocardial infarction, stroke, stent thrombosis, and mortality were analyzed, and risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Five RCTs involving 32,393 patients were included. Ticagrelor monotherapy significantly reduced MACCE (RR: 0.88; 95% CI: 0.77 to 0.99; p = 0.04) and major bleeding (RR: 0.53; 95% CI: 0.37 to 0.77; p = 0.0008) compared to extended DAPT. It also significantly reduced all-cause mortality (RR: 0.82; 95% CI: 0.67 to 0.99; p = 0.04) and cardiovascular death (RR: 0.68; 95% CI: 0.49 to 0.94; p = 0.02). The incidence of myocardial infarction, stent thrombosis, and stroke were similar between the groups. Net adverse clinical events (NACE) were 27% lower with ticagrelor monotherapy (RR: 0.73; 95% CI: 0.63 to 0.85; p <0.0001). In conclusion, ticagrelor monotherapy after short-duration DAPT reduces major bleeding complications without compromising cardiovascular protection. This approach offers a promising strategy to optimize outcomes for PCI patients, particularly those at high bleeding risk. Further studies are needed to refine the optimal DAPT duration in various patient populations, especially those with higher ischemic risk.

Revolutionizing cleft lip and palate management through artificial intelligence: a scoping review

PURPOSE

Not much is known about the applications of artificial intelligence (AI) in cleft lip and/or palate. We aim to perform a scoping review to synthesize the literature in the last 10 years on integrating AI in the approach to this condition and highlight aspects of research into its prediction, diagnosis and treatment.

METHODS

A search was performed via PubMed, Science Direct, Scopus, and LILACS from 2014 to 2024, in which 649 articles were identified, and 3 studies were identified via the snowball method; the title and abstract were identified, and 35 articles were obtained for full reading. Finally, 25 studies were selected after applying the inclusion and exclusion criteria to execute this review.

RESULTS

The articles reviewed included different types of studies, with observational and experimental studies being frequent and systematic reviews and narratives being less frequent. Similarly, there was evidence of a generalized distribution, with a greater concentration in the United States. These studies were analyzed according to the use of AI applied to cleft lip/palate, obtaining 6 subcategories, including diagnosis, prediction, treatment, and education, in which different types of AI models were included, most frequently using deep learning and machine learning.

CONCLUSION

These technologies promise to optimize the care of patients with this condition. Although current advances are promising, further research is essential to expand and refine their beneficial use. AI has driven significant advances in various stages of the cleft lip and/or palate approach, integrating tools such as assisted algorithms, genetics-based predictive models, and advanced surgical planning.

Effectiveness and Safety of Nemolizumab in Patients with Prurigo Nodularis: a Systematic Review and Meta-Analysis of Randomized Controlled Trials

Prurigo nodularis (PN) is a chronic, severely pruritic condition that markedly impairs quality of life. Existing treatments show limited efficacy, prompting investigation of nemolizumab, an IL-31 receptor antagonist. This meta-analysis evaluated randomized controlled trials (RCTs) comparing nemolizumab with placebo in patients with PN. Effectiveness endpoints included a ≥ 4-point improvement in the Peak Pruritus Numerical Rating Scale (PP-NRS4), a ≥ 2-point reduction in the Investigator's Global Assessment (IGA), and a ≥ 4-point improvement in the Sleep Disturbance Numerical Rating Scale (SD-NRS). Three RCTs involving 497 patients met the inclusion criteria. Pooled analyses showed nemolizumab significantly increased the likelihood of achieving PP-NRS4 response (OR = 6.92, 95% CI: 3.84-12.45, P < .00001), IGA reduction (OR = 7.59, 95% CI: 3.58-16.12, P < .00001), and SD-NRS improvement (OR = 3.99, 95% CI: 2.39-6.66, P < .00001). Safety outcomes did not differ significantly between nemolizumab and placebo for adverse events, serious adverse events, or other specific categories. In conclusion, while maintaining a favorable safety profile, nemolizumab demonstrates robust efficacy in reducing pruritus, lesion severity, and sleep disturbance in patients with PN. While these findings are promising, the small number of included studies and potential for publication bias warrant cautious interpretation and highlight the need for further research. These findings support its role as a promising option for individuals with PN who are unresponsive to standard therapies.

Lipoprotein(a) in youth and childhood as a marker of cardiovascular risk stratification: a meta-analysis

BACKGROUND AND AIMS

Lipoprotein(a) [Lp(a)] is recognized as a risk factor for atherosclerotic cardiovascular diseases (ASCVD), yet its impact during childhood and youth remains understudied. This study aims to evaluate the role of Lp(a) as an independent risk factor for premature ASCVD among young patients.

METHODS

PubMed, Scopus, and CINAHL Complete databases were systematically searched from inception to 12 December 2023 for adjusted observational studies examining the impact of Lp(a) in young patients. Premature coronary artery disease (CAD) and premature arterial stroke were designed as primary endpoints, while the association with family history of premature CAD and familial hypercholesterolemia were secondary endpoints.

RESULTS

Fourteen studies, encompassing 9923 patients, were included in the analysis. Nine studies assessed Lp(a) as an independent risk factor for premature CAD. Meta-analysis revealed Lp(a) to be significantly associated with premature CAD [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.01-1.13, P = 0.02]. Four studies revealed that the high levels of Lp(a) were associated with a more than two-fold increased risk of arterial stroke (OR 2.51; 95% CI 1.51-4.16, P = 0.004). However, insufficient studies were retrieved to perform a metanalysis for the secondary endpoints.

CONCLUSION

Findings from adjusted observational studies suggest that Lp(a) serves as a risk factor for premature CAD and for arterial stroke in the youngest population.

Laser hair removal in gender-affirming care: applications and barriers in transgender and gender-diverse populations

PURPOSE

Laser hair removal (LHR) plays a significant role in gender-affirming care of transgender and gender-diverse patients. This systematic review aims to synthesize and critically evaluate the current literature on the utility of LHR in these populations, while addressing limitations and barriers.

METHODS

A search of the PubMed, EMBASE and Web of Science databases was conducted according to PRISMA guidelines. Studies were included if they directly discussed the topic, were of the appropriate study type and were published in peer-reviewed journals in English. Our search yielded 10 studies that met our inclusion criteria. From the included studies, data was individually extracted and scrutinized, following formal quality assessment.

RESULTS

In transwomen receiving vaginoplasty, LHR has been established as an effective method for preprocedural hair removal, with preliminary studies comparing its efficacy to electrolysis. In transmen undergoing phalloplasty, early findings suggest LHR as satisfactory in decreasing hair density in the neourethra. While limited, available evidence indicates that adequate hair removal may contribute to improved psychosocial outcomes. Efficacy of LHR prior to gender-affirming surgery may differ based on treatment protocols and patient demographics, potentially contributing to the variability in results included within our review. Moreover, cost, lack of provider expertise, and overall fear and anxiety remain recognized barriers to care for LHR and electrolysis.

CONCLUSION

These results highlight the significant role of LHR in the gender-affirming care of transgender individuals, by aiding in surgical readiness and facilitating gender congruence. Our review is subject to several limitations including limited sample sizes, underscoring the need for future research.

Generative adversarial networks in medical image reconstruction: A systematic literature review

PURPOSE

Recent advancements in generative adversarial networks (GANs) have demonstrated substantial potential in medical image processing. Despite this progress, reconstructing images from incomplete data remains a challenge, impacting image quality. This systematic literature review explores the use of GANs in enhancing and reconstructing medical imaging data.

METHOD

A document survey of computing literature was conducted using the ACM Digital Library to identify relevant articles from journals and conference proceedings using keyword combinations, such as "generative adversarial networks or generative adversarial network," "medical image or medical imaging," and "image reconstruction."

RESULTS

Across the reviewed articles, there were 122 datasets used in 175 instances, 89 top metrics employed 335 times, 10 different tasks with a total count of 173, 31 distinct organs featured in 119 instances, and 18 modalities utilized in 121 instances, collectively depicting significant utilization of GANs in medical imaging. The adaptability and efficacy of GANs were showcased across diverse medical tasks, organs, and modalities, utilizing top public as well as private/synthetic datasets for disease diagnosis, including the identification of conditions like cancer in different anatomical regions. The study emphasized GAN's increasing integration and adaptability in diverse radiology modalities, showcasing their transformative impact on diagnostic techniques, including cross-modality tasks. The intricate interplay between network size, batch size, and loss function refinement significantly impacts GAN's performance, although challenges in training persist.

CONCLUSIONS

The study underscores GANs as dynamic tools shaping medical imaging, contributing significantly to image quality, training methodologies, and overall medical advancements, positioning them as substantial components driving medical advancements.

The association of SCN1A polymorphisms with epilepsy and drug resistance: a systematic review and meta-analysis

Epilepsy is one of the most common neurological afflictions worldwide, with one-third of patients exhibiting resistance to treatment. It has been speculated that the polymorphisms of the sodium channel alpha subunit 1 (SCN1A) gene are associated with both the occurrence of epilepsy and its resistance to treatment. The aim of this study is to systematically review the literature and conduct meta-analyses revealing the associations of the SCN1A polymorphisms with epilepsy and resistance to treatment. We conducted a search of Pubmed, Web of Science, and Scopus, and if more than two studies investigated a polymorphism, odds ratios for association with epilepsy and/or resistance to treatment were calculated in three allelic, homozygous, and recessive genetic models. The initial search yielded 4106 items, and a total of 64 articles met the final inclusion criteria. With respect to the occurrence of epilepsy, the rs2298771 polymorphism was revealed to be negatively associated in the recessive model, while the associations of other polymorphisms were not statistically significant. With regard to resistance to treatment, rs2298771 was revealed to be positively associated across all three models, and rs10167228 was positively associated in the allelic and homozygous models, but not the recessive model. Other polymorphisms were not shown to be associated with resistance to treatment. In conclusion, we demonstrated that the rs2298771 polymorphism had a significant and negative association with the occurrence of epilepsy. Furthermore, rs2298771 and rs10167228 polymorphisms had positive associations with resistance to treatment. Further studies are needed to explore these associations among other polymorphisms.

Views and attitudes of healthcare professionals on do-not-attempt-cardiopulmonary-resuscitation in low-and-lower-middle-income countries: a systematic review

BACKGROUND

Healthcare Professionals (HCPs) are important stakeholders and gatekeepers in resuscitation decision-making. This systematic review explored the views and attitudes of HCPs on do-not-attempt-cardiopulmonary resuscitation (DNAR) in low-and-lower-middle-income countries (LLMICs).

METHODS

PubMed, EMBASE, PsycInfo, CINAHL, Cochrane library, Scopus, and Web of Science were searched from 01-Jan-1990 to 24-February-2023. Empirical peer-reviewed literature exploring views and attitudes of HCPs on DNAR for adult patients (aged ≽18 years) in LLMIC were included. No restriction on empirical study designs was imposed. Two independent reviewers performed screening, data extraction and critical appraisal. Hawker's tool and Popay's narrative synthesis were used for critical appraisal and data synthesis respectively. Review findings were interpreted using Cognitive Dissonance theory (CDT).

RESULTS

Of the 5132 records identified, 44 studies encompassing 7490 HCPs were included. The median Hawker score was 28 with 27% studies having low risk of bias. Three themes emerged. 1: Meaning-Making of DNAR construct. Most HCPs agreed that DNAR avoided inappropriate resuscitations, needless suffering and allowed fair allocation of resources. However, there was a lack of consensus on DNAR timing. 2: Barriers and Facilitators. Sociocultural norms, lack of legal clarity, organisational policies, societal and family views, religious and ethical beliefs, and healthcare providers' presuppositions often hindered DNAR practice. HCPs had inconsistent religious and ethical beliefs about DNAR. 3: Tensions and complexities of contemporary practice. HCPs expressed fears, concerns, guilt and distress while recommending DNAR. HCPs differed on involving patients. The DNAR practice was arbitrary and suboptimal like informal DNAR orders, pretended and symbolic CPRs.

CONCLUSION

Most HCPs in LLMICs viewed DNAR as essential However, they faced barriers to DNAR implementation at macro-(law, sociocultural norms), meso-(organization) and micro-(HCP- and family views) levels. These barriers contributed to HCPs' fears, concerns and distress concerning DNAR. The CDT provided the lens to link HCPs cognitions, affect and behaviour into a chain of events that explained suboptimal resuscitation practices.

TRIAL REGISTRATION

CRD42023395887.

Neurodevelopmental screening for neonates less than 44 weeks gestation in low-income and middle-income countries: a systematic review

INTRODUCTION

With global improvements in neonatal survival, more small and sick newborns in low-income and middle-income countries (LMICs) are at increased risk of neurodevelopmental disability and delay. While there is increased recognition of the importance of early identification of neurodevelopmental differences and timely initiation of therapy, little is known about standardised neonatal neurodevelopmental screening tools in these settings.

METHODS

We performed a systematic review to determine what standardised neurodevelopmental assessments had been used in LMICs for neonates before 44 weeks corrected gestational age and published in the literature. We excluded short-term clinical assessments designed for specific pathologies. We performed the search across seven databases, screened studies for eligibility and inclusion and extracted bibliographic data, country, patient characteristics, assessments and study aims. Results were summarised in tabular and graphical presentation.

RESULTS

There were 2477 records screened, yielding 67 studies for inclusion. Studies in Asian countries made up 65.7%, while Latin America and Africa made up 19.4% and 16.4%, respectively. Physicians and paramedical staff performed the screening assessments in only 16.4% of studies, and 92.5% of studies used inpatient recruitment. The Neonatal Behavioural Neurological Assessment (25.4%) was the most frequently used screening tool followed by the General Movements Assessment (22.4%), the Hammersmith Neonatal Neurological Examination/Dubowitz (16.4%) and the Neonatal Behavioural Assessment Scale (10.4%).

CONCLUSIONS

We did not identify any one neonatal neurodevelopmental screening assessment that is rapid, globally validated, identifies targets for intervention, has high predictive prognostic value and does not require neonatal or kinesiologic expertise or uncommon equipment. Such an assessment, in concert with evidence-based intervention, therapeutic delivery platforms, established referral pathways and trained personnel would improve functional outcomes for high-risk small and sick neonates in LMICs.

Human Papilloma Virus Infection and Sinonasal Inverted Papilloma Recurrence: A Meta-Analysis

OBJECTIVE

Prior studies have been contradictory on the role of human papillomavirus (HPV) infection in sinonasal inverted papilloma (SNIP) recurrence. This systematic review and meta-analysis was performed to further evaluate this potential association.

DATA SOURCES

PubMed, Embase, and Scopus electronic databases.

REVIEW METHODS

Case-control studies reporting SNIP recurrence data and HPV status identified by polymerase chain reaction (PCR) and in-situ hybridization (ISH). Meta-analysis was performed to determine pooled odds ratios (ORs) and 95% confidence intervals (CI).

RESULTS

25 studies were identified including a total of 1116 benign SNIP tumors. A total of 267 SNIP were HPV+, 103 of which were recurrent, and 849 SNIP were HPV-, with 231 being recurrent. The pooled standard OR for recurrence in HPV+ tumors was 2.05 (95% CI: 1.31-3.19). Stratification by low-risk and high-risk HPV subtypes were not statistically significant. The standard OR for SNIP recurrence in low-risk and high-risk HPV+ subtypes were 1.57 (95% CI: 0.98-2.54) and 1.67 (95% CI: 0.98-2.80), respectively.

CONCLUSION

Infection with HPV may be associated with an increased risk of SNIP recurrence. This increased risk seems to be independent of HPV subtype based on low-risk or high-risk status. However, this correlation was variable among recently published studies requiring additional investigation.

Updating the Role of JUNO and Factors Involved in Its Function during Fertilization

INTRODUCTION

The final step of the fertilization process involves gametes adhesion and fusion. JUNO is an essential folate receptor 4 protein present in the ooplasm of oocytes, which binds to IZUMO1, its receptor on the sperm surface. Both proteins are indispensable for the sperm-oocyte interaction, and their absence results in infertility. Despite the importance of JUNO in reproduction, there is still controversy about how different factors affect the functionality of JUNO. Therefore, the goal of this study was to provide a comprehensive overview of what we know so far about the presence and functionality of JUNO.

METHODS

In order to accomplish this, a total of 198 articles were identified. Based on both inclusion and exclusion criteria, 40 articles were finally included in this study.

RESULTS

The results showed that during oocyte maturation, the expression levels of JUNO undergo alterations and, in some instances, cross-species gamete fusion is possible. Additionally, it has been observed that exposure of oocytes to factors such as bisphenol A, 17α-ethynylestradiol, diazinon, benzo(a)pyrene, butylparaben, bis(2-ethylhexyl) phthalate, hydroxyurea, dichlorophenol, isoniazid, and para-phenylenediamine disrupt JUNO and decrease the fertilization process rates. Moreover, exposure to ionic radiation, vitrification, and synthetic materials as microplastics has the same effect. Nonetheless, other compounds such as melatonin, mogroside V, cholesterol-loaded methyl-β-cyclodextrin, methyl-β-cyclodextrin, protocatechuic acid, coenzyme Q10, resveratrol, and Shoutai pills have been shown to enhance female fertility in terms of JUNO functionality.

CONCLUSION

In summary, this update highlights the crucial role of JUNO during fertilization and reveals how different factors and experimental procedures affect its activity.

Removal of bent or broken tibial intramedullary nails: A systematic review of case studies

BACKGROUND

The bending or fracture of a tibial intramedullary nail is a rare complication with a paucity of literature regarding available methods of extraction. This systematic review discusses the currently described surgical techniques for extracting deformed tibial intramedullary nails as well any potential associated challenges.

METHODS

A review of the PubMed, EMBASE, and Scopus databases was conducted for articles describing the extraction of deformed tibial intramedullary nails according to the Preferred Reporting Items for Systematic Reviews guidelines. Study quality was assessed using the Joanna Briggs Institute Quality Appraisal tool.

RESULTS

24 case reports were identified as describing the extraction of 27 deformed tibial intramedullary nails. The most common methods of removal were the use of hook extractors (29.6 %), standard extraction (14.8 %) and grasping of broken distal segments via forceps (11.1 %). Challenges included nails with small internal diameters, nail segment tilting during extraction, poor capture of the nail, and subsidence of the proximal segment of the nail. Factors to consider during preoperative planning include the type and material of IMN, degree and direction of IMN angulation, and access to instrumentation.

CONCLUSION

There are a few core methods of removing deformed intramedullary nails depending on the nature of the deformity, nail type, material, and diameter, and tools available to the surgeon. Regardless of technique, extraction of deformed tibial intramedullary nails is associated with satisfactory patient outcomes.

LEVEL OF EVIDENCE

Level IV, a systematic review of Level IV studies.

Association between antihypertensive drug use and the risk of depression: a systematic review and network meta-analysis

Hypertension is the biggest and most prevalent risk factor for cardiovascular diseases. Depression is the most common psychiatric illness worldwide. Many studies have linked the development of new depression to the use of antihypertensive drugs. This meta-analysis was done to ascertain the relationship. Using standard reporting techniques a literature search was undertaken in Pubmed from inception till 10 May 2024. The risk bias assessment was done using the ROBINS-I tool. Data for the odds ratio were combined using Revman 5.4 using a random or fixed effects model. Our analysis found a significant association between beta blockers and calcium channel blockers use and the risk of developing new depression. Results for other classes of antihypertensives were not significant. The findings highlight the importance of taking into account the potential psychiatric side effects of antihypertensive drugs in people with hypertension. Physicians should stay vigilant and screen their patients for these conditions regularly.

Identifying competencies in advanced healthcare practice: an umbrella review

The four pillars of advanced healthcare practice (AHCP) are clinical practice, leadership and management, education, and research. It is unclear, however; how competencies of AHCP as defined by individual health professions relate to these pillars. Addressing this knowledge gap will help to facilitate the operationalization of AHCP as a concept and help inform educational curricula. To identify existing competencies across AHCP literature and examine how they relate to the four pillars of a multi-professional AHCP framework. An umbrella review was conducted in accordance with JBI methodology. The electronic search for published and grey literature was completed using CINAHL, Scopus, Medline (OVID), Embase (OVID), ERIC (OVID) and Google. Secondary reviews and research syntheses of master level AHCP programs published after 1990 in either English or French were considered for inclusion and results were analyzed using a directed content analysis. Seventeen publications detailing 620 individual competencies were included. AHCP competencies were described across four professions and 22 countries, with many publications related to nursing and AHCP in the United Kingdom, Canada, and Australia. Many retrieved competencies were found to map to the four pillars of AHCP, although clinical practice and leadership and management pillars were addressed more often. Competencies of AHCP are generally consistent with the four pillars. However, the distribution of competencies is unequal across pillars, professions, and geographical regions, which may provide direction for further research. Doi: 10.17605/OSF.IO/KV2FD Published on March 07, 2023.

The effect of exercise-induced muscle fatigue on gait parameters among older adults: a systematic review and meta-analysis

BACKGROUND

Exercise-induced fatigue is a common consequence of physical activities. Particularly in older adults, it can affect gait performance. Due to a wide variety in fatiguing protocols and gait parameters used in experimental settings, pooled effects are not yet clear. Furthermore, specific elements of fatiguing protocols (i.e., intensity, duration, and type of activity) might lead to different changes in gait parameters. We aimed to systematically quantify to what extent exercise-induced fatigue alters gait in community-dwelling older adults, and whether specific elements of fatiguing protocols could be identified.

METHODS

This systematic review and meta-analysis was conducted in accordance with the PRISMA guidelines. In April 2023, PubMed, Web of Science, Scopus, Cochrane and CINAHL databases were searched. Two independent researchers screened and assessed articles using ASReview, Rayyan, and ROBINS-I. The extracted data related to spatio-temporal, stability, and variability gait parameters of healthy older adults (55 +) before and after a fatiguing protocol or prolonged physical exercise. Random-effects meta-analyses were performed on both absolute and non-absolute effect sizes in RStudio. Moderator analyses were performed on six clusters of gait parameters (Dynamic Balance, Lower Limb Kinematics, Regularity, Spatio-temporal Parameters, Symmetry, Velocity).

RESULTS

We included 573 effect sizes on gait parameters from 31 studies. The included studies reflected a total population of 761 older adults (57% female), with a mean age of 71 (SD 3) years. Meta-analysis indicated that exercise-induced fatigue affected gait with a standardized mean change of 0.31 (p < .001). Further analyses showed no statistical differences between the different clusters, and within clusters, the effects were non-uniform, resulting in an (indistinguishable from) zero overall effect within all clusters. Elements of fatiguing protocols like duration, (perceived) intensity, or type of activity did not moderate effects.

DISCUSSION

Due to the (mainly) low GRADE certainty ratings as a result of the heterogeneity between studies, and possible different strategies to cope with fatigue between participants, the only conclusion that can be drawn is that older adults, therapist, and researchers should be aware of the small to moderate changes in gait parameters as a result of exercise-induced fatigue.

A systematic review of language and motor skills in children with developmental coordination disorder (DCD) and developmental language disorder (DLD)

AIM

To investigate: (a) language difficulties in children with developmental coordination disorder (DCD), and (b) motor difficulties in children with developmental language disorder (DLD).

METHOD

In this systematic review, PubMed, CINAHL, PsycINFO, and Embase were searched to identify peer-reviewed studies. Two researchers independently identified, screened and evaluated the methodological quality of the included studies following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). For objective (a), we combined the terms: "developmental coordination disorder" AND "language skills" AND "children". For objective (b) we combined the terms: "developmental language disorder" AND "motor skills" AND "children".

RESULTS

Ten studies on language skills in children with DCD and 34 studies on motor skills in children with DLD are included, most with relatively good methodological quality. The results for language comprehension and production in children with DCD are contradictory, but there is evidence that children with DCD have communication and phonological problems. Evidence for general motor problems in children with DLD is consistent. Studies report problems in balance, locomotor, and fine motor skills in children with DLD. Evidence for aiming and catching skills is inconsistent.

INTERPRETATION

The findings of this systematic review highlight the co-occurrence of language impairments in children with DCD and motor impairments in children with DLD. Healthcare professionals involved in the assessment and diagnosis of children with DCD or DLD should be attentive to this co-occurrence. In doing so, children with DCD and DLD can receive optimal interventions to minimize problems in their daily life.

Naloxone Dosing and Hospitalization for Nitazene Overdose: A Scoping Review

INTRODUCTION

Nitazene compounds are high potency, synthetic opioids, recently detected in the United States illicit opioid supply. This is a scoping review to summarize the available body of literature on naloxone and hospitalization reports in response to nitazene compound overdose.

METHODS

This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) extension for Scoping Reviews. PubMed, ProQuest, and Google Scholar were accessed. Articles were limited to full-text peer-reviewed publications appearing in scholarly journals between January 2018 and December 2024. Total naloxone dose (in mg, primary outcome) and total length of stay (LOS, in hours, secondary outcome) were recorded.

RESULTS

Of 109 articles screened, 103 were excluded (44 non-human; 35 no nitazene exposure, 9 no naloxone administered, 9 post-mortem data only, 3 non-overdose, 2 non-English, and 1 full text unavailable), leaving 6 articles included. Data were described on 19 distinct patients with nitazene compound overdose (meto-, isoto-, proto-, and eto-nitazene), all of whom had naloxone data, and 10 of whom had LOS data. Median total naloxone doses were the following: metonitazene 6.00mg; etonitazene 3.06mg; isotonitazene 3.00mg; protonitazene 1mg (p=0.4). Mean hospital LOS were the following: metonitazene 360 hours; etonitazene 122.25 hrs; isotonitazene 32.67 hrs; protonitazene 20 hrs.

CONCLUSION

This scoping review reveals a paucity of data on nitazene compound overdoses and identifies a gap in our current opioid crisis response. Most nitazene cases reviewed involved hospitalization, had high naloxone dosing, and relatively long LOS. Differences in naloxone dose and hospital LOS could underscore the unpredictable and potent nature of these substances.

The prevalence of gas exchange data processing methods: a semi-automated scoping review

Cardiopulmonary exercise testing involves collecting variable breath-by-breath data and sometimes requiring data processing of outlier removal, interpolation, and averaging before later analysis. These data processing choices, such as averaging duration, affect calculated values such as ˙VO2max. However, assessing the implications of data processing without knowing popular methods worth comparing is difficult. In addition, such details aid study reproduction. We conducted a semi-automated scoping review of articles with exercise testing that collected data breath-by-breath from three databases. Of the 8,344 articles, 376 (mean: 4.5% and 95% confidence interval: 4.1-5.0%) and 581 (mean: 7.0% and 95% confidence interval: 6.4-7.5%) described outlier removal and interpolation, respectively. A random subset of 1,078 articles revealed (mean: 60.9% and 95% confidence interval: 57.9-63.7%) the reported averaging methods. The commonly documented outlier cutoffs were±3 or 4 SD (39.1 and 51.6%, respectively). The dominating interpolation duration and procedure were 1 s (93.9%) and linear interpolation (92.5%). Averaging methods commonly described were 30 (30.9%), 60 (12.4%), 15 (11.6%), 10 (11.0%), and 20 (8.1%) second bin averages. This shows that studies collecting breath-by-breath data often lack detailed descriptions of data processing methods, particularly for outlier removal and interpolation. While averaging methods are more commonly reported, improved documentation across all processing steps will enhance reproducibility and facilitate future research comparing data processing choices.

On the Concepts, Methods, and Use of "Probability of Success" for Drug Development Decision-Making: A Scoping Review

Drug development is a lengthy process with considerable uncertainty at each milestone. Several trials are needed to progress to confirmatory evaluation and establish a positive benefit-risk balance. One of the critical milestones is the decision to progress to phase III based on phase II trial results. Use of probability of success is becoming standard in pharmaceutical companies to support this decision. However, the lack of consistency in terminology makes it difficult to assess the comparative value of different approaches. By leveraging the availability of high-quality external data (e.g., real-world data, historical clinical trial data, etc.), probability of success-based procedures may further improve decision-making. We performed a scoping review of approaches to calculate the probability of success of a phase III trial depending on the available data sources and the availability of specific endpoints. Calculation of probability of success is relatively straightforward if data for the primary endpoint of the phase III trial are also available in phase II trials. Often, phase II trials are based on biomarker or surrogate outcomes, due to challenges associated with study duration and required sample size. Probability of success-based procedures as reviewed can incorporate external data sources, for example, from clinical trials testing the same or similar drug or real-world data on the targeted population-optimizing the calculation of probability of trial success and the projected drug candidate value. We conclude the paper by reflecting on alternative approaches and ideas for uses within pharmaceutical companies and academia.

Efficacy and safety of azithromycin in treating sinusitis patients: a systematic review and meta-analysis of randomized controlled trails

Background

Sinusitis is an inflammation of the paranasal sinuses and is commonly treated with antibiotics. The widely used antibiotics for this condition are macrolides, especially azithromycin. However, its effectiveness and side effects are still questionable compared to the other antibiotics. Therefore, this systematic review and meta-analysis assessed the efficacy and safety profile of azithromycin in sinusitis.

Methods

We adhered to PRISMA guidelines. A comprehensive literature review was performed to find out about randomized controlled trials concerning azithromycin compared with other antibiotics in sinusitis treatment. The main outcomes were the cure rate, pathogen eradication rate, and relapse rate. The secondary outcome was the adverse events rate.

Results

Fourteen trials were considered for review, with a sample size of 4201 patients. The pooled analysis for included studies indicated a high cure rate (70.86%) and pathogen eradication rate (74.55%), as well as a low relapse rate (4.82%) and adverse events rate (14.33%) for azithromycin in treating sinusitis patients. The quality of the included studies was considered to be moderate. In a meta-analysis, azithromycin demonstrated superiority in the cure rate to other antibiotics in the study but no difference in pathogen eradication rate, relapse rate, or adverse events rate.

Conclusion

Our results showed promising efficacy and safety of azithromycin in the management of sinusitis patients. However, moderate heterogeneity among studies and a 14.33% rate of adverse effects, primarily gastrointestinal, indicate the importance of individualized treatment decisions. Further research is needed to address variability and optimize its clinical application.

Multidisciplinary Approach on Metabolic Bariatric Surgery Evasion: Analysis of Predictors and Potential Influencing Factors in the Preoperative Period

This study aims to identify evasion predictors and factors in the preoperative period of metabolic bariatric surgery (MBS) through a review and evaluations of professionals involved, as well as patient knowledge and information, aiming at positive long-term results. This article performed a systematic literature review (SLR) in the PubMed, Scopus, and Web of Science databases. It used the PRISMA Protocol with a record of 7 years to obtain documents published a year before the pandemic, during and after it. The search strategy resulted in 4649 records, of which 51 studies were included in the review. Subsequently, an analysis was carried out in which the professionals who met the patient participated in a qualitative survey, in which the results were analyzed and compared to those obtained in the SLR. The decision to undergo MBS is influenced by fears, uncertainties, and the need for support, particularly for elderly patients. Health professionals are crucial in providing continuous guidance and support throughout the process.

Antioxidant Therapies in the Treatment of Aminoglycoside-Induced Ototoxicity: A Meta-Analysis

OBJECTIVE

A feared complication of aminoglycoside treatment is ototoxicity, which is theorized to be attributed to the production of aminoglycoside-induced reactive oxygen species. Previous studies using animal models have suggested that numerous therapies targeting reducing oxidative stress may prevent ototoxicity from aminoglycosides. However, few clinical studies have been conducted on these antioxidants. This systematic review and meta-analysis examines the effectiveness of antioxidant therapies in the treatment of aminoglycoside-induced ototoxicity.

DATA SOURCES

PubMed, Embase, Web of Science, and ClinicalTrials.gov.

REVIEW METHOD

A literature search was conducted in August 2024. This review sought randomized controlled trials to be conducted on humans to examining otologic outcomes in aminoglycoside-induced ototoxicity following administration of medications intended to reduce oxidative stress.

RESULTS

A systematic review yielded 2037 results, of which seven studies met inclusion criteria. N-acetylcysteine (NAC) was investigated in four studies, aspirin in two studies, and vitamin E in one study. Six studies examined the benefit of antioxidant treatments for up to 8 weeks after administration while one study tested subjects' hearing after 1 year. In pooled analysis, two studies assessing NAC showed the greatest reduction in ototoxicity (RR 0.112, 95% CI, 0.032-0.395; p = 0.0007; I2 = 18%), followed by two studies examining aspirin (RR 0.229, 95% CI, 0.080-0.650; p = 0.0057; I2 = 0%). One study performed with vitamin E did not find a reduction in ototoxicity compared to the placebo (RR 0.841, 95% CI, 0.153-4.617; p = 0.8416).

CONCLUSIONS

Multiple studies have shown that NAC and aspirin are effective in reducing ototoxicity from treatment with aminoglycosides. However, there is a lack of high-quality evidence. Additional studies should examine whether aspirin and N-acetylcysteine provide long-term benefit, and which of the other promising antioxidants translate from animal models.

LEVEL OF EVIDENCE

NA Laryngoscope, 135:1278-1286, 2025.

Exploring the Efficacy of Virtual Reality Training in Obstetric Procedures and Patient Care-A Systematic Review

BACKGROUND

As technology continues to shape society, younger generations are increasingly accustomed to its integration into daily life, making it mandatory for medical educators to adopt innovative tools like virtual reality (VR). This systematic review examines the efficacy of VR in obstetric training and patient care, focusing on its impact on educational engagement, procedural skill acquisition, and pain management in obstetric patients.

METHODS

A systematic review of the current literature was conducted using databases: PubMed, Web of Science, Science Direct, Scopus, Embase, The Cochrane Library, and Clinicaltrials.gov analyzing randomized controlled studies on VR's use in obstetric training and patient care. Inclusion criteria focused on studies evaluating VR's role in enhancing clinical skills, and pain and anxiety management during labor and procedures. Only randomized controlled trials published in English were considered. The risk of bias was assessed using RoB 2 for RCTs. Data extraction and quality appraisal were performed independently by two reviewers.

RESULTS

A total of 18 studies met the inclusion criteria. Among them, 13 studies focused on VR for pain relief and anxiety reduction, and 5 studies on medical training and skill acquisition. Most studies used immersive VR headsets, while some utilized interactive VR or serious gaming platforms. Adverse effects such as motion sickness and visual discomfort were reported in a few cases but did not significantly impact participant engagement.

CONCLUSIONS

VR holds the potential to improve obstetric training and patient care by aligning with the learning preferences of younger generations and enhancing both educational and patient care experiences. However, heterogeneity in sample sizes, participants, and intervention types limits generalizability. Further large-scale, high-quality RCTs are needed to validate findings and standardize VR applications in obstetrics. This review was registered in PROSPERO (Registration ID: CRD42024619197).

The comparative effectiveness of pelvic floor muscle training and hypopressive breathing techniques for pelvic organ prolapse: A systematic review and pooled analysis of randomized controlled trials

BACKGROUND

Pelvic floor (PF) disorder affects 25 ​% of females, often progressing to Pelvic Organ Prolapse (POP). PF muscle training (PFMT) and hypopressive breathing (HB) are conservative techniques used to repair pelvic muscles. This study analyzes the comparative efficacy of PFMT and HB for POP.

METHODS

A systematic review was conducted and seven records were included in the pooled analysis, which compared PF outcomes between HB and PFMT.

RESULTS

PFMT (d ​= ​2.14 and d ​= ​1.07) demonstrated a larger effect size compared to HB (d ​= ​1.24 and d ​= ​0.78) for sEMG contractility and the Modified Oxford Scale, respectively. The Pelvic Floor Disability Index (PFDI-20) found a lower effect size of PFMT (d ​= ​0.558) compared to HB (d ​= ​0.961).

CONCLUSIONS

PFMT was found to improve PF strength (Oxford) more than HB, while HB had a greater effect on quality of life (PFDI-20). Results were insignificant for contractility.

Effects of natalizumab on oligoclonal bands in the cerebrospinal fluid of patients with multiple sclerosis: a systematic review and meta-analysis

INTRODUCTION

Oligoclonal bands (OCBs) in cerebrospinal fluid (CSF) are utilized for diagnosing multiple sclerosis (MS), as they are found in 95% of patients. Additionally, OCBs are linked to disease prognosis. The primary contributors to OCB production are long-lived plasma cells. This study aims to quantify the impact of natalizumab (NTZ) on OCB levels in the CSF of MS patients.

METHODS

A systematic search on MEDLINE, SCOPUS and Web of Science for English-written and peer-reviewed longitudinal studies on adults was performed. Methodological quality was assessed with the Newcastle-Ottawa Scale. Proportional meta-analysis was performed in R using a generalized linear mixed-effects model. We investigated heterogeneity with influence diagnostics, sensitivity analysis and meta-regression.

RESULTS

Eight eligible studies of adequate quality with a total sample of 326 relapsing-remitting MS patients were included. A summary rate of 14.07% [95% CI, 4.48%-36.36%] for complete loss of OCBs and 42.02% [95% CI, 15.23%-74.51%] for reduction in OCB number or intensity was observed, both with considerable heterogeneity. Pooled estimates dropped (11% [95% CI, 0.04%-0.29%] and 34% [95% CI, 0.11%-0.68%] respectively) after the identification of an influential study. Multivariable meta-regression identified IgG index as a factor contributing to heterogeneity (adj. p = 0.0279), regarding reduction of OCB number or intensity.

DISCUSSION

In conclusion, our systematic review and meta-analysis showed that NTZ can lead to reduction of intrathecal OCBs in MS patients, indicating a possible effect of NTZ on memory plasma cells, which are the main source of OCBs in MS.

A Narrative Review of Culturally Informed Breastfeeding Interventions for African American Women

PURPOSE

The aim of this narrative review was to map the current literature on culturally informed breastfeeding interventions for African American women.

BACKGROUND

Breastfeeding is associated with positive health outcomes for women and infants. Nonetheless, despite interventions aimed at improving breastfeeding for African American women, they continue to have lower breastfeeding rates compared to Hispanic and Non-Hispanic White women. Therefore, there is a need for culturally informed interventions to promote exclusive breastfeeding in African American women.

METHODS

PubMed, EmCare, CINAHL complete, APA PsycInfo, Scopus and Web of Science were systematically searched for articles published between 2001 and 2024. Preprints were searched in medRxiv; dissertations were searched in ProQuest Dissertations & Theses and EBSCO Open Dissertations; and other gray literatures were searched in governmental/organizational websites. Hand searches of reference lists were conducted. Data were synthesized using narrative synthesis.

RESULTS

Sixteen articles that met inclusion criteria were included. Randomized controlled trial design was used in 7 studies and community-based participatory research design was used in 4 studies. Multilevel breastfeeding education and support provided mostly in-person across 4 socioecological levels (individual, interpersonal, community, and culture) was associated with increased breastfeeding knowledge, self-efficacy, intention, initiation, duration, and exclusivity in African American women. No policy-level intervention was identified. Seven different terms were used to describe the incorporation of culture into breastfeeding interventions.

CONCLUSION

This narrative review provides evidence on the utility and essence of culturally informed breastfeeding interventions for African American women. Multilevel breastfeeding education provided across the perinatal period is effective to promote breastfeeding outcomes in African American women.

Competing views on interventions for pragmatic language skills in persons with pragmatic language impairment: An umbrella review

This umbrella review aimed to evaluate the effectiveness of pragmatic language interventions and existing competing views in improving pragmatic language skills in persons with pragmatic language impairment (PLI). A comprehensive search was conducted to identify qualitative and quantitative systematic reviews that included diagnostic criteria, features, development and course, risk and prognostic factors, differential diagnosis of PLI, and existing interventions, views, and arguments to improve the pragmatic language abilities/skills of persons with PLI. Syntheses were critically appraised by two independent reviewers using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. This umbrella review was registered with PROSPERO on 9th December 2022 under the registration number CRD42022378690. Out of 3,609 studies, 42 reviews were included in this umbrella review. The extracted findings were categorized based on theoretical intervention perspectives, which included behavioral, social-pragmatic, and cognitive-linguistic approaches. The studies revealed that pragmatic language interventions had a positive impact on improving pragmatic language skills in persons with PLI. However, competing views on pragmatic language interventions were also identified, suggesting the need for a more comprehensive approach that includes both behavioral and cognitive-linguistic components. In conclusion, cognitive-linguistic approach was the most documented intervention method, and suiting intervention methods to the complex nature of PLI is crucial. The documented intervention methods reflected competing views on the nature of PLI, highlighting the need for tailored interventions.

Efficacy of glucagon-like peptide-1 receptor agonists for prevention of stroke among patients with and without diabetes: A meta-analysis with the SELECT and FLOW trails

Background

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown a reduction in major adverse cardiovascular events (MACE) among patients with type 2 diabetes mellitus (T2DM). However, its efficacy on cerebrovascular events is yet to be well established among diabetic and non diabetic patients.

Objective

We sought to evaluate the efficacy of GLP-1 RAs on stroke risk among its different types in patients with and without Diabetes.

Methods

We performed a systematic literature search on PubMed, EMBASE, and ClinicalTrials.gov for relevant randomized controlled trials (RCTs) from inspection until 15th July 2024, without any language restrictions. Odds ratios (OR) and 95 % confidence intervals (CI) were pooled using a random-effect model, and a p-value of < 0.05 was considered statistically significant.

Results

A total of 11 RCTs with 85,373 patients were included (43,339 in GLP-1 RA and 42,034 in the placebo group) in the analysis. The mean age of the patients in GLP-1 RAs and the placebo groups was 63.5 and 63.1 years, respectively. Pooled analysis of primary and secondary endpoints showed that GLP-1 RAs significantly reduced the risk of incidence of stroke by 15 % (OR, 0.85(95 %CI: 0.77-0.93), P < 0.001) and nonfatal stroke by 13 % (OR, 0.87(95 %CI: 0.79-0.95), P < 0.001) compared with placebo. However, the risk of fatal stroke (OR, 0.94(95 %CI: 0.75-1.17), P = 0.56) was comparable between both groups of patients. Similarly, the risk of serious adverse events such as cerebrovascular accident (OR, 0.75(95 %CI: 0.57-1.00), P = 0.05), hemorrhagic stroke (OR, 0.82(95 %CI: 0.42-1.60), P = 0.57, and ischemic stroke (OR, 0.85(95 %CI: 0.64-1.13), P = 0.26) was comparable between GLP-1RAs and placebo.

Conclusion

Treatment with GLP-1 receptor agonists has beneficial effects in reducing the risk of stroke, and nonfatal stroke in patients with and without diabetes. However, no such effect was observed for fatal stroke.

Maximizing the Value of Concierge Medicine: A Systematic Review of Cost, Access, and Outcomes

Alternative models of care are emerging at an exponential rate. Concierge medicine is one such model touting personalized high-quality care and access to a robust panel of preventative health services. While limited evidence exists to confirm the benefits of concierge medicine on patient clinical outcomes, this model boasts significantly increased patient and physician satisfaction. Ethical concerns overshadow the future of concierge medicine; however, possibilities of improved clinical outcomes, decreased chronic disease progression, and timely illness management give this model merit. Maximizing the value of concierge medicine requires the strategic use of economic principles, such as a willingness to pay and an enticing customer value proposition. Further value can be found in the expansion of coverage eligibility and in the prudent delivery of personalized health services that reduce hospital admissions and national healthcare spending.

Digital and AI-Enhanced Cognitive Behavioral Therapy for Insomnia: Neurocognitive Mechanisms and Clinical Outcomes

Background/Objectives: This systematic review explores the integration of digital and AI-enhanced cognitive behavioral therapy (CBT) for insomnia, focusing on underlying neurocognitive mechanisms and associated clinical outcomes. Insomnia significantly impairs cognitive functioning, overall health, and quality of life. Although traditional CBT has demonstrated efficacy, its scalability and ability to deliver individualized care remain limited. Emerging AI-driven interventions-including chatbots, mobile applications, and web-based platforms-present innovative avenues for delivering more accessible and personalized insomnia treatments. Methods: Following PRISMA guidelines, this review synthesized findings from 78 studies published between 2004 and 2024. A systematic search was conducted across PubMed, Scopus, Web of Science, and PsycINFO. Studies were included based on predefined criteria prioritizing randomized controlled trials (RCTs) and high-quality empirical research that evaluated AI-augmented CBT interventions targeting sleep disorders, particularly insomnia. Results: The findings suggest that digital and AI-enhanced CBT significantly improves sleep parameters, patient adherence, satisfaction, and the personalization of therapy in alignment with individual neurocognitive profiles. Moreover, these technologies address critical limitations of conventional CBT, notably those related to access and scalability. AI-based tools appear especially promising in optimizing treatment delivery and adapting interventions to cognitive-behavioral patterns. Conclusions: While AI-enhanced CBT demonstrates strong potential for advancing insomnia treatment through neurocognitive personalization and broader clinical accessibility, several challenges persist. These include uncertainties surrounding long-term efficacy, practical implementation barriers, and ethical considerations. Future large-scale longitudinal research is necessary to confirm the sustained neurocognitive and behavioral benefits of digital and AI-powered CBT for insomnia.

HIV Prevention Interventions and Research in the Philippines for High-Risk Populations: Proposals From a Scoping Review of Contributing Factors

ABSTRACT

Despite a global decrease in HIV cases and efforts to reduce HIV incidence in the country, the Philippines has an increasing HIV incidence rate, which is the highest in the Asia-Pacific region. A multiplicity of factors is driving the HIV epidemic in the Philippines. Our scoping review aims to describe the current literature about factors influencing the Philippine HIV landscape. The available literature shows that individual, sociocultural, environmental, educational, environmental, and biological factors fueled the HIV epidemic in the Philippines. Specifically, low levels of HIV knowledge, low testing rates, high-risk sex behaviors, stigma, lifestyle, location, lack of HIV education in schools, conservative society, and restrictive policies are contributing factors. Our findings provide direction for designing comprehensive targeted interventions, increasing public awareness, advocating for policy formulation, and developing a dedicated HIV research program to guide HIV preventive programs and research in the country.

Effectiveness of Combined Cognitive Stimulation and Physical Activity Interventions on Activities of Daily Living, Cognitive Function, and Physical Function in Older People with Mild Cognitive Impairment: A Systematic Review with Meta-Analysis

Background/Objectives: This systematic review with meta-analysis aimed to evaluate and synthesize scientific evidence about the combined cognitive stimulation and physical activity interventions on Activities of Daily Living (ADL), cognitive function, and physical function in older people with Mild Cognitive Impairment (MCI). Methods: A systematic literature search was conducted between August 2024 and October 2024 using the core collection of six generic databases: PubMed, EBSCOhost, CINAHL Complete, Cochrane, Scopus, and Web of Science. The PRISMA, RoB 2, and GRADEpro tools assessed the evidence's methodological quality and certainty. The protocol was registered in PROSPERO, CRD42024577229. Results: Of 270 records identified in the databases, 9 studies were analyzed using the PICOS format. The MMSE meta-analysis showed significant improvements in cognitive function in favor of the experimental groups (p = 0.010). In contrast, no significant improvements were found for TMT-A (p = 0.51) and TMT-B (p = 0.37). No significant differences were reported for the other variables studied. Conclusions: Cognitive function, as measured by the MMSE, showed significant improvements, while the interventions analyzed did not produce significant improvements in ADL or physical function among older people with MCI. Individual studies suggest that programs that integrate both cognitive stimulation and physical activity components may provide some benefits.

Factors influencing health-promoting lifestyle among medical personnel: a systematic review protocol

INTRODUCTION

A health-promoting lifestyle is essential for improving quality of life and reducing the risk of chronic diseases. However, despite their high health literacy, medical personnel often show low adherence to such lifestyles. Identifying the factors influencing these behaviours in medical professionals is critical for developing effective interventions. This review aims to identify the factors that influence the health-promoting lifestyle among medical personnel.

METHODS AND ANALYSIS

We will conduct a systematic search across three electronic databases: Web of Science, Scopus and PubMed. To ensure comprehensive literature coverage, we will also examine the reference lists of included studies and relevant reviews identified during the search. Eligible studies will include quantitative, qualitative and mixed-methods research articles that investigate factors influencing health-promoting lifestyles among medical personnel. No restrictions will be applied regarding geographical location or publication year. Only original, peer-reviewed journal articles published in English will be considered. The search strategy will incorporate key terms and their synonyms, including Medical Subject Headings terms such as 'factor', 'barrier', 'enabler', 'health-promoting lifestyle', 'medical personnel', 'doctor', 'nurse', 'medical technician', 'pharmacist' and 'hospital administrative staff.' All retrieved studies will be imported into Rayyan software for duplicate removal. Two independent reviewers will conduct the screening process based on predefined inclusion and exclusion criteria. The risk of bias in individual studies will be assessed using the Mixed Methods Appraisal Tool. A narrative synthesis approach will be employed to synthesise findings, categorising identified influencing factors into five levels of the Ecological Model of Health Behavior: intrapersonal, interpersonal, organisational, community and public policy levels.

ETHICS AND DISSEMINATION

Ethical approval is not required as no original data collection is involved. Findings will be disseminated via peer-reviewed journals, conferences and the primary author's PhD thesis.

PROSPERO REGISTRATION NUMBER

CRD42024579746.

The role of high-density EEG in diagnosis and prognosis of neurological diseases: A systematic review

OBJECTIVE

The use of High-Density Electroencephalography (HD-EEG) increased in neurological disorders, due to analysis of brain connectivity. This method is able to create a detailed brain mapping. The aim is to investigate studies that employed HD-EEG in neurological and neurodegenerative filed.

METHODS

This systematic review was conducted and reported in accordance with the PRISMA. A research terms was conducted for: (1) dementia, (2) Multiple Sclerosis (MS), (3) Parkinson Disease (PD), (4) stroke, (5) epilepsy.

RESULTS

The study included a total of 89 articles: 22 dementia; 33 epilepsy; 5 MS; 24 PD; 5 S. Articles were discussed for each neurological disorder and for different types of EEG analysis: analysis of event-related potentials, specific EEG features at resting state, spectral and connectivity analysis, time-frequency analysis and EEG recordings combined with other types of intervention.

DISCUSSION

HD-EEG recordings provide evidence about the evaluation of early markers of the disease onset, mapping of cortical activity distribution of neurological disorders.

SIGNIFICANCE

HD-EEG demonstrated it effectiveness in detection of biomarkers for the diagnosis and prognosis. In dementia contributed to misdiagnosis between different subtype and identifying markers of cognitive decline, investigating motor and cognitive networks dynamics in stroke, PD and MS, and to detect task-specific network reorganization.

A Systematic Review of Breast Cancer Knowledge Among School-Level Students Worldwide

Breast cancer knowledge and the practice of breast self-examination among school students are crucial topics in health education due to the high incidence rate. However, there is little research on this subject. This systematic review aims to synthesize the empirical literature on the topic, analyzing and identifying patterns in the learning strategies and evaluation methodologies used. A systematic search, following the PRISMA method across the Scopus, Web of Science, and ERIC databases, found only six studies published between 2000 and 2021 that focused on school education. The results revealed a significant lack of explicit and detailed educational interventions. Only two studies included educational interventions, but both lacked specific methodological details, limiting the ability to assess their effectiveness and replicate the results. While cross-sectional studies are useful for evaluating general knowledge, they did not sufficiently explore the underlying causes of knowledge deficiencies, nor did they propose strategies to address them. There is an urgent need to develop detailed and well-documented educational interventions on breast cancer within school contexts. This review provides an initial foundation and suggests that future research should address the identified methodological gaps to effectively contribute to health education and breast cancer prevention in young populations.

Paediatric trauma and hypocalcaemia: a systematic review

BACKGROUND

Trauma is a leading cause of mortality and morbidity in children worldwide. While adult studies have demonstrated hypocalcaemia's association with adverse outcomes, its impact on paediatric trauma patients remains understudied. This systematic review aims to investigate current evidence into the prevalence, clinical implications and associations of hypocalcaemia in paediatric trauma.

METHODS

A comprehensive literature search was conducted searching four databases, grey literature and additional sources for original studies looking at outcomes for paediatric trauma patients with ionised calcium measurements before blood product administration. Exclusion criteria comprised studies which included patients with blood product administration prior to calcium measurement, case reports, case series, reviews and papers not available in English. The review protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO): CRD42023432473. Data extraction was performed on included papers and quality assessment performed using Newcastle-Ottawa Scale.

RESULTS

Of 779 initial studies, two studies met inclusion criteria for detailed analysis. Both retrospective cohort studies originated in Israel and collectively included 568 patients. Hypocalcaemia incidence ranged from 5.3% to 19.8%. Although trends towards increased mortality, blood transfusion requirements and prolonged hospital stays were observed in patients with hypocalcaemia, statistical significance was not consistently achieved.

CONCLUSION

Hypocalcaemia in paediatric trauma appears reduced in incidence compared with adult populations. Limited available studies suggest potential associations with adverse outcomes, although most were not statistically significant. Studies had small patient numbers, necessitating further prospective research to facilitate a clearer understanding. Insights from such studies can guide patient management and improve outcomes in this vulnerable population.

PROSPERO REGISTRATION NUMBER

CRD42023432473.

The origin of YouTube videos on hereditary angioedema matters

BACKGROUND

Hereditary angioedema (HAE) is a rare, potentially life-threatening condition that requires accessible and reliable information. YouTube has emerged as a significant source of health-related content, offering valuable insights while posing the risk of misinformation that warrants caution among users. The aim of this study was to evaluate the popularity, reliability, understandability, actionability, and overall quality of YouTube videos related to HAE.

METHOD

A search was conducted on YouTube using the term "hereditary angioedema." Videos were categorized based on their origin (health or nonhealth) and content type (medical professional education (MPE), patient education (PE), patient experience, or awareness). The quality, reliability, understandability, and actionability of the videos were assessed via the Global Quality Scale (GQS), the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V), and the Quality Criteria for Consumer Health Information (DISCERN) tool. Three independent allergists evaluated the videos.

RESULTS

Out of 135 reviewed videos, 111 met the inclusion criteria. The health group presented significantly higher scores than did the nonhealth group in several metrics: PEMAT-A/V understandability (83, IQR: 56-92, p = 0.001), total DISCERN score (37, IQR: 3-45, p < 0.001), reliability (23, IQR: 19-26, p < 0.001), treatment (15, IQR: 8-21, p = 0.007), and modified DISCERN score (3, IQR: 2-4, p = 0.002). Health videos were uploaded more recently (p = 0.006), while awareness videos tended to be older than more recent MPE videos (p = 0.002). The MPE videos had the longest duration, whereas the awareness videos had the shortest duration (p < 0.001). Video quality scores, assessed via the GQS, were higher in both the MPE and PE groups (scores: 3, 4, and 5; p = 0.005). Compared with the other groups, the MPE group also had significantly higher PEMAT-A/V understandability scores (91, IQR: 70.75-92, p < 0.001), total DISCERN scores (40, IQR: 30.75-49.5, p < 0.001), reliability scores (24, IQR: 21-27.25, p < 0.001), and overall scores for moderate to high quality (83, 74.8%, p = 0.002).

CONCLUSION

YouTube videos on HAE uploaded by health care professionals generally offer higher-quality information, but their overall reliability remains suboptimal. There is a pressing need for higher-quality, trustworthy content, particularly from professional medical organizations, to address this gap.

Application of Exercise Snacks across Youth, Adult and Clinical Populations: A Scoping Review

BACKGROUND

Interest in 'exercise snacks' has increased, yet a comprehensive and holistic review of this novel concept is lacking. We aimed to map global research on 'exercise snacks', across youth, adult and clinical populations through a scoping review.

METHODS

A systematic search was conducted in six databases. Grey literature searches were also conducted. Studies whereby participants were prescribed a structured bout of intense exercise dispersed across the day, or the exercise was explicitly defined as a form of 'snacks', in any setting were included. We used the Consensus on Exercise Reporting Template (CERT) to assess the completeness of exercise descriptions. Data were recorded into spreadsheets, then descriptively analyzed and summarized in graphic form.

RESULTS

The 45 publications meeting our inclusion criteria represented 33 original studies. These 33 studies enrolled a total of 1118 participants, with a median sample size of 24. Studies were categorized as either acute (n = 12) or chronic (n = 21) trials with both trial types performed across a wide range of participant ages (range 8.7 to 78 years) but mostly conducted on healthy adults and older adults. The majority of studies (20/33) defined the concept as 'exercise snacks', with study context being predominantly the laboratory or home. A wide variety of exercise modes (e.g., cycling, stair climbing, body weight exercises) and comparator conditions (e.g., moderate intensity continuous exercise, prolonged sitting, non-exercise controls) were used. 'Exercise snack' intensity was prescribed more frequently than it was reported, and, of the available data, mean intensity was estimated at 76.9% of maximal heart rate and 5.2 Arbitrary Units (AU) on the Ratings of Perceived Exertion (RPE) CR10 scale. Study outcome measures were predominantly cardiovascular, metabolic, muscular, and psychological, with studies mostly adhering to the CERT, though there was underreporting of detail for the exercise provider, motivation strategies, adverse events and intervention fidelity.

CONCLUSION

The 'exercise snack' concept is being increasingly used to cover an array of exercise models. The most common protocols to date utilize body weight exercises or stair climbing. We recommend 'exercise snacks' terminology is consistently used to describe protocols whereby short, purposeful structured exercise is dispersed throughout the day. Future studies should provide detailed descriptions of their 'exercise snacks' model, through exercise and adverse event reporting checklists.

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

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

Pharmacists delivering hypertension care services: a systematic review and meta-analysis of randomized controlled trials

Background

Community-based models of care with the involvement of pharmacists and other nonphysician healthcare professionals can help improve blood pressure (BP) control. We aimed to synthesize the evidence of effectiveness of pharmacist interventions on BP among patients with hypertension.

Methods

We performed systematic searches to identify randomized controlled trials (RCTs) assessing the effect of pharmacist interventions on BP among outpatients (latest search, March 2024). The effect on systolic and diastolic BP change or BP control were pooled using random effects model. Subgroup analysis for the types of pharmacist interventions and healthcare settings were performed. The risk of bias was assessed using the Cochrane Risk of Bias Tool 2. The protocol was registered in PROSPERO (CRD42021279751) and published in an open-access peer-reviewed journal.

Results

Out of 2,330 study records identified in 7 electronic databases, a total of 95 RCTs, with 31,168 participants (control 16,157, intervention 15,011), were included. The intervention was led by the pharmacist in 75% of the studies and in collaboration with other healthcare providers in 25%. Pharmacist interventions included patient education in 88%, feedback to healthcare providers in 49%, and patient reminders in 24% of the studies. Systolic and diastolic BP were reduced after pharmacist intervention by -5.3 mmHg (95% CI: -6.3 to -4.4; I 2 = 86%) and -2.3 mmHg (95% CI: -2.9 to -1.8; I 2 = 75%), respectively. The reduction of systolic BP tended to be larger if the intervention was collaborative, conducted in outpatient clinics, based on healthcare provider education, or through healthcare provider feedback. Analyses restricted to relatively large or high-quality studies yielded similar estimates, with lower between-studies heterogeneity.

Conclusion

Pharmacist care for patients with hypertension consistently improves BP across various settings and interventions. Pharmacist care is one key element of the solution to the global burden of hypertension and cardiovascular diseases.

PROSPERO registration number

CRD42021279751.

Balancing benefits and burdens: a systematic review on ethical and social dimensions of gene and cell therapies for hereditary blood diseases

BACKGROUND

Sickle cell disease (SCD) and Diamond-Blackfan anemia syndrome (DBAS) are two hereditary blood diseases that present significant challenges to patients, their caregivers, and the healthcare system. Both conditions cause severe health complications and have limited treatment options, leaving many individuals without access to curative therapies like hematopoietic stem cell transplantation. Recent advancements in gene and cell therapies offer the potential for a new curative option, marking a pivotal shift in the management of these debilitating diseases. However, the implementation of these therapies necessitates a nuanced understanding of the ethical and social implications.

METHODS

In this mixed methods systematic review, we explore the responsible development and implementation of gene and cell therapies for SCD and DBAS and aim to sketch a path toward ethically and socially sound implementation. Drawing upon principles of Responsible Research & Innovation and the 4A framework of availability, accessibility, acceptability, and affordability, we thematically analyze existing research to illuminate the ethical and social dimensions of these therapies. Following established PRISMA and JBI Manual guidelines, a search across multiple databases yielded 51 peer-reviewed studies with publication dates ranging from 1991 to 2023.

RESULTS

Our thematic analysis shows that the theme of acceptability is heavily shaped by interactions between patients, caregivers, healthcare professionals and researchers, influencing treatment decisions and shaping the development of curative gene and cell therapies. Despite the generally positive perspective on these therapies, factors like the limited treatment options, financial constraints, healthcare professional attitudes, and (historical) mistrust can impede stakeholder decision-making. While acceptability focuses on individual decisions, the themes of availability, accessibility, and affordability are interconnected and primarily driven by healthcare systems, where high research and development costs, commercialization and a lack of transparency challenge equitable access to these therapies. This diminishes the acceptability for patients, revealing a complex interdependence of the themes.

CONCLUSIONS

The findings suggest the need for improved communication strategies in clinical practice to facilitate informed decision-making for patients and caregivers. Policy development should focus on addressing pricing disparities and promoting international collaboration to ensure equitable access to therapies. This review has been pre-registered in PROSPERO under registration number CRD42023474305.

Enhanced Recovery After Cardiac Surgery for Minimally Invasive Valve Surgery: A Systematic Review of Key Elements and Advancements

Background and Objectives: Minimally invasive valve surgery (MIVS), integrated within enhanced recovery after surgery (ERAS) programs, is a pivotal advancement in modern cardiac surgery, aiming to reduce perioperative morbidity and accelerate recovery. This systematic review analyzes the integration of ERAS components into MIVS programs and evaluates their impact on perioperative outcomes and patient recovery. Materials and Methods: A systematic search of PubMed/Medline, conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, identified studies on ERAS in MIVS patients. Coronary and robotic surgery were excluded to prioritize widely adopted minimally invasive valve methods. Studies were included if they applied ERAS protocols primarily to MIVS patients, with at least five participants per study. Data on study characteristics, ERAS components, and patient outcomes were extracted for analysis. Results: Eight studies met the inclusion criteria, encompassing 1287 MIVS patients (842 ERAS, 445 non-ERAS). ERAS protocols in MIVS were heterogeneous, with studies implementing 9 to 18 of 24 ERAS measures recommended by the ERAS consensus guideline, reflecting local hospital practices and resource availability. Common elements include patient education and multidisciplinary teams, early extubation followed by mobilization, multimodal opioid-sparing pain management, and timely removal of invasive lines. Despite protocol variability, these programs were associated with reduced morbidity, shorter hospital stays (intensive care unit-stay reductions of 4-20 h to complete omission, and total length of stay by ≥1 day), and cost savings of up to EUR 1909.8 per patient without compromising safety. Conclusions: ERAS protocols and MIVS synergistically enhance recovery and reduce the length of hospital stay. Standardizing ERAS protocols for MVS could amplify these benefits and broaden adoption.

The Insulin-like Growth Factor Family as a Potential Peripheral Biomarker in Psychiatric Disorders: A Systematic Review

Psychiatric disorders (PDs), including schizophrenia (SZ), major depressive disorder (MDD), bipolar disorder (BD), autism spectrum disorder (ASD), among other disorders, represent a significant global health burden. Despite advancements in understanding their biological mechanisms, there is still no reliable objective and reliable biomarker; therefore, diagnosis remains largely reliant on subjective clinical assessments. Peripheral biomarkers in plasma or serum are interesting due to their accessibility, low cost, and potential to reflect central nervous system processes. Among these, the insulin-like growth factor (IGF) family, IGF-1, IGF-2, and IGF-binding proteins (IGFBPs), has gained attention for its roles in neuroplasticity, cognition, and neuroprotection, as well as for their capability to cross the blood-brain barrier. This review evaluates the evidence for IGF family alterations in PDs, with special focus on SZ, MDD, and BD, while also addressing other PDs covering almost 40 years of history. In SZ patients, IGF-1 alterations have been linked to metabolic dysregulation, treatment response, and hypothalamic-pituitary-adrenal axis dysfunction. In MDD patients, IGF-1 appears to compensate for impaired neurogenesis, although findings are inconsistent. Emerging studies on IGF-2 and IGFBPs suggest potential roles across PDs. While promising, heterogeneity among studies and methodological limitations highlights the need for further research to validate IGFs as reliable psychiatric biomarkers.