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Hach S, Alder G, Stavric V, Taylor D, Signal N. Usability Assessment Methods for Mobile Apps for Physical Rehabilitation: Umbrella Review. JMIR Mhealth Uhealth 2024; 12:e49449. [PMID: 39365988 DOI: 10.2196/49449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 05/04/2024] [Accepted: 07/30/2024] [Indexed: 10/06/2024] Open
Abstract
BACKGROUND Usability has been touted as one determiner of success of mobile health (mHealth) interventions. Multiple systematic reviews of usability assessment approaches for different mHealth solutions for physical rehabilitation are available. However, there is a lack of synthesis in this portion of the literature, which results in clinicians and developers devoting a significant amount of time and effort in analyzing and summarizing a large body of systematic reviews. OBJECTIVE This study aims to summarize systematic reviews examining usability assessment instruments, or measurements tools, in mHealth interventions including physical rehabilitation. METHODS An umbrella review was conducted according to a published registered protocol. A topic-based search of PubMed, Cochrane, IEEE Xplore, Epistemonikos, Web of Science, and CINAHL Complete was conducted from January 2015 to April 2023 for systematic reviews investigating usability assessment instruments in mHealth interventions including physical exercise rehabilitation. Eligibility screening included date, language, participant, and article type. Data extraction and assessment of the methodological quality (AMSTAR 2 [A Measurement Tool to Assess Systematic Reviews 2]) was completed and tabulated for synthesis. RESULTS A total of 12 systematic reviews were included, of which 3 (25%) did not refer to any theoretical usability framework and the remaining (n=9, 75%) most commonly referenced the ISO framework. The sample referenced a total of 32 usability assessment instruments and 66 custom-made, as well as hybrid, instruments. Information on psychometric properties was included for 9 (28%) instruments with satisfactory internal consistency and structural validity. A lack of reliability, responsiveness, and cross-cultural validity data was found. The methodological quality of the systematic reviews was limited, with 8 (67%) studies displaying 2 or more critical weaknesses. CONCLUSIONS There is significant diversity in the usability assessment of mHealth for rehabilitation, and a link to theoretical models is often lacking. There is widespread use of custom-made instruments, and preexisting instruments often do not display sufficient psychometric strength. As a result, existing mHealth usability evaluations are difficult to compare. It is proposed that multimethod usability assessment is used and that, in the selection of usability assessment instruments, there is a focus on explicit reference to their theoretical underpinning and acceptable psychometric properties. This could be facilitated by a closer collaboration between researchers, developers, and clinicians throughout the phases of mHealth tool development. TRIAL REGISTRATION PROSPERO CRD42022338785; https://www.crd.york.ac.uk/prospero/#recordDetails.
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Affiliation(s)
- Sylvia Hach
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Gemma Alder
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Verna Stavric
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Denise Taylor
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Nada Signal
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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Deschodt M, Heeren P, Cerulus M, Duerinckx N, Pape E, van Achterberg T, Vanclooster A, Dauvrin M, Detollenaere J, Van den Heede K, Dobbels F. The effect of consultations performed by specialised nurses or advanced nurse practitioners on patient and organisational outcomes in patients with complex health conditions: An umbrella review. Int J Nurs Stud 2024; 158:104840. [PMID: 38945063 DOI: 10.1016/j.ijnurstu.2024.104840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 04/22/2024] [Accepted: 06/04/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Policymakers and researchers often suggest that nurses may play a crucial role in addressing the evolving needs of patients with complex conditions, by taking on advanced roles and providing nursing consultations. Nursing consultations vary widely across settings and countries, and their activities range from complementing to substituting traditional physician-led consultations or usual care. OBJECTIVE This study was aimed at describing the effects of nursing consultations with patients with complex conditions in any setting on patient outcomes (quality of life, physical status, psychosocial health, health behaviour, medication adherence, mortality, anthropometric and physiological outcomes, and patient satisfaction) and organisational outcomes (health resource use and costs). DESIGN Umbrella review. METHODS We followed the Joanna Briggs Institute method for umbrella reviews. We searched PubMed, Embase, Cochrane Database of Systematic Reviews and CINAHL to identify relevant articles published in English, Dutch, French, Spanish or German between January 2013 and February 2023. We included systematic literature reviews, with or without meta-analyses, that included randomised controlled trials conducted in high-income countries. Reviews were eligible if they pertained to consultations led by specialised nurses or advanced nurse practitioners. Article selection, data extraction and quality appraisal were performed independently by at least two reviewers. RESULTS We included 50 systematic reviews based on 473 unique trials. For all patient outcomes, nursing consultations achieved effects at least equivalent to those of physician-led consultations or usual care (i.e., non-inferiority). For quality of life, health behaviour, medication adherence, mortality and patient satisfaction, more than half the meta-analyses found statistically significant effects in favour of nursing consultations (i.e., superiority). Cost results must be interpreted with caution, because very few and heterogeneous cost-related data were extracted, and the methodological quality of the cost analyses was questionable. Narrative syntheses confirmed the overall conclusions of the meta-analyses. CONCLUSIONS The effects of nursing consultations on patients with complex health conditions across healthcare settings appear to be at least similar to physician-led consultations or usual care. Nursing consultations appear to be more effective than physician-led consultations or usual care in terms of quality of life, health behaviour, mortality, patient satisfaction and medication adherence. Further analysis of the primary data is necessary to determine the patient populations and settings in which nursing consultations are most effective. Moderate study quality, diversity amongst and within systematic reviews, and quality of reporting hamper the strength of the findings.
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Affiliation(s)
- Mieke Deschodt
- Gerontology and Geriatrics, Department of Public Health and Primary Care, KU Leuven, Belgium; Competence Center of Nursing, University Hospitals Leuven, Belgium.
| | - Pieter Heeren
- Competence Center of Nursing, University Hospitals Leuven, Belgium; Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium
| | - Marie Cerulus
- Gerontology and Geriatrics, Department of Public Health and Primary Care, KU Leuven, Belgium; Competence Center of Nursing, University Hospitals Leuven, Belgium
| | - Nathalie Duerinckx
- Competence Center of Nursing, University Hospitals Leuven, Belgium; Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium; Heart Transplant Program, Department of Cardiovascular Diseases, KU Leuven, Belgium
| | - Eva Pape
- Cancer Centre, Ghent University Hospital, Belgium
| | - Theo van Achterberg
- Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium
| | | | | | | | | | - Fabienne Dobbels
- Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium
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Matu J, Griffiths A, Shannon OM, Jones A, Day R, Radley D, Feeley A, Mabbs L, Blackshaw J, Sattar N, Ells L. The association between excess weight and COVID-19 outcomes: An umbrella review. Obes Rev 2024; 25:e13803. [PMID: 39096049 DOI: 10.1111/obr.13803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/14/2024] [Accepted: 07/04/2024] [Indexed: 08/04/2024]
Abstract
This umbrella review assessed the association between excess weight and COVID-19 outcomes. MEDLINE, PsycINFO, and CINAHL were systematically searched for reviews that assessed the association between excess weight and COVID-19 outcomes. A second-order meta-analysis was conducted on the available data for intensive care unit admission, invasive mechanical ventilation administration, disease severity, hospitalization, and mortality. The quality of included reviews was assessed using the AMSTAR-2 appraisal tool. In total, 52 systematic reviews were included, 49 of which included meta-analyses. The risk of severe outcomes (OR = 1.86; 95% CI: 1.70 to 2.05), intensive care unit admission (OR = 1.58; 95% CI: 1.45 to 1.72), invasive mechanical ventilation administration (OR = 1.70; 95% CI: 1.57 to 1.83), hospitalization (OR = 1.82; 95% CI: 1.61 to 2.05), and mortality (OR = 1.35; 95% CI: 1.24 to 1.48) following COVID-19 infection was significantly higher in individuals living with excess weight compared with those with a healthy weight. There was limited evidence available in the included reviews regarding the influence of moderating factors such as ethnicity, and the majority of included reviews were of poor quality. Obesity appears to represent an important modifiable pre-infection risk factor for severe COVID-19 outcomes, including death.
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Affiliation(s)
- Jamie Matu
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Alex Griffiths
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Oliver M Shannon
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Jones
- Psychology, Liverpool John Moores University, Liverpool, UK
| | - Rhiannon Day
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Duncan Radley
- Obesity Institute, School of Sport, Leeds Beckett University, Leeds, UK
| | - Alison Feeley
- Office for Health Improvement and Disparities, London, UK
| | - Lisa Mabbs
- Office for Health Improvement and Disparities, London, UK
| | | | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Louisa Ells
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
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Tiani KA, Arenaz CM, Spill MK, Foster MJ, Davis JS, Bailey RL, Field MS, Stover PJ, MacFarlane AJ. The Use of Ginger Bioactive Compounds in Pregnancy: An Evidence Scan and Umbrella Review of Existing Meta-Analyses. Adv Nutr 2024:100308. [PMID: 39343171 DOI: 10.1016/j.advnut.2024.100308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 08/16/2024] [Accepted: 09/11/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND Ginger is a commonly used nonpharmacological treatment of pregnancy-related symptoms including nausea and vomiting, inflammation, and gastrointestinal dysfunction. Determining the efficacy of ginger is particularly important during pregnancy and lactation when maternal and neonatal detrimental effects may be a concern. OBJECTIVES This evidence scan and umbrella review aimed to assess the extent and quality of the evidence regarding the effectiveness and safety of using dietary preparations of ginger during pregnancy and lactation. METHODS We searched MEDLINE, Embase, CAB Abstracts, and International Pharmaceutical Abstracts up to 23 December, 2023, to identify maternal and neonatal outcomes associated with ginger use during pregnancy or lactation compared with placebo or conventional medicines. Outcomes for which a meta-analysis (MA) of intervention studies was identified were synthesized in an umbrella review. The A MeaSurement Tool to Assess systematic Reviews-2 tool was used to critically appraise the reviews. The percent overlap in primary studies was calculated overall and pairwise for each included MA. Data extracted from each MA included the summary estimate of the effect of ginger, the formulation of the ginger treatment, gestational timepoint at intervention, population enrolled in the study, type of intervention, comparator intervention, and number of study participants. RESULTS The evidence scan identified 90 articles relevant to ginger use during pregnancy and lactation. Seven MAs of ginger use for treating nausea and vomiting of pregnancy reported 22 independent studies with a 49% study overlap among them. The majority of the MAs found a significant positive effect of ginger on the improvement of nausea in pregnancy compared with placebo, or equivalence to conventional treatments, and no evidence of significant adverse effects. The quality of the MAs ranged from critically low to low. CONCLUSIONS The evidence suggests that ginger is effective at reducing nausea in pregnancy; however, the included studies contained substantial heterogeneity and were of low quality.
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Affiliation(s)
- Kendra A Tiani
- Institute for Advancing Health Through Agriculture, Texas A&M University, College Station, TX, United States
| | - Cristina M Arenaz
- Institute for Advancing Health Through Agriculture, Texas A&M University, College Station, TX, United States
| | - Maureen K Spill
- Texas A&M Agriculture, Food and Nutrition Evidence Center, Fort Worth, TX, United States
| | - Margaret J Foster
- Center for Systematic Reviews and Evidence Syntheses, Texas A&M University, College Station, TX, United States
| | - Julie S Davis
- Texas A&M Agriculture, Food and Nutrition Evidence Center, Fort Worth, TX, United States
| | - Regan L Bailey
- Institute for Advancing Health Through Agriculture, Texas A&M University, College Station, TX, United States; Department of Nutrition, Texas A&M University, College Station, TX, United States
| | - Martha S Field
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - Patrick J Stover
- Department of Nutrition, Texas A&M University, College Station, TX, United States; Department of Biochemistry and Biophysics, Texas A&M University, College Station, TX, United States
| | - Amanda J MacFarlane
- Texas A&M Agriculture, Food and Nutrition Evidence Center, Fort Worth, TX, United States; Department of Nutrition, Texas A&M University, College Station, TX, United States.
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Huff NR, Dunderdale L, Kellogg AJ, Isbell LM. Factors related to help-seeking and service utilization for professional mental healthcare among young people: An umbrella review. Clin Psychol Rev 2024; 114:102504. [PMID: 39395209 DOI: 10.1016/j.cpr.2024.102504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 09/12/2024] [Accepted: 09/18/2024] [Indexed: 10/14/2024]
Abstract
The aim of this umbrella review is to summarize evidence on factors that influence help-seeking and service utilization for professional mental healthcare among young people ages 0-30. The CINAHL, Cochrane, Epistemonikos, MEDLINE, PsycINFO, PubMed, and Web of Science databases were searched in December 2023 for systematic reviews in English. The search yielded 26 eligible reviews, all of which are medium or high quality. Primary study overlap was rare. Using an established framework, we organize intrapersonal (n = 37), interpersonal (n = 14), institutional (n = 9), community (n = 7), and public policy (n = 6) factors. The most frequently reviewed factor at each level is trust of professionals (intrapersonal), close others' support for treatment (interpersonal), cost (institutional), availability (community), and insurance (public policy). Stigma is widely referenced (18 reviews) and classified as multi-dimensional. Narrative synthesis reveals population-specific variability (e.g., rural, racial/ethnic minority, refugees, immigrants) in the importance of many factors. To develop interventions and healthcare systems sensitive to young people's needs, we recommend promoting stigma-reduction campaigns, and targeting trustworthiness, affordability, anonymity, accessibility, and mental health literacy. Identifying commonalities and differences across populations and contexts assists in the design of nuanced and efficient treatment delivery systems for young people, who are at a critical time for their mental health.
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Affiliation(s)
- Nathan R Huff
- Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01003, United States of America.
| | - Laura Dunderdale
- Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01003, United States of America
| | - Alexander J Kellogg
- Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01003, United States of America
| | - Linda M Isbell
- Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01003, United States of America
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Alemu BK, Wu L, Azeze GG, Lau SL, Wang Y, Wang CC. Microbiota-targeted interventions and clinical implications for maternal-offspring health: An umbrella review of systematic reviews and meta-analyses of randomised controlled trials. J Glob Health 2024; 14:04177. [PMID: 39269153 PMCID: PMC11395958 DOI: 10.7189/jogh.14.04177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024] Open
Abstract
Background Microbes in the human body are the determinants of life-long health and disease. Microbiome acquisition starts in utero and matures during early childhood through breastfeeding. However, maternal gut dysbiosis affects the maternal-offspring microbiome interplay. Lines of evidence on dysbiosis-targeted interventions and their effect on maternal-offspring health and gut microbiome are inconsistent and inconclusive. Therefore, this study summarised studies to identify the most common microbiota-targeted intervention during pregnancy and lactation and to comprehensively evaluate its effects on maternal and offspring health. Methods This umbrella review was conducted by systematically searching databases such as PubMed and the Web of Science from inception to 2 September 2023. The quality was assessed using the Assessment of Multiple Systematic Reviews-2 checklist. The Grading of Recommendations Assessment, Development, and Evaluation was used for grading the strength and certainty of the studies. The overlap of primary studies was quantified by the corrected covered area score. Results A total of 17 systematic reviews and meta-analyses with 219 randomised controlled trials, 39 113 mothers, and 20 915 infants were included in this study. About 88% of studies had moderate and above certainty of evidence. Probiotics were the most common and effective interventions at reducing gestational diabetes risk (fasting blood glucose with the mean difference (MD) = -2.92, -0.05; I2 = 45, 98.97), fasting serum insulin (MD = -2.3, -2.06; I2 = 45, 77), glycated haemoglobin (Hb A1c) = -0.16; I2 = 0.00)), Homeostatic Model Assessment of insulin resistance (HOMA-IR) (MD = -20.55, -0.16; I2 = 0.00, 72.00), and lipid metabolism (MD = -5.47, 0.98; I2 = 0.00, 90.65). It was also effective in preventing and treating mastitis (risk ratio (RR) = 0.49; I2 = 2.00), relieving anxiety symptoms (MD = -0.99, 0.01; I2 = 0.00, 70.00), depression in lactation (MD = -0.46, -0.22; I2 = 0.00, 74.00) and reducing recto-vaginal bacterial colonisation (odds ratio (OR) = 0.62; I2 = 4.80), and with no adverse events. It also effectively remodelled the infant gut microbiome (MD = 0.89; I2 = 95.01) and prevented infant allergies. However, studies on pregnancy outcomes and preeclampsia incidences are limited. Conclusions Our findings from high-quality studies identify that probiotics are the most common microbiome interventions during pregnancy and lactation. Probiotics have a strong impact on maternal and offspring health through maintaining gut microbiome homeostasis. However, further studies are needed on the effect of microbiota-targeted interventions on maternal cardiometabolic health, pregnancy, and neonatal outcomes. Registration This umbrella review was registered with PROSPERO, CRD42023437098.
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Affiliation(s)
- Bekalu Kassie Alemu
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
- Department of Midwifery, College of Medicine and Health Sciences, Debre Markos University, Ethiopia
| | - Ling Wu
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Getnet Gedefaw Azeze
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
- Department of Midwifery, College of Medicine and Health Sciences, Injibara University, Ethiopia
| | - So Ling Lau
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Yao Wang
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
- LI Ka Shing Institute of Health Sciences; Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Chi Chiu Wang
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
- LI Ka Shing Institute of Health Sciences; Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
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Cruciani M, Masiello F, Pati I, Pupella S, De Angelis V. Platelet rich plasma for facial rejuvenation: an overview of systematic reviews. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2024; 22:429-440. [PMID: 38557322 PMCID: PMC11390617 DOI: 10.2450/bloodtransfus.730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/17/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Platelet-rich plasma (PRP) as a non-surgical therapy for facial rejuvenation is increasingly adopted. This article aims to review the literature and critically appraise the available evidence regarding the efficacy and safety of PRP for facial rejuvenation. MATERIAL AND METHODS An overview of systematic reviews (SRs) of PRP use for facial rejuvenation. The methodological quality of the SRs was assessed using the AMSTAR-2 checklist; quality of the evidence from the trials included in each SR was appraised following the GRADE approach. RESULTS Thirteen SRs published between 2015 and 2023, reporting data from 114 overlapping reports, based on 28 individual primary studies (18 uncontrolled reports), were included in this umbrella review. Eight primary studies evaluated PRP in combination with other treatments (laser therapy, fat grafting, hyaluronic acid, basic fibroblast growth factor), and 20 PRP monotherapy. Most of the included primary studies were uncontrolled, and meta-analysis for outcomes related to facial rejuvenation was conducted in only 1 of the 13 SRs, showing that patients treated with PRP as an adjunct treatment have increased satisfaction over controls without PRP (mean difference, 0.63; 95% confidence intervals (CIs) 0.25/1; p=0-001; low certainty of evidence due to risk of bias (ROB) and inconsistency). No other quantitative data were available from the SRs, although 4 SRs concluded in a descriptive way reveal that PRP combined with laser therapy increased subject satisfaction and skin elasticity, and decreased the erythema index (very low certainty of evidence due to imprecision, unsystematic clinical observations, and ROB). The occurrence of adverse events was a predefined outcome in only 2 SRs (15%). Almost all the SRs demonstrated poor compliance with the AMSTAR 2 items, and the confidence in the results of SRs was graded as low or critically low in 12 of the 13 SRs. DISCUSSION The available evidence is insufficient to suggest firm conclusions about the use of PRP, alone or in combination with other treatments, in promoting facial rejuvenation.
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Affiliation(s)
- Mario Cruciani
- National Blood Centre, Italian National Institute of Health, Rome, Italy
| | - Francesca Masiello
- National Blood Centre, Italian National Institute of Health, Rome, Italy
| | - Ilaria Pati
- National Blood Centre, Italian National Institute of Health, Rome, Italy
| | - Simonetta Pupella
- National Blood Centre, Italian National Institute of Health, Rome, Italy
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Karipidis K, Baaken D, Loney T, Blettner M, Brzozek C, Elwood M, Narh C, Orsini N, Röösli M, Paulo MS, Lagorio S. The effect of exposure to radiofrequency fields on cancer risk in the general and working population: A systematic review of human observational studies - Part I: Most researched outcomes. ENVIRONMENT INTERNATIONAL 2024; 191:108983. [PMID: 39241333 DOI: 10.1016/j.envint.2024.108983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 08/09/2024] [Accepted: 08/22/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND The objective of this review was to assess the quality and strength of the evidence provided by human observational studies for a causal association between exposure to radiofrequency electromagnetic fields (RF-EMF) and risk of the most investigated neoplastic diseases. METHODS Eligibility criteria: We included cohort and case-control studies of neoplasia risks in relation to three types of exposure to RF-EMF: near-field, head-localized, exposure from wireless phone use (SR-A); far-field, whole body, environmental exposure from fixed-site transmitters (SR-B); near/far-field occupational exposures from use of hand-held transceivers or RF-emitting equipment in the workplace (SR-C). While no restrictions on tumour type were applied, in the current paper we focus on incidence-based studies of selected "critical" neoplasms of the central nervous system (brain, meninges, pituitary gland, acoustic nerve) and salivary gland tumours (SR-A); brain tumours and leukaemias (SR-B, SR-C). We focussed on investigations of specific neoplasms in relation to specific exposure sources (i.e. E-O pairs), noting that a single article may address multiple E-O pairs. INFORMATION SOURCES Eligible studies were identified by literature searches through Medline, Embase, and EMF-Portal. Risk-of-bias (RoB) assessment: We used a tailored version of the Office of Health Assessment and Translation (OHAT) RoB tool to evaluate each study's internal validity. At the summary RoB step, studies were classified into three tiers according to their overall potential for bias (low, moderate and high). DATA SYNTHESIS We synthesized the study results using random effects restricted maximum likelihood (REML) models (overall and subgroup meta-analyses of dichotomous and categorical exposure variables), and weighted mixed effects models (dose-response meta-analyses of lifetime exposure intensity). Evidence assessment: Confidence in evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. RESULTS We included 63 aetiological articles, published between 1994 and 2022, with participants from 22 countries, reporting on 119 different E-O pairs. RF-EMF exposure from mobile phones (ever or regular use vs no or non-regular use) was not associated with an increased risk of glioma [meta-estimate of the relative risk (mRR) = 1.01, 95 % CI = 0.89-1.13), meningioma (mRR = 0.92, 95 % CI = 0.82-1.02), acoustic neuroma (mRR = 1.03, 95 % CI = 0.85-1.24), pituitary tumours (mRR = 0.81, 95 % CI = 0.61-1.06), salivary gland tumours (mRR = 0.91, 95 % CI = 0.78-1.06), or paediatric (children, adolescents and young adults) brain tumours (mRR = 1.06, 95 % CI = 0.74-1.51), with variable degree of across-study heterogeneity (I2 = 0 %-62 %). There was no observable increase in mRRs for the most investigated neoplasms (glioma, meningioma, and acoustic neuroma) with increasing time since start (TSS) use of mobile phones, cumulative call time (CCT), or cumulative number of calls (CNC). Cordless phone use was not significantly associated with risks of glioma [mRR = 1.04, 95 % CI = 0.74-1.46; I2 = 74 %) meningioma, (mRR = 0.91, 95 % CI = 0.70-1.18; I2 = 59 %), or acoustic neuroma (mRR = 1.16; 95 % CI = 0.83-1.61; I2 = 63 %). Exposure from fixed-site transmitters (broadcasting antennas or base stations) was not associated with childhood leukaemia or paediatric brain tumour risks, independently of the level of the modelled RF exposure. Glioma risk was not significantly increased following occupational RF exposure (ever vs never), and no differences were detected between increasing categories of modelled cumulative exposure levels. DISCUSSION In the sensitivity analyses of glioma, meningioma, and acoustic neuroma risks in relation to mobile phone use (ever use, TSS, CCT, and CNC) the presented results were robust and not affected by changes in study aggregation. In a leave-one-out meta-analyses of glioma risk in relation to mobile phone use we identified one influential study. In subsequent meta-analyses performed after excluding this study, we observed a substantial reduction in the mRR and the heterogeneity between studies, for both the contrast Ever vs Never (regular) use (mRR = 0.96, 95 % CI = 0.87-1.07, I2 = 47 %), and in the analysis by increasing categories of TSS ("<5 years": mRR = 0.97, 95 % CI = 0.83-1.14, I2 = 41 %; "5-9 years ": mRR = 0.96, 95 % CI = 0.83-1.11, I2 = 34 %; "10+ years": mRR = 0.97, 95 % CI = 0.87-1.08, I2 = 10 %). There was limited variation across studies in RoB for the priority domains (selection/attrition, exposure and outcome information), with the number of studies evenly classified as at low and moderate risk of bias (49 % tier-1 and 51 % tier-2), and no studies classified as at high risk of bias (tier-3). The impact of the biases on the study results (amount and direction) proved difficult to predict, and the RoB tool was inherently unable to account for the effect of competing biases. However, the sensitivity meta-analyses stratified on bias-tier, showed that the heterogeneity observed in our main meta-analyses across studies of glioma and acoustic neuroma in the upper TSS stratum (I2 = 77 % and 76 %), was explained by the summary RoB-tier. In the tier-1 study subgroup, the mRRs (95 % CI; I2) in long-term (10+ years) users were 0.95 (0.85-1.05; 5.5 %) for glioma, and 1.00 (0.78-1.29; 35 %) for acoustic neuroma. The time-trend simulation studies, evaluated as complementary evidence in line with a triangulation approach for external validity, were consistent in showing that the increased risks observed in some case-control studies were incompatible with the actual incidence rates of glioma/brain cancer observed in several countries and over long periods. Three of these simulation studies consistently reported that RR estimates > 1.5 with a 10+ years induction period were definitely implausible, and could be used to set a "credibility benchmark". In the sensitivity meta-analyses of glioma risk in the upper category of TSS excluding five studies reporting implausible effect sizes, we observed strong reductions in both the mRR [mRR of 0.95 (95 % CI = 0.86-1.05)], and the degree of heterogeneity across studies (I2 = 3.6 %). CONCLUSIONS Consistently with the published protocol, our final conclusions were formulated separately for each exposure-outcome combination, and primarily based on the line of evidence with the highest confidence, taking into account the ranking of RF sources by exposure level as inferred from dosimetric studies, and the external coherence with findings from time-trend simulation studies (limited to glioma in relation to mobile phone use). For near field RF-EMF exposure to the head from mobile phone use, there was moderate certainty evidence that it likely does not increase the risk of glioma, meningioma, acoustic neuroma, pituitary tumours, and salivary gland tumours in adults, or of paediatric brain tumours. For near field RF-EMF exposure to the head from cordless phone use, there was low certainty evidence that it may not increase the risk of glioma, meningioma or acoustic neuroma. For whole-body far-field RF-EMF exposure from fixed-site transmitters (broadcasting antennas or base stations), there was moderate certainty evidence that it likely does not increase childhood leukaemia risk and low certainty evidence that it may not increase the risk of paediatric brain tumours. There were no studies eligible for inclusion investigating RF-EMF exposure from fixed-site transmitters and critical tumours in adults. For occupational RF-EMF exposure, there was low certainty evidence that it may not increase the risk of brain cancer/glioma, but there were no included studies of leukemias (the second critical outcome in SR-C). The evidence rating regarding paediatric brain tumours in relation to environmental RF exposure from fixed-site transmitters should be interpreted with caution, due to the small number of studies. Similar interpretative cautions apply to the evidence rating of the relation between glioma/brain cancer and occupational RF exposure, due to differences in exposure sources and metrics across the few included studies. OTHER This project was commissioned and partially funded by the World Health Organization (WHO). Co-financing was provided by the New Zealand Ministry of Health; the Istituto Superiore di Sanità in its capacity as a WHO Collaborating Centre for Radiation and Health; and ARPANSA as a WHO Collaborating Centre for Radiation Protection. REGISTRATION PROSPERO CRD42021236798. Published protocol: [(Lagorio et al., 2021) DOI https://doi.org/10.1016/j.envint.2021.106828].
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Affiliation(s)
- Ken Karipidis
- Australian Radiation Protection and Nuclear Safety Agency (ARPANSA), Yallambie, VIC, Australia.
| | - Dan Baaken
- Competence Center for Electromagnetic Fields, Federal Office for Radiation Protection (BfS), Cottbus, Germany; Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University of Mainz, Germany(1)
| | - Tom Loney
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University of Mainz, Germany(1)
| | - Chris Brzozek
- Australian Radiation Protection and Nuclear Safety Agency (ARPANSA), Yallambie, VIC, Australia
| | - Mark Elwood
- Epidemiology and Biostatistics, School of Population Health, University of Auckland, New Zealand
| | - Clement Narh
- Department of Epidemiology and Biostatistics, School of Public Health (Hohoe Campus), University of Health and Allied Sciences, PMB31 Ho, Ghana
| | - Nicola Orsini
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Marilia Silva Paulo
- Comprehensive Health Research Center, NOVA Medical School, Universidad NOVA de Lisboa, Portugal
| | - Susanna Lagorio
- Department of Oncology and Molecular Medicine, National Institute of Health (Istituto Superiore di Sanità), Rome, Italy(1)
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9
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Bevione F, Panero M, Abbate-Daga G, Cossu G, Carta MG, Preti A. Risk of suicide and suicidal behavior in refugees. A meta-review of current systematic reviews and meta-analyses. J Psychiatr Res 2024; 177:287-298. [PMID: 39059026 DOI: 10.1016/j.jpsychires.2024.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 07/13/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Despite the exposure to a wide combination of risk factors, evidence concerning risk of suicide among refugees is mixed. AIMS We aimed to establish more precise estimates of suicide and suicidal behavior in refugees and asylum seekers, investigate the role of somatic and psychiatric comorbidities, and the effectiveness of preventative interventions. METHODS We searched PubMed/Medline, EMBASE, CINAHL, and PsycInfo without time limitations from inception until June 5, 2024. Studies were included if systematic reviews or meta-analyses reporting data on suicide or suicidal behavior in refugees or asylum seekers, or detailing the results of preventive interventions. Quality was assessed using the National Institutes of Health Quality Assessment Tool for Systematic Reviews and Meta-Analyses. RESULTS Out of 49 papers, 10 systematic reviews and meta-analyses were included. Refugees showed significantly higher suicide death rates and suicidal ideation, suicide plan and suicide attempt prevalence compared to people living in the host countries. Refugees who arrived in low-income and lower-middle-income countries displayed lower suicidal ideation, but higher suicide death rates and suicide attempt prevalence compared to refugees who arrived in high-income and upper-middle-income countries. However, no review provided data regarding somatic comorbidity, psychiatric comorbidity, or the effectiveness of treatments, and evidence on specific categories of refugees is scarce. CONCLUSION Refugees have been proven to be at risk for suicide and suicidal behavior. More research is required to identify the targets and procedures of intervention.
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Affiliation(s)
| | - Matteo Panero
- Department of Neuroscience, University of Turin, Turin, Italy
| | | | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Preti
- Department of Neuroscience, University of Turin, Turin, Italy.
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10
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Fontanier V, Bruchard A, Tremblay M, Mohammed R, da Silva-Oolup S, Suri-Chilana M, Pasquier M, Hachem S, Meyer AL, Honoré M, Vigne G, Bermon S, Murnaghan K, Lemeunier N. Classification of myo-connective tissue injuries for severity grading and return to play prediction: A scoping review. J Sci Med Sport 2024:S1440-2440(24)00257-3. [PMID: 39232948 DOI: 10.1016/j.jsams.2024.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 06/28/2024] [Accepted: 07/25/2024] [Indexed: 09/06/2024]
Abstract
OBJECTIVES To conduct a systematic literature search to identify currently used classifications of acute non-contact muscle injuries in sporting adults. DESIGNS Scoping review. METHODS A systematic literature search from January 1, 2010 to April 19, 2022 of Medline and SPORTDiscus yielded 13,426 articles that were screened for eligibility. Findings from included studies were qualitatively synthesized. Classifications and their grading, as well as outcomes and definitions were extracted. RESULTS Twenty-four classifications were identified from the 37 included studies, most of which had low evidence study designs. Majority (57 %) of classifications were published after 2009 and were mostly developed for hamstring or other lower limb injuries. The six most cited classifications accounted for 70 % of the reports (BAMIC, modified Peetrons, Munich, Cohen, Chan and MLG-R). Outcome reporting was sparse, making it difficult to draw conclusions. Still, significant relationships between grading and time to return to play were reported for the BAMIC, modified Peetrons, Munich and Cohen classifications. Other classifications either had a very low number of reported associations, reported no associations, reported inconclusive associations, or did not report an assessment of the association. Other outcomes were poorly investigated. CONCLUSIONS There is no agreed-upon use of muscle classification, and no consensus on definitions and terminology. As a result, reported outcomes and their relationship to severity grading are inconsistent across studies. There is a need to improve the generalizability and applicability of existing classifications and to refine their prognostic value. High-level evidence studies are needed to resolve these inconsistencies.
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Affiliation(s)
| | | | - Mathieu Tremblay
- Groupe de Recherche sur les Affections Neuromusculosquelettiques, Université du Québec à Trois-Rivières, Canada
| | | | - Sophia da Silva-Oolup
- Undergraduate and Graduate Education Departments: Canadian Memorial Chiropractic College, Canada
| | - Minisha Suri-Chilana
- Undergraduate and Graduate Education Departments: Canadian Memorial Chiropractic College, Canada
| | | | - Sarah Hachem
- Paris-Saclay University, Inserm, "Exposome and Heredity" Team, CESP, France
| | | | | | | | - Stéphane Bermon
- Health and Science Department, World Athletics, Monaco; LAMHESS, Université Côte d'Azur, France
| | - Kent Murnaghan
- Library Services, Canadian Memorial Chiropractic College, Canada
| | - Nadège Lemeunier
- Medinetic Learning, Research Department, France; UMR1295, Toulouse III University, Inserm, Equipe EQUITY, Equipe constitutive du CERPOP, France; Faculty of Health Sciences, Ontario Tech University, Canada
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11
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Maghraby H, Elsuity MA, Adel N, Magdi Y, Abdelbadie AS, Rashwan MM, Ahmed OY, Elmahdy M, Khan KS, Fawzy M. Quantifying the association of sperm DNA fragmentation with assisted reproductive technology outcomes: An umbrella review. BJOG 2024; 131:1181-1196. [PMID: 38450853 DOI: 10.1111/1471-0528.17796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Systematic reviews and meta-analyses are instrumental in shaping clinical practice. However, their findings can sometimes be marred by discrepancies and potential biases, thereby diluting the strength of the evidence presented. Umbrella reviews serve to comprehensively assess and synthesise these reviews, offering a clearer insight into the quality of the evidence presented. In the context of the relationship between sperm DNA fragmentation (SDF) and assisted conception outcomes, there is a divergence in the literature. Some reviews suggest a clear cause-and-effect linkage, whereas others present conflicting or inconclusive results. OBJECTIVES In this umbrella review we aimed to synthesise the evidence collated in systematic reviews and meta-analyses summarising the association of SDF with assisted reproductive technology (ART) outcomes. SEARCH STRATEGY After preregistration (https://doi.org/10.17605/OSF.IO/6JHDP), we performed a comprehensive search of the PubMed, Scopus, Cochrane Library, Web of Science and Embase databases. We conducted a search for systematic reviews on the association between SDF and ART without any restrictions on language or publication date. SELECTION CRITERIA Systematic reviews and meta-analyses assessing the association between SDF and ART outcomes were eligible. DATA COLLECTION AND ANALYSIS We assessed the quality of the included reviews using AMSTAR 2 and ROBIS, and determined the degree of overlap of primary studies between reviews estimating the corrected covered area (CCA), adjusted for structural missingness. We evaluated the most recent reviews assessing the association of SDF with live birth, pregnancy, miscarriage, implantation, blastulation and fertilisation. The synthesis of evidence was harmonised across all included quantitative syntheses, re-estimating the odds ratio (eOR) in random-effects meta-analyses with 95% confidence intervals (95% CIs) and 95% prediction intervals (95% PIs). We categorised the evidence strength into convincing, highly suggestive, suggestive, weak or nonsignificant, according to the meta-analysis re-estimated P-value, total sample size, I2 statistic for heterogeneity, small study effect, excess significance bias and the largest study significance. MAIN RESULTS We initially captured and screened 49 332 records. After excluding duplicate and ineligible articles, 22 systematic reviews, 15 of which were meta-analyses, were selected. The 22 reviews showed a moderate degree of overlap (adjusted CCA 9.2%) in their included studies (overall n = 428, with 180 unique studies). The 15 meta-analyses exhibited a high degree of overlap (adjusted CCA = 13.6%) in their included studies (overall n = 274, with 118 unique studies). AMSTAR 2 categorised the quality of evidence in 18 reviews as critically low and the quality of evidence in four reviews as low. ROBIS categorised all the reviews as having a high risk of bias. The re-estimated results showed that the association of SDF with live birth was weak in one and nonsignificant in four meta-analyses. Similarly, the association of SDF with pregnancy, miscarriage, implantation, blastulation and fertilisation was also weak or nonsignificant. The association of high SDF with different ART outcomes was also weak or nonsignificant for different interventions (IVF, ICSI and IUI) and tests. CONCLUSIONS This umbrella review did not find convincing or suggestive evidence linking SDF with ART outcomes. Caution should be exercised in making any claims, policies or recommendations concerning SDF.
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Affiliation(s)
- Hassan Maghraby
- Obstetrics and Gynaecology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Egyptian Foundation for Reproductive Medicine and Embryology (EFRE), Alexandria, Egypt
| | - Mohamad AlaaEldein Elsuity
- Egyptian Foundation for Reproductive Medicine and Embryology (EFRE), Alexandria, Egypt
- Dermatology, Venereology and Andrology Department, Sohag University, Sohag, Egypt
- Ibnsina, Ajyal, Qena, Amshag IVF Facilities, Sohag and Assiut, Egypt
| | - Nehal Adel
- Egyptian Foundation for Reproductive Medicine and Embryology (EFRE), Alexandria, Egypt
- Madina Fertility Centre, Madina Women's Hospital, Alexandria, Egypt
| | - Yasmin Magdi
- Egyptian Foundation for Reproductive Medicine and Embryology (EFRE), Alexandria, Egypt
- Al-Yasmeen Fertility and Gynaecology Centre, Benha, Qalubyia, Egypt
| | - Amr S Abdelbadie
- Egyptian Foundation for Reproductive Medicine and Embryology (EFRE), Alexandria, Egypt
- Department of Obstetrics and Gynaecology, Aswan University, Aswan, Egypt
| | - Mosab M Rashwan
- Ibnsina, Ajyal, Qena, Amshag IVF Facilities, Sohag and Assiut, Egypt
- Forensic Medicine & Clinical Toxicology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Ola Youssef Ahmed
- Obstetrics and Gynaecology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Egyptian Foundation for Reproductive Medicine and Embryology (EFRE), Alexandria, Egypt
| | - Mohamed Elmahdy
- Obstetrics and Gynaecology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Egyptian Foundation for Reproductive Medicine and Embryology (EFRE), Alexandria, Egypt
| | - Khalid S Khan
- Centre for Biomedical Research in Epidemiology and Public Health Network (CIBERESP), University of Granada, Granada, Spain
| | - Mohamed Fawzy
- Egyptian Foundation for Reproductive Medicine and Embryology (EFRE), Alexandria, Egypt
- Ibnsina, Ajyal, Qena, Amshag IVF Facilities, Sohag and Assiut, Egypt
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12
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Xu X, Zhou Z, Li N, Quan G. Comment on Chaboyer et al. (2024) 'The effect of pressure injury prevention care bundles on pressure injuries in hospital patients'. Int J Nurs Stud 2024; 156:104810. [PMID: 38815543 DOI: 10.1016/j.ijnurstu.2024.104810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 04/30/2024] [Accepted: 05/13/2024] [Indexed: 06/01/2024]
Affiliation(s)
- Xiaoyan Xu
- Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, China
| | - Zhiying Zhou
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, China
| | - Ning Li
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, China
| | - Gang Quan
- Qingyang Hospital of Traditional Chinese Medicine, Gansu Province, China.
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13
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Chaboyer W, Latimer S, Sugathapala RDUP, Gillespie BM. Authors' response to "Comment on Chaboyer et al. (2024) 'The effect of pressure injury prevention care bundles on pressure injuries in hospital patients'". Int J Nurs Stud 2024; 156:104811. [PMID: 38788264 DOI: 10.1016/j.ijnurstu.2024.104811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024]
Affiliation(s)
- Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia.
| | - Sharon Latimer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia
| | - R D Udeshika Priyadarshani Sugathapala
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; Department of Nursing and Midwifery, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Sri Lanka
| | - Brigid M Gillespie
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; Gold Coast University Hospital and Health Service, Gold Coast, QLD, Australia
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14
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Basile FW, Sweeney S, Singh MP, Bijker EM, Cohen T, Menzies NA, Vassall A, Indravudh P. Uncertainty in tuberculosis clinical decision-making: An umbrella review with systematic methods and thematic analysis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003429. [PMID: 39042611 PMCID: PMC11265660 DOI: 10.1371/journal.pgph.0003429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 06/12/2024] [Indexed: 07/25/2024]
Abstract
Tuberculosis is a major infectious disease worldwide, but currently available diagnostics have suboptimal accuracy, particularly in patients unable to expectorate, and are often unavailable at the point-of-care in resource-limited settings. Test/treatment decision are, therefore, often made on clinical grounds. We hypothesized that contextual factors beyond disease probability may influence clinical decisions about when to test and when to treat for tuberculosis. This umbrella review aimed to identify such factors, and to develop a framework for uncertainty in tuberculosis clinical decision-making. Systematic reviews were searched in seven databases (MEDLINE, CINAHL Complete, Embase, Scopus, Cochrane, PROSPERO, Epistemonikos) using predetermined search criteria. Findings were classified as barriers and facilitators for testing or treatment decisions, and thematically analysed based on a multi-level model of uncertainty in health care. We included 27 reviews. Study designs and primary aims were heterogeneous, with seven meta-analyses and three qualitative evidence syntheses. Facilitators for decisions to test included providers' advanced professional qualification and confidence in tests results, availability of automated diagnostics with quick turnaround times. Common barriers for requesting a diagnostic test included: poor provider tuberculosis knowledge, fear of acquiring tuberculosis through respiratory sampling, scarcity of healthcare resources, and complexity of specimen collection. Facilitators for empiric treatment included patients' young age, severe sickness, and test inaccessibility. Main barriers to treatment included communication obstacles, providers' high confidence in negative test results (irrespective of negative predictive value). Multiple sources of uncertainty were identified at the patient, provider, diagnostic test, and healthcare system levels. Complex determinants of uncertainty influenced decision-making. This could result in delayed or missed diagnosis and treatment opportunities. It is important to understand the variability associated with patient-provider clinical encounters and healthcare settings, clinicians' attitudes, and experiences, as well as diagnostic test characteristics, to improve clinical practices, and allow an impactful introduction of novel diagnostics.
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Affiliation(s)
- Francesca Wanda Basile
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sedona Sweeney
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Maninder Pal Singh
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Else Margreet Bijker
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- Department of Paediatrics, Maastricht University Medical Centre, MosaKids Children’s Hospital, Maastricht, the Netherlands
| | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Nicolas A. Menzies
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Pitchaya Indravudh
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
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15
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Singh B, Ahmed M, Staiano AE, Gough C, Petersen J, Vandelanotte C, Kracht C, Huong C, Yin Z, Vasiloglou MF, Pan CC, Short CE, Mclaughlin M, von Klinggraeff L, Pfledderer CD, Moran LJ, Button AM, Maher CA. A systematic umbrella review and meta-meta-analysis of eHealth and mHealth interventions for improving lifestyle behaviours. NPJ Digit Med 2024; 7:179. [PMID: 38969775 PMCID: PMC11226451 DOI: 10.1038/s41746-024-01172-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 06/21/2024] [Indexed: 07/07/2024] Open
Abstract
The aim of this meta-meta-analysis was to systematically review randomised controlled trial (RCT) evidence examining the effectiveness of e- and m-Health interventions designed to improve physical activity, sedentary behaviour, healthy eating and sleep. Nine electronic databases were searched for eligible studies published from inception to 1 June 2023. Systematic reviews with meta-analyses of RCTs that evaluate e- and m-Health interventions designed to improve physical activity, sedentary behaviour, sleep and healthy eating in any adult population were included. Forty-seven meta-analyses were included, comprising of 507 RCTs and 206,873 participants. Interventions involved mobile apps, web-based and SMS interventions, with 14 focused on physical activity, 3 for diet, 4 for sleep and 26 evaluating multiple behaviours. Meta-meta-analyses showed that e- and m-Health interventions resulted in improvements in steps/day (mean difference, MD = 1329 [95% CI = 593.9, 2065.7] steps/day), moderate-to-vigorous physical activity (MD = 55.1 [95% CI = 13.8, 96.4] min/week), total physical activity (MD = 44.8 [95% CI = 21.6, 67.9] min/week), sedentary behaviour (MD = -426.3 [95% CI = -850.2, -2.3] min/week), fruit and vegetable consumption (MD = 0.57 [95% CI = 0.11, 1.02] servings/day), energy intake (MD = -102.9 kcals/day), saturated fat consumption (MD = -5.5 grams/day), and bodyweight (MD = -1.89 [95% CI = -2.42, -1.36] kg). Analyses based on standardised mean differences (SMD) showed improvements in sleep quality (SMD = 0.56, 95% CI = 0.40, 0.72) and insomnia severity (SMD = -0.90, 95% CI = -1.14, -0.65). Most subgroup analyses were not significant, suggesting that a variety of e- and m-Health interventions are effective across diverse age and health populations. These interventions offer scalable and accessible approaches to help individuals adopt and sustain healthier behaviours, with implications for broader public health and healthcare challenges.
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Affiliation(s)
- Ben Singh
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia.
| | - Mavra Ahmed
- Department of Nutritional Sciences and Joannah and Brian Lawson Centre for Child Nutrition, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Amanda E Staiano
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Claire Gough
- Flinders University, College of Nursing and Health Sciences, Adelaide, SA, Australia
| | - Jasmine Petersen
- Flinders University: College of Education, Psychology and Social Work, Adelaide, SA, Australia
| | - Corneel Vandelanotte
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Rockhampton, QLD, Australia
| | - Chelsea Kracht
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Christopher Huong
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX, USA
| | - Zenong Yin
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX, USA
| | - Maria F Vasiloglou
- Nestlé Institute of Health Sciences, Nestlé Research, 1000, Lausanne, Switzerland
| | - Chen-Chia Pan
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
- Department of Prevention and Health Promotion, Institute for Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Camille E Short
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences and Melbourne School of Health Sciences (jointly appointed), University of Melbourne, Parkville, VIC, Australia
| | - Matthew Mclaughlin
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Lauren von Klinggraeff
- Department of Community and Behavioral Health Sciences, Institute of Public and Preventive Health, School of Public Health, Augusta University, Augusta, GA, USA
| | - Christopher D Pfledderer
- Department of Health Promotion and Behavorial Sciences, University of Texas Health Science Center Houston, School of Public Health in Austin, Austin, TX, USA
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - Alyssa M Button
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Carol A Maher
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
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16
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Jung A, Geidl W, Matting L, Hoessel LM, Siemens W, Sudeck G, Pfeifer K. Efficacy of Physical Activity Promoting Interventions in Physical Therapy and Exercise Therapy for Persons With Noncommunicable Diseases: An Overview of Systematic Reviews. Phys Ther 2024; 104:pzae053. [PMID: 38564265 DOI: 10.1093/ptj/pzae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/21/2023] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE The objective of this study was to synthesize the evidence from systematic reviews on the efficacy of physical therapy and exercise therapy, including interventional elements explicitly aiming at physical activity promotion (PAP) in patients with noncommunicable diseases (NCDs). METHODS PubMed, Scopus, PsycINFO, and Cochrane Database of Systematic Reviews were searched from inception to February 28, 2023. Two independent reviewers screened the literature to identify systematic reviews that evaluated the effects of physical therapy and exercise therapy, including PAP interventions. Patient-reported and device-based measures of physical activity (PA) outcomes were included. Qualitative and quantitative data from systematic reviews were extracted by 2 independent reviewers. Assessment of the methodological quality of the included systematic reviews was performed using A Measurement Tool to Assess Systematic Reviews (AMSTAR 2). We assessed primary study overlap by calculating the corrected covered area and conducted the evidence synthesis in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS Fourteen systematic reviews were included in the present overview, including patients with a variety of NCDs. Most included systematic reviews had critically low (n = 5) to low (n = 7) methodological quality. Most meta-analyses (67%; 8/12) provided evidence supporting the short- and long-term efficacy of PAP interventions, but not all pooled estimates were clinically relevant. Only three of the systematic reviews with meta-analysis included an assessment of the certainty of the evidence. The evidence from systematic reviews without meta-analysis was inconclusive. CONCLUSIONS The results of the present overview suggest that PAP interventions in physical therapy or exercise therapy may be effective in improving PA for patients with NCDs in the short and long term. The results should be interpreted with caution due to the limited certainty of evidence and critically low-to-low methodological quality of the included systematic reviews. Both high-quality primary studies and systematic reviews are required to confirm these results. IMPACT There is limited evidence that PAP interventions in physical therapy and exercise therapy may be effective in improving PA for patients with NCDs.
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Affiliation(s)
- Andres Jung
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Wolfgang Geidl
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Leon Matting
- Institute of Sports Science, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Lina-Marie Hoessel
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Waldemar Siemens
- Faculty of Medicine, Institute for Evidence in Medicine, Medical Center - University of Freiburg, Freiburg, Germany
- Cochrane Germany Foundation, Freiburg, Germany
| | - Gorden Sudeck
- Institute of Sports Science, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Klaus Pfeifer
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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Roby S, Morse Z, Trevelyan F, Boocock M. Work-related musculoskeletal disorders in oral health professionals: an umbrella review protocol. JBI Evid Synth 2024; 22:1336-1346. [PMID: 38505963 DOI: 10.11124/jbies-23-00270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVE The objective of this review is to synthesize the evidence on the prevalence, incidence, risk factors, and preventive and management interventions for work-related musculoskeletal disorders (MSD) in oral health professionals. INTRODUCTION Oral health professionals face a considerable risk of developing work-related MSD due to the nature of their work. These disorders can lead to loss of employment, reduced job quality, increased occupational injuries, and early retirement. They can also lead to significant financial burdens for employers and society. INCLUSION CRITERIA This umbrella review will include systematic reviews and meta-analyses that have oral health professionals as a population group and address at least one of the following topics: the prevalence or incidence, risk factors, and the efficiency or effectiveness of interventions for the prevention or management of work-related MSD. METHODS A systematic search will be conducted across CINAHL Complete (EBSCOhost), Dentistry and Oral Sciences Source (EBSCOhost), MEDLINE (EBSCOhost), Cochrane Library (Ovid), Scopus, PsycINFO (Ovid), AMED Allied and Complementary Medicine (Ovid), Epistemonikos, Ergonomics Abstracts Online (EBSCOhost), and Google Scholar (first 200 articles). The search will be limited to articles published in English, with no restrictions on geographical location. Two independent reviewers will screen the titles and abstracts against the inclusion criteria. The reviews will be assessed using the JBI critical appraisal instrument for systematic reviews and research syntheses, and data will be extracted from each review using a modified version of the JBI data extraction tool. A narrative summary and tables will be used to describe the review characteristics and findings. Results will be presented in a table using visual indicators (traffic light system) to represent beneficial, neutral, and negative effects with each risk factor and intervention. The GRADE approach will be used to rate the overall quality and strength of the evidence. REVIEW REGISTRATION PROSPERO CRD42023388779.
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Affiliation(s)
- Shiba Roby
- Ergonomics and Human Factors Group, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Zac Morse
- Oral Health, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Fiona Trevelyan
- Ergonomics and Human Factors Group, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Mark Boocock
- Ergonomics and Human Factors Group, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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18
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Harris DM, O’Bryan SJ, Latella C. Non-invasive brain stimulation as treatment for motor impairment in people with Parkinson's disease: Protocol for an umbrella review. PLoS One 2024; 19:e0304717. [PMID: 38870241 PMCID: PMC11175533 DOI: 10.1371/journal.pone.0304717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/15/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a progressive neurodegenerative disorder that predominantly affects movement and currently has no cure. Alongside medication, non-invasive brain stimulation (NIBS) may be used as an adjunct therapy to attenuate the motor symptoms experienced by people with PD. However, there is considerable heterogeneity in the evidence exploring the effects of NIBS for improving aspects of physical function in people with PD. Therefore, this protocol paper will outline the objectives, structure and procedure of a proposed umbrella review which will comprehensively summarise and map the current body evidence on the effectiveness of NIBS for improving physical function in people with PD. METHODS AND ANALYSIS This study will adhere to the Joanna Briggs Institute (JBI) reviewer's manual and the PRISMA guidelines for conducting an umbrella review. The protocol is registered in PROSPERO (CRD42022380544). The population, intervention, comparison, and outcomes (PICO) method will be used to guide the search strategies and inclusion/exclusion criteria. Systematic reviews, with or without meta-analyses, based on quantitative or mixed-methods studies, will be searched for, and then critically evaluated by two authors using the Assessment of Multiple Systematic Reviews 2 (AMSTAR2) tool. If the data allows, we will run a random effects pooled meta-analysis using standardized mean differences (SMDs), with heterogeneity and publication bias reported using the I2 statistic. We will determine the level of evidence using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) tool. Overlap in studies across reviews will be assessed using citation matrices and corrected covered areas (CCAs). Lastly, visual bubble plots will display the effects and strength of evidence from each review. DISCUSSION This umbrella review will be the first to examine the collective evidence on the effectiveness of NIBS in improving physical outcomes for individuals with PD. It aims to provide an overall understanding of the relationship between NIBS and motor function changes, discuss underlying physiological mechanisms, and identify future therapeutic strategies. TRIAL REGISTRATION PROSPERO registration number: CRD42022380544.
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Affiliation(s)
- Dale M. Harris
- Institute for Health and Sport (IHeS), Victoria University, Melbourne, Australia
| | - Steven J. O’Bryan
- Institute for Health and Sport (IHeS), Victoria University, Melbourne, Australia
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Christopher Latella
- Neurophysiology Research Laboratory, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
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Gutierrez-Arias R, Pieper D, Lunny C, Torres-Castro R, Aguilera-Eguía R, Oliveros MJ, Seron P. Only half of the authors of overviews of exercise-related interventions use some strategy to manage overlapping primary studies-a metaresearch study. J Clin Epidemiol 2024; 170:111328. [PMID: 38513993 DOI: 10.1016/j.jclinepi.2024.111328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/10/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES The conduct of systematic reviews (SRs) and overviews share several similarities. However, because the unit of analysis for overviews is the SRs, there are some unique challenges. One of the most critical issues to manage when conducting an overview is the overlap of data across the primary studies included in the SRs. This metaresearch study aimed to describe the frequency of strategies to manage the overlap in overviews of exercise-related interventions. STUDY DESIGN AND SETTING A systematic search in MEDLINE (Ovid), Embase (Ovid), Cochrane Library, Epistemonikos, and other sources was conducted from inception to June 2022. We included overviews of SRs that considered primary studies and evaluated the effectiveness of exercise-related interventions for any health condition. The overviews were screened by two authors independently, and the extraction was performed by one author and checked by a second. We found 353 overviews published between 2005 and 2022 that met the inclusion criteria. RESULTS One hundred and sixty-four overviews (46%) used at least one strategy to visualize, quantify, or resolve overlap, with a matrix (32/164; 20%), absolute frequency (34/164; 21%), and authors' algorithms (24/164; 15%) being the most used methods, respectively. From 2016 onwards, there has been a trend toward increasing the use of some strategies to manage overlap. Of the 108 overviews that used some strategy to resolve the overlap, ie, avoiding double or multiple counting of primary study data, 79 (73%) succeeded. In overviews where no strategies to manage overlap were reported (n = 189/353; 54%), 16 overview authors (8%) recognized this as a study limitation. CONCLUSION Although there is a trend toward increasing its use, only half of the authors of the overviews of exercise-related interventions used a strategy to visualize, quantify, or resolve overlap in the primary studies' data. In the future, authors should report such strategies to communicate more valid results.
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Affiliation(s)
- Ruvistay Gutierrez-Arias
- Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autònoma de Barcelona, Barcelona, Spain; Departamento de Apoyo en Rehabilitación Cardiopulmonar Integral, Instituto Nacional del Tórax, Santiago, Chile; Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, 7591538, Chile; INTRehab Research Group, Instituto Nacional del Tórax, Santiago, Chile.
| | - Dawid Pieper
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School (Theodor Fontane), Institute for Health Services and Health Systems Research, Rüdersdorf, Germany; Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), Rüdersdorf, Germany
| | - Carole Lunny
- Knowledge Translation Program, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Raúl Aguilera-Eguía
- Departamento de Salud Pública, Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Maria-Jose Oliveros
- Universidad de La Frontera, Facultad de Medicina, Departamento de Ciencias de la Rehabilitación & CIGES, Temuco, Chile
| | - Pamela Seron
- Universidad de La Frontera, Facultad de Medicina, Departamento de Ciencias de la Rehabilitación & CIGES, Temuco, Chile
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20
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Lu T, Liu B, Lu C, Du Z, Yang K, Ge L. Reporting quality of acupuncture overviews: A methodological investigation based on the PRIOR statement. Complement Ther Med 2024; 82:103034. [PMID: 38521419 DOI: 10.1016/j.ctim.2024.103034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 03/25/2024] Open
Abstract
OBJECTIVE Acupuncture overviews are increasing rapidly; however, their reporting quality is yet unclear. We aimed to investigate the reporting quality of relevant overviews according to the preferred reporting items for overviews of reviews (PRIOR) statement. METHODS We systematically searched PubMed from inception to August 16, 2022 for overviews on acupuncture therapies. Reporting quality of included overviews was evaluated using the PRIOR statement, and the results were cross-checked. Multiple linear regression analysis was used to assess the predictors of the reporting completeness. GraphPad 9.4 was utilized to generate an evidence map, Excel 2019 was used to extract and manage data, and R 4.2.3 was used for data analysis. RESULTS A total of 49 overviews published from 2006 to 2022 were included, of which China ranked first with 38 overviews. The most frequently searched database was PubMed/ Medline (n = 48, 98%), and commonly used methodological quality assessment tool was AMSTAR-2 (n = 14, 29%). The overarching themes centered on acupuncture for obstetrics, gynecology, reproductive diseases, as well as depression, anxiety, and insomnia. Reporting quality needs to be improved involving the definition of systematic reviews (SRs), overlap of primary studies and SRs, methods for managing discrepant data across SRs, risk of bias in primary studies, heterogeneity, and sensitivity analysis of synthesized results, reporting bias assessment, and registration and protocol. Moreover, publication in recent years and receiving funding support were significantly associated with higher overall reporting quality score (P < 0.05). CONCLUSION Based on the PRIOR statement, this methodological study indicates that the reporting quality of the included acupuncture overviews is poor. In the future, authors of overviews are encouraged to use the PRIOR statement for standardized reporting. Furthermore, it is recommended that journal editors mandate the inclusion of this statement in authors' reports and require a complete PRIOR checklist.
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Affiliation(s)
- Tingting Lu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Bin Liu
- Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province, Gansu Provincial Hospital, Lanzhou 730000, China
| | - Cuncun Lu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China.
| | - Zouxi Du
- Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou 730000, China
| | - Long Ge
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou 730000, China.
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21
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Dibben GO, Gardiner L, Young HM, Wells V, Evans RA, Ahmed Z, Barber S, Dean S, Doherty P, Gardiner N, Greaves C, Ibbotson T, Jani BD, Jolly K, Mair FS, McIntosh E, Ormandy P, Simpson SA, Ahmed S, Krauth SJ, Steell L, Singh SJ, Taylor RS. Evidence for exercise-based interventions across 45 different long-term conditions: an overview of systematic reviews. EClinicalMedicine 2024; 72:102599. [PMID: 39010975 PMCID: PMC11247153 DOI: 10.1016/j.eclinm.2024.102599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 07/17/2024] Open
Abstract
Background Almost half of the global population face significant challenges from long-term conditions (LTCs) resulting in substantive health and socioeconomic burden. Exercise is a potentially key intervention in effective LTC management. Methods In this overview of systematic reviews (SRs), we searched six electronic databases from January 2000 to October 2023 for SRs assessing health outcomes (mortality, hospitalisation, exercise capacity, disability, frailty, health-related quality of life (HRQoL), and physical activity) related to exercise-based interventions in adults (aged >18 years) diagnosed with one of 45 LTCs. Methodological quality was assessed using AMSTAR-2. International Prospective Resister of Systematic Reviews (PROSPERO) ID: CRD42022319214. Findings Forty-two SRs plus three supplementary RCTs were included, providing 990 RCTs in 936,825 people across 39 LTCs. No evidence was identified for six LTCs. Predominant outcome domains were HRQoL (82% of SRs/RCTs) and exercise capacity (66%); whereas disability, mortality, physical activity, and hospitalisation were less frequently reported (≤25%). Evidence supporting exercise-based interventions was identified in 25 LTCs, was unclear for 13 LTCs, and for one LTC suggested no effect. No SRs considered multimorbidity in the delivery of exercise. Methodological quality varied: critically-low (33%), low (26%), moderate (26%), and high (12%). Interpretation Exercise-based interventions improve HRQoL and exercise capacity across numerous LTCs. Key evidence gaps included limited mortality and hospitalisation data and consideration of multimorbidity impact on exercise-based interventions. Funding This study was funded by the National Institute for Health and Care Research (NIHR; Personalised Exercise-Rehabilitation FOR people with Multiple long-term conditions (multimorbidity)-NIHR202020).
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Affiliation(s)
- Grace O. Dibben
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Lucy Gardiner
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Hannah M.L. Young
- University Hospitals of Leicester NHS Trust, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Valerie Wells
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Rachael A. Evans
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Zahira Ahmed
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Shaun Barber
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Sarah Dean
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Nikki Gardiner
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Colin Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Tracy Ibbotson
- General Practice & Primary Care, University of Glasgow, Glasgow, UK
| | - Bhautesh D. Jani
- General Practice & Primary Care, University of Glasgow, Glasgow, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Frances S. Mair
- General Practice & Primary Care, University of Glasgow, Glasgow, UK
| | - Emma McIntosh
- Health Economics & Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Paula Ormandy
- School of Health and Society, University of Salford, Salford, UK
| | - Sharon A. Simpson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Sayem Ahmed
- Health Economics & Health Technology Assessment, University of Glasgow, Glasgow, UK
| | | | - Lewis Steell
- General Practice & Primary Care, University of Glasgow, Glasgow, UK
| | - Sally J. Singh
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Rod S. Taylor
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
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22
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Al Maqbali M, Alsayed A, Hughes C, Hacker E, Dickens GL. Stress, anxiety, depression and sleep disturbance among healthcare professional during the COVID-19 pandemic: An umbrella review of 72 meta-analyses. PLoS One 2024; 19:e0302597. [PMID: 38722888 PMCID: PMC11081353 DOI: 10.1371/journal.pone.0302597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 04/08/2024] [Indexed: 05/13/2024] Open
Abstract
The outbreak of SARS-CoV-2, which causes COVID-19, has significantly impacted the psychological and physical health of a wide range of individuals, including healthcare professionals (HCPs). This umbrella review aims provide a quantitative summary of meta-analyses that have investigated the prevalence of stress, anxiety, depression, and sleep disturbance among HCPs during the COVID-19 pandemic. An umbrella review of systematic reviews and meta-analyses reviews was conducted. The search was performed using the EMBASE, PubMed, CINAHL, MEDLINE, PsycINFO, and Google Scholar databases from 01st January 2020 to 15th January 2024. A random-effects model was then used to estimate prevalence with a 95% confidence interval. Subgroup analysis and sensitivity analyses were then conducted to explore the heterogeneity of the sample. Seventy-two meta-analyses involved 2,308 primary studies were included after a full-text review. The umbrella review revealed that the pooled prevalence of stress, anxiety, depression, and sleep disturbance among HCPs during the COVID-19 pandemic was 37% (95% CI 32.87-41.22), 31.8% (95% CI 29.2-34.61) 29.4% (95% CI 27.13-31.84) 36.9% (95% CI 33.78-40.05) respectively. In subgroup analyses the prevalence of anxiety and depression was higher among nurses than among physicians. Evidence from this umbrella review suggested that a significant proportion of HCPs experienced stress, anxiety, depression, and sleep disturbance during the COVID-19 pandemic. This information will support authorities when implementing specific interventions that address mental health problems among HCPs during future pandemics or any other health crises. Such interventions may include the provision of mental health support services, such as counseling and peer support programs, as well as the implementation of organizational strategies to reduce workplace stressors.
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Affiliation(s)
| | - Ahmad Alsayed
- Faculty of Pharmacy, Department of Clinical Pharmacy and Therapeutics, Applied Science Private University, Amman, Jorden
| | - Ciara Hughes
- Institute of Nursing and Health Research School of Health Sciences, Ulster University, Belfast, United Kingdom
| | - Eileen Hacker
- University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Geoffrey L. Dickens
- Midwifery and Health Faculty of Health and Life Sciences, Mental Health Nursing Department of Nursing, Northumbria University, Newcastle-Upon-Tyne, United Kingdom
- Adjunct Professor Western Sydney University, Parramatta, NSW, Australia
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23
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Shi H, Yuan X, Fan W, Yang X, Liu G. Stem Cell Therapy for Diabetic Foot: An Umbrella Review of Systematic Reviews and Meta-Analyses. Adv Wound Care (New Rochelle) 2024; 13:201-216. [PMID: 38149885 DOI: 10.1089/wound.2023.0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
Objective: This umbrella review aims to summarize and evaluate the evidence from current systematic reviews/meta-analyses (SRs/MAs) on the effectiveness of stem cell therapy for diabetic foot (DF). Approach: We conducted a comprehensive search in four databases for SRs/MAs that included randomized controlled trials (RCTs) on stem cell therapy for DF. Two separate researchers independently evaluated the methodological quality and evidence quality of the SRs/MAs that were included in the study. We conducted a quantitative synthesis of all RCTs included in the SRs/MAs to obtain objective and updated conclusions. Egger's test and sensitivity analysis are used to examine the reliability of the results. Results: This umbrella review includes eight SRs/MAs, and their methodological quality and evidence quality were all deemed unsatisfactory. Out of the 8 SRs/MAs, 26 RCTs were included, with a total corrected covered area of 21.4%, indicating a high degree of overlap. The test of super-significance did not yield any significant results. Our updated meta-analysis suggests that DF patients can benefit from stem cell therapy, as indicated by effectiveness in measures, including healing rate, amputation rate, ankle-brachial index, transcutaneous oxygen pressure, ulcer size reduction, complete healing time, pain-free walking distance, rest pain score, and new angiogenesis rate. Innovation: This study conducted a comprehensive evaluation and reanalysis of the current evidence regarding the effectiveness and safety of stem cell therapy for DF, which is the first of its kind. Conclusion: Based on the existing evidence, stem cell therapy is effective and safe for patients with DF.
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Affiliation(s)
- Hongshuo Shi
- Department of Peripheral Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xin Yuan
- Department of Peripheral Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Weijing Fan
- Department of Peripheral Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiao Yang
- Department of Peripheral Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guobin Liu
- Department of Peripheral Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
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24
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Han R, Acosta JN, Shakeri Z, Ioannidis JPA, Topol EJ, Rajpurkar P. Randomised controlled trials evaluating artificial intelligence in clinical practice: a scoping review. Lancet Digit Health 2024; 6:e367-e373. [PMID: 38670745 PMCID: PMC11068159 DOI: 10.1016/s2589-7500(24)00047-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 04/28/2024]
Abstract
This scoping review of randomised controlled trials on artificial intelligence (AI) in clinical practice reveals an expanding interest in AI across clinical specialties and locations. The USA and China are leading in the number of trials, with a focus on deep learning systems for medical imaging, particularly in gastroenterology and radiology. A majority of trials (70 [81%] of 86) report positive primary endpoints, primarily related to diagnostic yield or performance; however, the predominance of single-centre trials, little demographic reporting, and varying reports of operational efficiency raise concerns about the generalisability and practicality of these results. Despite the promising outcomes, considering the likelihood of publication bias and the need for more comprehensive research including multicentre trials, diverse outcome measures, and improved reporting standards is crucial. Future AI trials should prioritise patient-relevant outcomes to fully understand AI's true effects and limitations in health care.
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Affiliation(s)
- Ryan Han
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA; Department of Computer Science, Stanford University, Stanford, CA, USA; University of California Los Angeles-Caltech Medical Scientist Training Program, Los Angeles, CA, USA
| | - Julián N Acosta
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA; Rad AI, San Francisco, CA, USA
| | - Zahra Shakeri
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA, USA; Meta-Research Innovation Center at Stanford, Stanford University, Stanford, CA, USA
| | - Eric J Topol
- Scripps Research Translational Institute, Scripps Research, La Jolla, CA, USA.
| | - Pranav Rajpurkar
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
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Greenwood H, Davidson AR, Thomas R, Albarqouni L. Common barriers and enablers to the use of non-drug interventions for managing common chronic conditions in primary care: an overview of reviews. BMC PRIMARY CARE 2024; 25:108. [PMID: 38582829 PMCID: PMC10998330 DOI: 10.1186/s12875-024-02321-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/23/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Non-drug interventions are recommended for chronic condition prevention and management yet are underused in clinical practice. Understanding barriers and enablers to using non-drug interventions may help implement non-drug interventions in primary care. We aimed to conduct an overview of reviews to identify and summarise common barriers and enablers for using non-drug interventions for common chronic conditions in primary care. METHODS We included qualitative and quantitative reviews that used systematic process or methods to examine barriers and enablers to using non-drug interventions for chronic condition prevention and management in primary care settings. We searched 5 electronic databases (PubMed, Cochrane Database of Systematic Reviews, EMBASE, PsycInfo and CINAHL) from inception to September 2022. Two authors independently screened reviews. One author extracted and deductively coded data to Consolidated Framework of Implementation Research (CFIR) (and where relevant, Theoretical Domains Framework [TDF]). A second author validated 10% of extracted data and coding. Data was synthesised thematically using CFIR and TDF. One author assessed the methodological quality of included reviews using a modified AMSTAR 2 tool, with 10% validated by a second author. We assessed overlap between primary studies in included reviews. RESULTS From 5324 records, we included 25 reviews, with data predominately from patients. Overall, 130 subthemes (71 barrier and 59 enabler) were identified across 4 CFIR domains (Innovation, Outer Setting, Inner Setting, and Individuals), and all TDF domains. Common barrier and enabler subthemes were identified for CFIR constructs of Innovation Adaptability, Innovation Cost, Innovation Relative Advantage, Local Attitudes, External Pressure, Local Conditions, Relational Connections, Available Resources, and Access to Knowledge and Information. For TDF domains, important barrier and enabler subthemes were identified for Knowledge, Skills, Environmental Context and Resources, Beliefs about Consequences, Reinforcement, and Emotion. CONCLUSIONS We synthesised reviews to provide new insight into common barriers and enablers for using non-drug interventions to prevent and manage chronic conditions in primary care. The factors identified can inform the development of generalisable implementation interventions to enhance uptake of multiple non-drug interventions simultaneously. TRIAL REGISTRATION This study was registered in PROSPERO (CRD42022357583).
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Affiliation(s)
- Hannah Greenwood
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia.
| | - Alexandra R Davidson
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
| | - Rae Thomas
- Tropical Australian Academic Health Centre, Townsville, Australia
| | - Loai Albarqouni
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
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Wiecha S, Posadzki P, Prill R, Płaszewski M. Physical Therapies for Delayed Onset Muscle Soreness: A Protocol for an Umbrella and Mapping Systematic Review with Meta-Meta-Analysis. J Clin Med 2024; 13:2006. [PMID: 38610771 PMCID: PMC11012564 DOI: 10.3390/jcm13072006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/15/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Delayed onset muscle soreness (DOMS), also known as exercise-induced muscle damage (EIMD), is typically caused by strenuous and/or unaccustomed physical exercise. DOMS/EIMD manifests itself in reduced muscle strength and performance levels, increased muscle soreness, swelling, and elevated levels of inflammatory biomarkers. Numerous randomised controlled trials (RCTs) and systematic reviews (SRs) of a wide variety of physiotherapy interventions for reducing the signs and symptoms of DOMS/EIMD have been published. However, these SRs often arrive at contradictory conclusions, impeding decision-making processes. OBJECTIVE We will systematically review the current evidence on clinical outcomes (efficacy, safety) of physiotherapy interventions for the treatment of DOMS/EIMD in healthy adults. We will also assess the quality of the evidence and identify, map, and summarise data from the available SRs. METHOD Umbrella review with evidence map and meta-meta-analyses. MEDLINE, Embase, Cochrane Database of Systematic Reviews, Epistemonikos and PEDro will be searched from January 1998 until February 2024. SRs of RCTs of any treatment used by physiotherapists (e.g., low-level laser therapy, electrical stimulation, heat/cold therapy, ultrasound, magnets, massage, manual therapies) to treat DOMS/EIMD in healthy adults will be eligible. Narrative/non-systematic reviews, studies of adolescents/children and medically compromised individuals, of complementary therapies, dietary, nutritional, or pharmacological interventions, as well as self-administered interventions, or those published before 1998, will be excluded. AMSTAR 2 will be used to evaluate the methodological quality of the included SRs. Corrected covered area, will be computed for assessing overlaps among included SRs, and an evidence map will be prepared to describe the credibility of evidence for interventions analysed in the relevant SRs. DISCUSSION DOMS/EIMD is a complex condition, and there is no consensus regarding the standard of clinical/physiotherapeutic care. By critically evaluating the existing evidence, we aim to inform clinicians about the most promising therapies for DOMS/EIMD. This umbrella review has the potential to identify gaps in the existing evidence base that would inform future research. The protocol has been registered at PROSPERO (CRD42024485501].
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Affiliation(s)
- Szczepan Wiecha
- Department of Physical Education and Health in Biala Podlaska, Faculty in Biala Podlaska, Jozef Pilsudski University of Physical Education, 00-968 Warsaw, Poland
| | - Paweł Posadzki
- Department of Clinical Rehabilitation, University School of Physical Education in Kraków, 31-571 Kraków, Poland
- Kleijnen Systematic Reviews Ltd., York YO19 6FD, UK
| | - Robert Prill
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 14770 Brandenburg an der Havel, Germany
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg a.d.H., Brandenburg Medical School Theodor Fontane, 14770 Brandenburg an der Havel, Germany
| | - Maciej Płaszewski
- Department of Physical Education and Health in Biala Podlaska, Faculty in Biala Podlaska, Jozef Pilsudski University of Physical Education, 00-968 Warsaw, Poland
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Gallego H, Arango S, Combalia A, Fuster S, Jaramillo C, Herrera AM. Treatment Options for Failed Back Surgery Syndrome: An Umbrella Systematic Review of Systematic Reviews on the Effectiveness of Therapeutic Interventions. Spine Surg Relat Res 2024; 8:143-154. [PMID: 38618223 PMCID: PMC11007241 DOI: 10.22603/ssrr.2023-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/30/2023] [Indexed: 04/16/2024] Open
Abstract
Background Failed back surgery syndrome (FBSS) is a common and incapacitating condition affecting patients with previous spine surgery in whom treatment approach can be challenging. This study aimed to summarize existing secondary studies and up-to-date randomized clinical trials (RCTs) that assess the effectiveness of available treatment options for FBSS. Methods Systematic searches were carried out in five databases (PubMed, Cochrane, Scielo, Epistemonikos, and Google scholar) for all systematic reviews on the effectiveness of treatment options for FBSS published after 2012. Outcomes of interest were pain levels measured through visual analog scale or numeric rating scale, Oswestry Disability Index, and quality of life. Methodological and risk of bias assessments were performed with the AMSTAR-2 tool for systematic reviews and the Joanna Briggs Institute checklist for RCT. Prospective PROSPERO registration: CRD42022307609. Results Fifteen studies, seven systematic reviews, and eight RCTs met the inclusion criteria and fulfilled the methodological quality assessment. Of the 15 included studies, 8 were on neurostimulation, 4 on adhesiolysis, 4 on epidural or intrathecal injections, and 3 on other treatment modalities. The risk of bias was low in seven studies, moderate in five, and high in three. Conclusions Based on this systematic overview and the considerable heterogeneity among studies, the FBSS therapeutic approach must be individualized. FBSS treatment should start with conservative management, considering the implementation of neurostimulation, a technique with the most robust evidence of effective results, in cases of refractory axial or neuropathic pain. As the last resource, in light of the evidence found, more invasive procedures or new surgical interventions are indicated.
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Affiliation(s)
- Hernán Gallego
- Department of Spine Surgery, Clinica del Campestre and Hospital Pablo Tobón Uribe, Medellín, Colombia
- Fellowship in Spine Surgery, Faculty of Medicine and Health Sciences, Universidad de Barcelona (UB), Barcelona, España
| | - Sergio Arango
- Department of Spine Surgery, Clinica del Campestre and Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - Andrés Combalia
- Department of Surgery and Medical-surgical Specialties, Faculty of Medicine and Health Sciences, Universidad de Barcelona (UB), Barcelona, España
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - Salvador Fuster
- Department of Surgery and Medical-surgical Specialties, Faculty of Medicine and Health Sciences, Universidad de Barcelona (UB), Barcelona, España
- Department of Spine Surgery, Hospital Clinic de Barcelona, Barcelona, España
| | | | - Ana Milena Herrera
- Department of Epidemiology and Clinical Research, Clinica del Campestre, Medellín, Colombia
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Paier-Abuzahra M, Posch N, Spary-Kainz U, Radl-Karimi C, Semlitsch T, Jeitler K, Siebenhofer A. Effects of task shifting from primary care physicians to nurses: a protocol for an overview of systematic reviews. BMJ Open 2024; 14:e078414. [PMID: 38458792 PMCID: PMC10928766 DOI: 10.1136/bmjopen-2023-078414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 02/14/2024] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION Task-shifting from primary care physicians (PCPs) to nurses is one option to better and more efficiently meet the needs of the population in primary care and to overcome PCP shortages. This protocol outlines an overview of systematic reviews to assess the effects of delegation or substitution by nurses of PCPs' activities regarding clinical, patient-relevant, professional and health services-related outcomes. METHODS AND ANALYSIS We will conduct a systematic literature search for secondary literature in PubMed/MEDLINE, EMBASE, CINAHL and Cochrane databases. Systematic reviews, meta-analyses and Health Technology Assessments in German and English comprising randomised controlled trials and prospective controlled trials will be considered for inclusion. Search terms will include Medical Subject Headings combined with free text words. At least one-third of abstracts and full-text articles are reviewed by two independent reviewers. Methodological quality will be assessed using the Overview Quality Assessment Questionnaire. We will only consider reviews if they include controlled trials, if the profession that substituted or delegated tasks was a nurse, if the profession of the control was a PCP, if the assessed intervention was the same in the intervention and control group and if the Overview Quality Assessment Questionnaire score is ≥5. The corrected covered area will be calculated to describe the degree of overlap of studies in the reviews included in the study. We will report the overview according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. ETHICS AND DISSEMINATION The overview of secondary literature does not require the approval of an Ethics Committee and will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42020183327.
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Affiliation(s)
- Muna Paier-Abuzahra
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Graz, Austria
| | - Nicole Posch
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Graz, Austria
| | - Ulrike Spary-Kainz
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Graz, Austria
| | - Christina Radl-Karimi
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Graz, Austria
| | - Thomas Semlitsch
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Graz, Austria
| | - Klaus Jeitler
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Graz, Austria
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Steiermark, Austria
| | - Andrea Siebenhofer
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Graz, Austria
- Institute for General Practice, Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
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Singh M, Wambua S, Lee SI, Okoth K, Wang Z, Fayaz FFA, Eastwood KA, Nelson-Piercy C, Reynolds JA, Nirantharakumar K, Crowe F. Autoimmune diseases and adverse pregnancy outcomes: an umbrella review. BMC Med 2024; 22:94. [PMID: 38438886 PMCID: PMC10913233 DOI: 10.1186/s12916-024-03309-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/19/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND There is a high prevalence of autoimmune conditions in women specially in the reproductive years; thus, the association with adverse pregnancy outcomes has been widely studied. However, few autoimmune conditions/adverse outcomes have been studied more than others, and this umbrella review aims to consolidate existing knowledge in this area with the aim to provide new knowledge and also identify gaps in this research area. METHODS Medline, Embase, and Cochrane databases were searched from inception to December 2023. Screening, data extraction, and quality appraisal (AMSTAR 2) were done by two independent reviewers. Data were synthesised narratively and quantitatively. Relative risks (RR)/odds ratio (OR) with 95% confidence intervals were reported. RESULTS Thirty-two reviews were included consisting of 709 primary studies. The review reported the association between 12 autoimmune conditions and 16 adverse pregnancy outcomes. Higher risk of miscarriage is reported in women with Sjögren's syndrome RR 8.85 (95% CI 3.10-25.26) and systemic lupus erythematosus (SLE) OR 4.90 (3.10-7.69). Pre-eclampsia was reported higher in women with type 1 diabetes mellitus (T1DM) OR 4.19 (3.08-5.71) and SLE OR 3.20 (2.54-4.20). Women reported higher risk of diabetes during pregnancy with inflammatory bowel disease (IBD) OR 2.96 (1.47-5.98). There was an increased risk of intrauterine growth restriction in women with systemic sclerosis OR 3.20 (2.21-4.53) and coeliac disease OR 1.71 (1.36-2.14). Preterm birth was associated with T1DM OR 4.36 (3.72-5.12) and SLE OR 2.79 (2.07-3.77). Low birth weight babies were reported in women with women with SLE or systemic sclerosis OR 5.95 (4.54-7.80) and OR 3.80 (2.16-6.56), respectively. There was a higher risk of stillbirth in women with T1DM OR 3.97 (3.44-4.58), IBD OR 1.57 (1.03-2.38), and coeliac disease OR 1.57 (1.17-2.10). T1DM in women was associated with 32% lower odds of small for gestational age baby OR 0.68 (0.56-0.83). CONCLUSIONS Pregnant women with autoimmune conditions are at a greater risk of developing adverse pregnancy outcomes. Further research is required to develop better preconception to postnatal care for women with autoimmune conditions.
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Affiliation(s)
- Megha Singh
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Steven Wambua
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Siang Ing Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kelvin Okoth
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Zhaonan Wang
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Kelly-Ann Eastwood
- Centre for Public Health, University of Belfast, Belfast, Queen, BT7 1NN, UK
- Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8EG, UK
| | | | - John A Reynolds
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | | | - Francesca Crowe
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Arora NK, Donath L, Owen PJ, Miller CT, Saueressig T, Winter F, Hambloch M, Neason C, Karner V, Belavy DL. The Impact of Exercise Prescription Variables on Intervention Outcomes in Musculoskeletal Pain: An Umbrella Review of Systematic Reviews. Sports Med 2024; 54:711-725. [PMID: 38093145 PMCID: PMC10978700 DOI: 10.1007/s40279-023-01966-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 04/01/2024]
Abstract
BACKGROUND Musculoskeletal pain conditions are the largest contributors to disability and healthcare burden globally. Exercise interventions improve physical function and quality of life in individuals with musculoskeletal pain, yet optimal exercise prescription variables (e.g. duration, frequency, intensity) are unclear. OBJECTIVE We aimed to examine evidence gaps, methodological quality and exercise prescription recommendations in systematic reviews of exercise for musculoskeletal pain. METHODS In our prospectively registered umbrella review, PubMed, SPORTDiscus, Cochrane Database of Systematic Reviews, EMBASE, and CINAHL were searched from inception to 14 February 2023. Backward citation tracking was performed. We included peer-reviewed, English language, systematic reviews and meta-analyses of randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that compared exercise with conservative treatment, placebo or other exercise interventions in adults with musculoskeletal pain. Data were extracted from the following groups of reviews based on their reporting of exercise prescription data and analysis of the relationship between prescription variables and outcomes: (1) those that did not report any exercise prescription data, (2) those that reported exercise prescription data but did not perform a quantitative analysis and (3) those that performed a quantitative analysis of the relationship between exercise prescription variables and outcomes. Outcome measures were physical function, pain, mental health, adverse effects and adherence to treatment. AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews) was used to assess methodological quality. RESULTS From 6757 records, 274 systematic reviews were included. 6.6% of reviews did not report any exercise prescription data, and only 10.9% quantitatively analyzed the relationship between prescription variables and the outcome(s). The overall methodological quality was critically low in 85% of reviews. CONCLUSION High methodological quality evidence is lacking for optimal exercise training prescription variables in individuals with musculoskeletal pain. To better inform practice and evidence gaps, future systematic reviews should (1) identify optimum exercise prescription variables, for example, via dose-response (network) meta-analysis, (2) perform high-quality reviews per AMSTAR-2 criteria and (3) include outcomes of mental health, adverse events and exercise adherence. PROSPERO REGISTRATION NUMBER CRD42021287440 ( https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021287440 ).
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Affiliation(s)
- Nitin Kumar Arora
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Cologne, Germany
| | - Lars Donath
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Cologne, Germany
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Clint T Miller
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Tobias Saueressig
- Science and Research, Physio Meets Science GmbH, Leimen, Baden-Württemberg, Germany
| | - Felicitas Winter
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
| | - Marina Hambloch
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
| | - Christopher Neason
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Vera Karner
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
| | - Daniel L Belavy
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany.
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Cruciani M, Pati I, Masiello F, Pupella S, De Angelis V. Nirmatrelvir/ritonavir for COVID-19: an overview of systematic reviews. J Antimicrob Chemother 2024; 79:477-497. [PMID: 38084876 DOI: 10.1093/jac/dkad376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/26/2023] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVES A reappraisal of the validity of the conclusions of systematic reviews (SRs) related to nirmatrelvir/ritonavir for the treatment of COVID-19. METHODS An overview of SRs (umbrella review). The methodological quality of the SRs was assessed using the AMSTAR 2 checklist; quality of the evidence from the trials included in each SR was appraised following the GRADE approach. RESULTS Sixteen SRs with meta-analysis published between 2020 and 2023 were included in this overview. The SRs reported data from 108 overlapping reports, based on 43 individual primary studies [3 randomized clinical trials (RCTs), 40 non-RCTs]. In outpatient settings the use of nirmatrelvir/ritonavir reduced overall mortality, hospital admission and progression of disease compared with controls (from moderate to low certainty of evidence); nirmatrelvir/ritonavir reduced mortality, hospital admission and progression of disease in both immunized and non-immunized patients. No differences in the occurrence of any adverse events between groups were observed in the large majority of SRs; serious adverse events, including adverse events requiring discontinuation of treatment, were reported with lower prevalence in nirmatrelvir recipients compared with controls (from low to moderate certainty of evidence). CONCLUSIONS There is low to moderate certainty of evidence from SRs that nirmatrelvir/ritonavir reduces mortality, clinical progression and hospitalization rate in COVID-19 patients compared with controls, without increasing the occurrence of overall and serious adverse events. Based on the overall methodological assessment, on average we can have high confidence in the quality of results generated by the SRs.
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Affiliation(s)
- Mario Cruciani
- National Blood Centre, Italian National Institute of Health, Rome 00161, Italy
| | - Ilaria Pati
- National Blood Centre, Italian National Institute of Health, Rome 00161, Italy
| | - Francesca Masiello
- National Blood Centre, Italian National Institute of Health, Rome 00161, Italy
| | - Simonetta Pupella
- National Blood Centre, Italian National Institute of Health, Rome 00161, Italy
| | - Vincenzo De Angelis
- National Blood Centre, Italian National Institute of Health, Rome 00161, Italy
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Wang Z, Lu C, Cui L, Fenfen E, Shang W, Wang Z, Song G, Yang K, Li X. Consumption of ultra-processed foods and multiple health outcomes: An umbrella study of meta-analyses. Food Chem 2024; 434:137460. [PMID: 37722333 DOI: 10.1016/j.foodchem.2023.137460] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 09/05/2023] [Accepted: 09/10/2023] [Indexed: 09/20/2023]
Abstract
Consumption of ultra-processed foods (UPFs) is associated with various adverse health outcomes, which significantly influence the global disease burden. This umbrella review aimed to fill the knowledge gap and guide public health practices by summarizing the association between UPFs and multiple health outcomes. A total of four databases were systematically searched from inception to December 2022, and 14 eligible systematic reviews (SRs) with meta-analyses (MAs) were identified. The SRs were published in 10 journals from 2020 to 2023, with 54,147-5,750,133 participants and 5-61 studies. The overall corrected covered area (CCA) was corresponded to a slight overlap. The results showed that an increased UPFs consumption is associated with multiple health outcomes (e.g., obesity, diabetes, hypertension, mortality). Only two SRs were "Moderate" regarding the overall methodological quality, while the other twelve were "Low" or "Critically low". Therefore, well-conducted SRs with high-quality prospective cohorts with a particular focus on special populations are needed to verify these findings further.
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Affiliation(s)
- Ziyi Wang
- Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou 730000, China; Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China
| | - Cuncun Lu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China.
| | - Lu Cui
- Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou 730000, China; Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China
| | - E Fenfen
- Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou 730000, China; Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China
| | - Wenru Shang
- Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou 730000, China; Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China
| | - Zhifei Wang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Guihang Song
- Gansu Healthcare Security Administration, Lanzhou 730000, China
| | - Kehu Yang
- Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou 730000, China; Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China.
| | - Xiuxia Li
- Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou 730000, China; Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China.
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Jain M, Duvendack M, Shisler S, Parsekar SS, Leon MDA. Effective interventions for improving routine childhood immunisation in low and middle-income countries: a systematic review of systematic reviews. BMJ Open 2024; 14:e074370. [PMID: 38365291 PMCID: PMC10875475 DOI: 10.1136/bmjopen-2023-074370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 01/30/2024] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVE An umbrella review providing a comprehensive synthesis of the interventions that are effective in providing routine immunisation outcomes for children in low and middle-income countries (L&MICs). DESIGN A systematic review of systematic reviews, or an umbrella review. DATA SOURCES We comprehensively searched 11 academic databases and 23 grey literature sources. The search was adopted from an evidence gap map on routine child immunisation sector in L&MICs, which was done on 5 May 2020. We updated the search in October 2021. ELIGIBILITY CRITERIA We included systematic reviews assessing the effectiveness of any intervention on routine childhood immunisation outcomes in L&MICs. DATA EXTRACTION AND SYNTHESIS Search results were screened by two reviewers independently applying predefined inclusion and exclusion criteria. Data were extracted by two researchers independently. The Specialist Unit for Review Evidence checklist was used to assess review quality. A mixed-methods synthesis was employed focusing on meta-analytical and narrative elements to accommodate both the quantitative and qualitative information available from the included reviews. RESULTS 62 systematic reviews are included in this umbrella review. We find caregiver-oriented interventions have large positive and statistically significant effects, especially those focusing on short-term sensitisation and education campaigns as well as written messages to caregivers. For health system-oriented interventions the evidence base is thin and derived from narrative synthesis suggesting positive effects for home visits, mixed effects for pay-for-performance schemes and inconclusive effects for contracting out services to non-governmental providers. For all other interventions under this category, the evidence is either limited or not available. For community-oriented interventions, a recent high-quality mixed-methods review suggests positive but small effects. Overall, the evidence base is highly heterogenous in terms of scope, intervention types and outcomes. CONCLUSION Interventions oriented towards caregivers and communities are effective in improving routine child immunisation outcomes. The evidence base on health system-oriented interventions is scant not allowing us to reach firm conclusions, except for home visits. Large evidence gaps exist and need to be addressed. For example, more high-quality evidence is needed for specific caregiver-oriented interventions (eg, monetary incentives) as well as health system-oriented (eg, health workers and data systems) and community-oriented interventions. We also need to better understand complementarity of different intervention types.
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Affiliation(s)
- Monica Jain
- International Initiative for Impact Evaluation, New Delhi, Delhi, India
| | | | - Shannon Shisler
- International Initiative for Impact Evaluation, Washington, DC, USA
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Garritty C, Hamel C, Trivella M, Gartlehner G, Nussbaumer-Streit B, Devane D, Kamel C, Griebler U, King VJ. Updated recommendations for the Cochrane rapid review methods guidance for rapid reviews of effectiveness. BMJ 2024; 384:e076335. [PMID: 38320771 DOI: 10.1136/bmj-2023-076335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Affiliation(s)
- Chantelle Garritty
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, K1G 5Z3, Canada
- Global Health and Guidelines Division, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Candyce Hamel
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, K1G 5Z3, Canada
- Canadian Association of Radiologists, Ottawa, ON, Canada
| | - Marialena Trivella
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Krems, Austria
- Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Gerald Gartlehner
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Krems, Austria
- Research Triangle Institute (RTI) International, Research Triangle Park, NC, USA
| | - Barbara Nussbaumer-Streit
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Krems, Austria
| | - Declan Devane
- Cochrane Ireland and Evidence Synthesis Ireland, School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Chris Kamel
- Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, ON, Canada
| | - Ursula Griebler
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Krems, Austria
| | - Valerie J King
- Center for Evidence-based Policy, Department of Family Medicine, Oregon Health and Science University (OHSU), Portland, OR, USA
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Rodgers LJ, Bialosky JE, Minick SA, Coronado RA. An overview of systematic reviews examining the quantitative sensory testing-derived hypoalgesic effects of manual therapy for musculoskeletal pain. J Man Manip Ther 2024; 32:67-84. [PMID: 37908101 PMCID: PMC10795637 DOI: 10.1080/10669817.2023.2267954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/03/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Changes in quantitative sensory testing (QST) after manual therapy can provide insight into pain relief mechanisms. Prior systematic reviews have evaluated manual-therapy-induced QST change. This overview of systematic reviews aims to consolidate this body of literature and critically review evidence on the hypoalgesic effects of manual therapy in clinical populations. METHODS A comprehensive search was conducted on PubMed, CINAHL, PsycInfo, and Embase. Peer-reviewed systematic reviews with or without meta-analysis were eligible if the reviews examined the effect of manual therapy compared to non-manual therapy interventions on QST outcomes in clinical populations. Methodological quality was assessed with the AMSTAR 2 tool. Meta-analysis results and qualitative (non-meta-analysis) interpretations were summarized by type of manual therapy. Overlap of studies was examined with the corrected covered area (CCA) index. RESULTS Thirty systematic reviews, including 11 meta-analyses, met inclusion. There was a slight overlap in studies (CCA of 1.72% for all reviews and 1.69% for meta-analyses). Methodological quality was predominantly low to critically low. Eight (27%) reviews examined studies with a range of manual therapy types, 13 (43%) reviews focused on joint-biased manual therapy, 7 (23%) reviews focused on muscle-biased manual therapy, and 2 (7%) reviews focused on nerve-biased manual therapy. Twenty-nine (97%) reviews reported on pressure pain threshold (PPT). Meta-analytic results demonstrated conflicting evidence that manual therapy results in greater hypoalgesic effects compared to other interventions or controls. CONCLUSION Our overview of QST effects, which has relevance to mechanisms underlying hypoalgesia, shows conflicting evidence from mostly low to critically low systematic reviews.
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Affiliation(s)
- Logan J. Rodgers
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Joel E. Bialosky
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
- Brooks-UF-PHHP Research Collaboration, Gainesville, FL, USA
| | - Sophie A. Minick
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rogelio A. Coronado
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA
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Goel S, Shabil M, Kaur J, Chauhan A, Rinkoo AV. Safety, efficacy and health impact of electronic nicotine delivery systems (ENDS): an umbrella review protocol. BMJ Open 2024; 14:e080274. [PMID: 38286688 PMCID: PMC10826537 DOI: 10.1136/bmjopen-2023-080274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/07/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Electronic nicotine delivery systems (ENDS), commonly known as e-cigarettes or vapes, have witnessed a rise in popularity, particularly among the youth. Although they were initially introduced as an alternative to traditional smoking, the design and function of ENDS vary. The potential health effects of ENDS, especially in comparison to traditional cigarettes, are a matter of ongoing debate. Given the increasing number of clinical studies and systematic reviews on this topic, there exists a demand for an umbrella review that offers a comprehensive assessment. The goal of this study is to perform an umbrella review of systematic reviews and meta-analyses to assess the safety, efficacy, health implications and potential gateway effect associated with ENDS. METHODS AND ANALYSIS This umbrella review will adhere to the Joanna Briggs Institute (JBI) framework and the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A planned literature search will be executed across databases such as OVID, PubMed/MEDLINE, EMBASE, Cochrane Library and Web of Science. The inclusion criteria are systematic reviews that discuss ENDS and e-liquids in the context of safety, efficacy and health outcomes. The exclusion criteria include narrative reviews, non-systematic reviews and studies not in English. Quality of the selected studies will be evaluated using the AMSTAR V.2 Scale. An overlap assessment will be done using the Corrected Covered Area, and data synthesis will be presented both narratively and in tabulated forms ETHICS AND DISSEMINATION: Ethics approval is not required for this study, as it does not involve the collection of original data. The results will be disseminated through peer-reviewed publication. The findings will offer crucial insights for stakeholders, policy-makers and the general public, underlining the health implications and the role of ENDS in tobacco cessation.
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Affiliation(s)
- Sonu Goel
- University of Limerick, Limerick, Ireland
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Muhammed Shabil
- Department of Pharmacy Practice, M. S. Ramaiah University of Applied Sciences, Banglore, India
| | - Jagdish Kaur
- World Health Organization Regional Office for South-East Asia, New Delhi, Delhi, India
| | - Anil Chauhan
- Department of Telemedicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Longhini J, Marzaro C, Bargeri S, Palese A, Dell'Isola A, Turolla A, Pillastrini P, Battista S, Castellini G, Cook C, Gianola S, Rossettini G. Wearable Devices to Improve Physical Activity and Reduce Sedentary Behaviour: An Umbrella Review. SPORTS MEDICINE - OPEN 2024; 10:9. [PMID: 38219269 PMCID: PMC10788327 DOI: 10.1186/s40798-024-00678-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 01/03/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND Several systematic reviews (SRs), with and without meta-analyses, have investigated the use of wearable devices to improve physical activity, and there is a need for frequent and updated syntheses on the topic. OBJECTIVE We aimed to evaluate whether using wearable devices increased physical activity and reduced sedentary behaviour in adults. METHODS We conducted an umbrella review searching PubMed, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, MedRxiv, Rxiv and bioRxiv databases up to February 5th, 2023. We included all SRs that evaluated the efficacy of interventions when wearable devices were used to measure physical activity in adults aged over 18 years. The primary outcomes were physical activity and sedentary behaviour measured as the number of steps per day, minutes of moderate to vigorous physical activity (MVPA) per week, and minutes of sedentary behaviour (SB) per day. We assessed the methodological quality of each SR using the Assessment of Multiple Systematic Reviews, version 2 (AMSTAR 2) and the certainty of evidence of each outcome measure using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations). We interpreted the results using a decision-making framework examining the clinical relevance and the concordances or discordances of the SR effect size. RESULTS Fifty-one SRs were included, of which 38 included meta-analyses (302 unique primary studies). Of the included SRs, 72.5% were rated as 'critically low methodological quality'. Overall, with a slight overlap of primary studies (corrected cover area: 3.87% for steps per day, 3.12% for MVPA, 4.06% for SB) and low-to-moderate certainty of the evidence, the use of WDs may increase PA by a median of 1,312.23 (IQR 627-1854) steps per day and 57.8 (IQR 37.7 to 107.3) minutes per week of MVPA. Uncertainty is present for PA in pathologies and older adults subgroups and for SB in mixed and older adults subgroups (large confidence intervals). CONCLUSIONS Our findings suggest that the use of WDs may increase physical activity in middle-aged adults. Further studies are needed to investigate the effects of using WDs on specific subgroups (such as pathologies and older adults) in different follow-up lengths, and the role of other intervention components.
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Affiliation(s)
- Jessica Longhini
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Silvia Bargeri
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Alvisa Palese
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Andrea Dell'Isola
- Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Orthopedics, Lund University, Lund, Sweden
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum Università di Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum Università di Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Simone Battista
- Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Orthopedics, Lund University, Lund, Sweden
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Campus of Savona, Savona, Italy
| | - Greta Castellini
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Chad Cook
- Department of Orthopaedics, Division of Physical Therapy, Duke University, Durham, NC, USA
| | - Silvia Gianola
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| | - Giacomo Rossettini
- School of Physiotherapy, University of Verona, Verona, Italy
- Department of Human Neurosciences, University of Roma "Sapienza Roma", Rome, Italy
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo s/n, Villaviciosa de Odón 28670, Spain
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Grant A, Kontak J, Jeffers E, Lawson B, MacKenzie A, Burge F, Boulos L, Lackie K, Marshall EG, Mireault A, Philpott S, Sampalli T, Sheppard-LeMoine D, Martin-Misener R. Barriers and enablers to implementing interprofessional primary care teams: a narrative review of the literature using the consolidated framework for implementation research. BMC PRIMARY CARE 2024; 25:25. [PMID: 38216867 PMCID: PMC10785376 DOI: 10.1186/s12875-023-02240-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 12/11/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Interprofessional primary care teams have been introduced across Canada to improve access (e.g., a regular primary care provider, timely access to care when needed) to and quality of primary care. However, the quality and speed of team implementation has not kept pace with increasing access issues. The aim of this research was to use an implementation framework to categorize and describe barriers and enablers to team implementation in primary care. METHODS A narrative review that prioritized systematic reviews and evidence syntheses was conducted. A search using pre-defined terms was conducted using Ovid MEDLINE, and potentially relevant grey literature was identified through ad hoc Google searches and hand searching of health organization websites. The Consolidated Framework for Implementation Research (CFIR) was used to categorize barriers and enablers into five domains: (1) Features of Team Implementation; (2) Government, Health Authorities and Health Organizations; (3) Characteristics of the Team; (4) Characteristics of Team Members; and (5) Process of Implementation. RESULTS Data were extracted from 19 of 435 articles that met inclusion/exclusion criteria. Most barriers and enablers were categorized into two domains of the CFIR: Characteristics of the Team and Government, Health Authorities, and Health Organizations. Key themes identified within the Characteristics of the Team domain were team-leadership, including designating a manager responsible for day-to-day activities and facilitating collaboration; clear governance structures, and technology supports and tools that facilitate information sharing and communication. Key themes within the Government, Health Authorities, and Health Organizations domain were professional remuneration plans, regulatory policy, and interprofessional education. Other key themes identified in the Features of Team Implementation included the importance of good data and research on the status of teams, as well as sufficient and stable funding models. Positive perspectives, flexibility, and feeling supported were identified in the Characteristics of Team Members domain. Within the Process of Implementation domain, shared leadership and human resources planning were discussed. CONCLUSIONS Barriers and enablers to implementing interprofessional primary care teams using the CFIR were identified, which enables stakeholders and teams to tailor implementation of teams at the local level to impact the accessibility and quality of primary care.
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Affiliation(s)
- Amy Grant
- Maritime SPOR Support Unit, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada
| | - Julia Kontak
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Elizabeth Jeffers
- Maritime SPOR Support Unit, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada
| | - Beverley Lawson
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Building Research for Integrated Primary Care, Halifax, Nova Scotia, Canada
| | - Adrian MacKenzie
- Nova Scotia Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Building Research for Integrated Primary Care, Halifax, Nova Scotia, Canada
| | - Leah Boulos
- Maritime SPOR Support Unit, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada
| | - Kelly Lackie
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Emily Gard Marshall
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Building Research for Integrated Primary Care, Halifax, Nova Scotia, Canada
| | - Amy Mireault
- Maritime SPOR Support Unit, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada
| | - Susan Philpott
- Nova Scotia Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | | | | | - Ruth Martin-Misener
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada.
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Kengne Talla P, Allison P, Bussières A, Giraudeau N, Komarova S, Basiren Q, Bergeron F, Emami E. Teledentistry for improving access to, and quality of oral health care: A protocol for an overview of systematic reviews and meta-analyses. PLoS One 2024; 19:e0288677. [PMID: 38165889 PMCID: PMC10760664 DOI: 10.1371/journal.pone.0288677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/28/2023] [Indexed: 01/04/2024] Open
Abstract
Digital technologies are becoming essential to address and optimize the suboptimal performance of healthcare systems. Teledentistry involves the use of information and communication technology to improve access to oral health care and the quality of oral health care delivery. Several systematic reviews (SRs) have been conducted to synthesize evidence on the effectiveness of teledentistry but with conflicting results. The aim of this review is to comprehensively summarize available SRs and provide evidence on the impact of teledentistry on access to oral care, patients' and oral healthcare providers' outcomes, quality of oral health care and costs. This protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42022373964). Six electronic databases including MEDLINE (Ovid), Embase (Embase.com), CINAHL (EBSCO), Web of Science, Cochrane Library and Epistemonikos will be searched for SRs of quantitative, qualitative, and mixed reviews evaluating teledentistry modalities involving both patients and/or oral health care providers (OHCPs). We will include studies published in English or French. The outcomes will include patients' outcomes (e.g., access to oral health care, patient-reported outcomes, and patient-reported experiences); patient indicators (e.g., clinical outcomes, adherence to treatment, adverse outcomes and costs); and OHCP indicators (e.g., diagnostic accuracy, barriers and enablers costs and equity). Two independent reviewers will perform data screening, data extraction and will assess the quality of included studies using AMSTAR 2 and ROBIS tools. Data will be synthesized narratively and presented by tables and graphs. We will report any overlap of primary studies in the SRs. A statement on the strength of evidence for each outcome will be provided if possible. This review will inform decision-makers, patients, OHCPs, and researchers on the potential effectiveness, benefits, and challenges of teledentistry and support them in making recommendations for its use. Results will be disseminated through peer-reviewed publications, presentations at conferences, and on social media.
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Affiliation(s)
- Pascaline Kengne Talla
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Paul Allison
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | - André Bussières
- Département de Chiropratique, Université de Québec à Trois Rivières, Trois-Rivières, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Nicolas Giraudeau
- Faculté d’Odontologie, Université de Montpellier, Montpellier, France
| | - Svetlana Komarova
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Quentin Basiren
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Frédéric Bergeron
- Laval University, Department of Preventive and Social Medicine, Quebec City, Quebec, Canada
| | - Elham Emami
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
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Shi W, Green H, Sikhosana N, Fernandez R. Effectiveness of Telehealth Cardiac Rehabilitation Programs on Health Outcomes of Patients With Coronary Heart Diseases: An Umbrella Review. J Cardiopulm Rehabil Prev 2024; 44:15-25. [PMID: 37335820 DOI: 10.1097/hcr.0000000000000807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
PURPOSE The aim of this study was to conduct an umbrella review summarizing the evidence from existing systematic reviews of telehealth cardiac rehabilitation (CR) on health outcomes of patients with coronary heart disease (CHD). REVIEW METHODS An umbrella review of systematic reviews was undertaken in accordance with the PRISMA and JBI guidelines. A systematic search was conducted in Medline, APA PsycINFO, Embase, CINAHL, Web of Science, Cochrane database of systematic reviews, JBI evidence synthesis, Epistemonikos, and PROSPERO, searching for systematic reviews published from 1990 to current and was limited to the language source of English and Chinese. Outcomes of interest were health behaviors and modifiable CHD risk factors, psychosocial outcomes, and other secondary outcomes. Study quality was appraised using the JBI checklist for systematic reviews. A narrative analysis was conducted, and meta-analysis results were synthesized. SUMMARY From 1301 identified reviews, 13 systematic reviews (10 meta-analyses) comprised 132 primary studies conducted in 28 countries. All the included reviews have high quality, with scores ranging 73-100%. Findings to the health outcomes remained inconclusive, except solid evidence was found in the significant improvement in physical activity (PA) levels and behaviors from telehealth interventions, exercise capacity from mobile health (m-health) only and web-based only interventions, and medication adherence from m-health interventions. Telehealth CR programs, work adjunct or in addition to traditional CR and standard care, are effective in improving health behaviors and modifiable CHD risk factors, particularly in PA. In addition, it does not increase the incidence in terms of mortality, adverse events, hospital readmission, and revascularization.
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Affiliation(s)
- Wendan Shi
- Centre for Research in Nursing and Health, St George Hospital, Kogarah, New South Wales, Australia (Ms Shi, Dr Green, Mr Sikhosana, and Dr Fernandez); Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia (Ms Shi); Faculty of Medicine and Health, University of Newcastle, Callaghan, New South Wales, Australia (Mr Sikhosana and Dr Fernandez); and School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, and Centre for Evidence based Initiatives in Health Care: A JBI Centre for Excellence, Wollongong, New South Wales, Australia (Dr Green)
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Sacre A, Bambra C, Wildman JM, Thomson K, Bennett N, Sowden S, Todd A. Socioeconomic inequalities in vaccine uptake: A global umbrella review. PLoS One 2023; 18:e0294688. [PMID: 38091273 PMCID: PMC10718431 DOI: 10.1371/journal.pone.0294688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
This global umbrella review aimed to synthesise evidence of socioeconomic inequalities in the uptake of routine vaccinations and identify the mechanisms that may contribute to the association. To our knowledge, no attempt has been made to synthesise the global body of systematic reviews across a variety of vaccines, geographical locations, and measures of SES. The inclusion criteria were as follows: studies assessing vaccination uptake according to education, income, occupation/employment, and/or area-level deprivation; any country or universally recommended routine vaccination (according to the WHO); qualitative or quantitative reviews, published 2011-present. The searches were performed in eight databases. The screening process followed PRISMA-E guidelines, each stage was performed by one reviewer, and a 10% sample checked by a second for consistency. Included reviews underwent data extraction, quality appraisal (AMSTAR-2), and narrative synthesis according to country-context. After deduplication, 9,163 reports underwent title and abstract screening, leaving 119 full texts to be assessed for eligibility. Overall, 26 studies were included in the umbrella review. Evidence for lower uptake amongst disadvantaged SES individuals was found in all 26 reviews. However, 17 reviews showed mixed results, as inverse associations were also identified (lower uptake for advantaged SES, and/or higher uptake for disadvantaged SES). Those that explored high-income countries had a greater prevalence of mixed findings than those focusing on low/middle-income countries. The two most frequently cited mechanisms were vaccination knowledge, and confidence in vaccination or vaccination providers. These mechanisms were often understood by review authors as varying by level of education. We find socioeconomic differences in routine vaccination uptake, but the association did not always follow a gradient. Whilst education may be associated with uptake globally, our study indicates that its role varies by country-context. A limitation is the overlap of some primary studies across the included systematic reviews.
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Affiliation(s)
- Amber Sacre
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC), Newcastle, United Kingdom
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC), Newcastle, United Kingdom
| | | | - Katie Thomson
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Natalie Bennett
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC), Newcastle, United Kingdom
| | - Sarah Sowden
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Adam Todd
- School of Pharmacy, Newcastle University, Newcastle, United Kingdom
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Sirisreetreerux P, Poprom N, Numthavaj P, Rattanasiri S, Thakkinstian A. Efficacy of Treatment for Metastatic Hormone-Sensitive Prostate Cancer: An Umbrella Review of Systematic Reviews and Meta-Analyses. Cancers (Basel) 2023; 15:5714. [PMID: 38136260 PMCID: PMC10742269 DOI: 10.3390/cancers15245714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/22/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
PURPOSE This umbrella review focused on evaluating the efficacy and adverse events of the metastatic hormone-sensitive prostate cancer patients receiving any treatment regimens, including ADT alone or combination treatments. METHODS This study conducted an umbrella review following the PRISMA 2020 checklist, aiming to summarize the available studies to evaluate the efficacy of medical treatments for metastatic hormone-sensitive prostate cancer. A literature search was performed to identify systematic reviews and meta-analyses (SRMAs) that included only randomized controlled trials (RCTs) up to September 2023. This study summarized their findings, evaluated overlapping data (i.e., the same RCTs were included in >one SRMA), tested for excessive significance (i.e., observed number of statistically significant studies > expected number by chance) and assessed the quality of the studies. RESULTS A total of 4191 studies were identified, but only 27 were included. Among those 27 studies, 12 were network meta-analyses and 15 were direct meta-analyses. Most studies showed no statistically significant difference in overall mortality among GnRH agonists, antagonists and bilateral orchiectomy. Combination treatment is more beneficial than ADT alone in both OS and PFS outcomes with more adverse events. Nevertheless, there is no OS advantage of any combination regimen over the others. CONCLUSION Combination treatments demonstrated clear benefits in OS and PFS over ADT alone with more AEs. Further studies are needed to compare among combination treatments.
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Affiliation(s)
- Pokket Sirisreetreerux
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (P.S.); (S.R.); (A.T.)
- Department of Surgery, Division of Urology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Napaphat Poprom
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (P.S.); (S.R.); (A.T.)
- Department of Surgery, Division of Urology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Pawin Numthavaj
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (P.S.); (S.R.); (A.T.)
| | - Sasivimol Rattanasiri
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (P.S.); (S.R.); (A.T.)
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (P.S.); (S.R.); (A.T.)
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Ou SL, Luo J, Wang S, Li KY, Du SY, Jiang Q. The sound and surprise: overlapping meta-analyses on the topic of safety and efficacy of PD-1 and PD-L1 inhibitors in the treatment of non-small cell lung cancer. Eur J Clin Pharmacol 2023; 79:1665-1673. [PMID: 37796282 DOI: 10.1007/s00228-023-03577-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 09/22/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE To analyze the characteristics of overlapping meta-analyses based on randomized controlled trials (RCTs) which reported PD-1/PD-L1 inhibitors in non-small cell cancer (NSCLC). METHODS Meta-analyses were identified from English and Chinese databases until January 1, 2022. Differences in characteristics of overlapping meta-analyses that conducted in China and other countries were compared to assess their publication propensity. The corrected covered area (CCA) and coverage of relevant RCTs were analyzed for subtopics according to detailed intervention types. The waste and redundancy of evidence were assessed in the case of PD-1/PD-L1 inhibitor monotherapy for second-line treatment for NSCLC. RESULTS Fifty-nine meta-analyses published in English and 17 meta-analyses published in Chinese reporting 26 RCTs were identified. Fifty-three (69.74%) meta-analyses were conducted in China. The overlapping meta-analyses in China were more likely to be from hospitals, supported by government funding, integrate first and second-line therapies. Five of the six subtopics had overlapping meta-analyses according to specific types of interventions. The CCA of overlapping meta-analyses ranged from 33.33 to 63.19%, and the coverage of relevant RCTs ranged from 63.64 to 100%. All the conclusions of overlapping meta-analyses have been consistent in the subtopic of PD-1/PD-L1 inhibitor monotherapy for second-line treatment since 2017. CONCLUSION Overlapping meta-analyses of PD-1/PD-L1 inhibitors in NSCLC hints that meta-analyses under this topic probably exist serious redundancy. Future research should focus on prospective registration of protocols for systematic reviews/meta-analyses, scientific designed PICO, and cumulative meta-analysis to reduce redundant and wasted studies. Journals should strengthen the requirement for reviewing previously published evidence in manuscript review.
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Affiliation(s)
- Shun-Long Ou
- Department of Pharmacy, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, No. 55, Section 4, Renmin South Road, Wuhou District, Chengdu, Sichuan, China
| | - Jing Luo
- Department of Pharmacy, The Second People's Hospital of Yibin, Yibin, China
| | - Song Wang
- Department of Pharmacy, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, No. 55, Section 4, Renmin South Road, Wuhou District, Chengdu, Sichuan, China
| | - Kai-Yue Li
- Department of Pharmacy, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, No. 55, Section 4, Renmin South Road, Wuhou District, Chengdu, Sichuan, China
| | - Su-Ya Du
- Department of Pharmacy, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, No. 55, Section 4, Renmin South Road, Wuhou District, Chengdu, Sichuan, China
| | - Qian Jiang
- Department of Pharmacy, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, No. 55, Section 4, Renmin South Road, Wuhou District, Chengdu, Sichuan, China.
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Law S, Dong S, Zhou F, Zheng D, Wang C, Dong Z. Bariatric surgery and mental health outcomes: an umbrella review. Front Endocrinol (Lausanne) 2023; 14:1283621. [PMID: 38027159 PMCID: PMC10653334 DOI: 10.3389/fendo.2023.1283621] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Aims To evaluate the breadth, depth and effectiveness of the evidence quality of all existing studies on bariatric surgery and mental health outcomes. Design Umbrella review of existing Systematic review and meta-analyses. Data sources PubMed, Embase, Web of Science, and the Cochrane Liberally databases of Systematic review and meta-analyses, and hand searching the reference lists of eligible publications. Results The search identified nine studies and 20 mental health outcomes from 1251 studies. Evidence shows that bariatric surgery is associated with significant improvement in areas such as anxiety, depression and eating disorders (including binge-eating disorder), and there is a significant harmful association with suicide, self-harm and alcohol use disorder (AUD). Among them, the most studied outcome is depression (4 articles). High-quality evidence proves that the score of depressive symptoms can be significantly improved after bariatric surgery within a two-year follow-up period and is not affected by the follow-up time. Low-quality evidence shows that bariatric surgery can significantly reduce depressive symptoms regardless of age and BMI, with an odds ratio (OR) of 0.49. Regardless of the postoperative BMI, the anxiety symptoms of women over 40 still decreased significantly, with an OR of 0.58. Regardless of the type of surgery, surgery can significantly reduce the incidence of eating disorders and symptoms. However, there is no obvious change in the follow-up time of AUD in the first two years after bariatric surgery, and the risk increases obviously in the third year, with an OR of 1.825. The evidence of moderate research shows that the risk of suicide and self-harm increases after bariatric surgery. The odds ratios in the same population and the control group were 1.9 and 3.8 times, respectively. Conclusion Bariatric surgery is beneficial for improving most mental health-related outcomes. However, we should be cautious about the increased risk of adverse mental health after surgery, such as suicide, self-harm, and AUD.
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Affiliation(s)
- Saikam Law
- Department of Metabolic and Bariatric Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
- School of Medicine, Jinan University, Guangzhou, China
| | - Shiliang Dong
- Department of Metabolic and Bariatric Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Fuqing Zhou
- Department of Metabolic and Bariatric Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Dexi Zheng
- Gernaral Surgery, Dancheng County People’s Hospital, Zhoukou, China
| | - Cunchuan Wang
- Department of Metabolic and Bariatric Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zhiyong Dong
- Department of Metabolic and Bariatric Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
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Arakelyan S, Mikula-Noble N, Ho L, Lone N, Anand A, Lyall MJ, Mercer SW, Guthrie B. Effectiveness of holistic assessment-based interventions for adults with multiple long-term conditions and frailty: an umbrella review of systematic reviews. THE LANCET. HEALTHY LONGEVITY 2023; 4:e629-e644. [PMID: 37924844 DOI: 10.1016/s2666-7568(23)00190-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 11/06/2023] Open
Abstract
Holistic assessment-based interventions (HABIs) are effective in older people admitted to hospital, but it is unclear whether similar interventions are effective in adults with multiple long-term conditions or frailty in the community. We conducted an umbrella review to comprehensively evaluate the literature on HABIs for adults (aged ≥18 years) with multiple long-term conditions, and frailty. We searched eight databases for systematic reviews reporting on experimental or quasi-experimental studies. Of 9803 titles screened, we identified 29 eligible reviews (14 with meta-analysis) reporting on 14 types of HABIs. The evidence for the effectiveness of HABIs was largely inconsistent across different types of interventions, settings, and outcomes. We found evidence of no benefit from hospital HABIs on health-related quality of life (HRQoL) and emergency department re-attendance, and evidence of no benefit from community HABIs on overall health-care utilisation rates, emergency department attendance, nursing home admissions, and mortality. The best evidence of effectiveness was for hospital comprehensive geriatric assessment (CGA) on nursing home admissions, keeping patients alive and in their own homes. There was some evidence of benefit from community CGA on hospital admissions, and from CGA spanning community and hospital settings on HRQoL. Patient-centred medical homes had beneficial effects on HRQoL, mental health, self-management, and hospital admissions.
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Affiliation(s)
- Stella Arakelyan
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK.
| | | | - Leonard Ho
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Nazir Lone
- NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Atul Anand
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Marcus J Lyall
- NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Stewart W Mercer
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
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Shi H, Yuan X, Fan W, Yang X, Liu G. An umbrella review of the evidence to guide decision-making in acupuncture therapies for chemotherapy-induced peripheral neuropathy. J Cancer Res Clin Oncol 2023; 149:15939-15955. [PMID: 37676268 DOI: 10.1007/s00432-023-05369-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Acupuncture therapy is believed to have therapeutic potential for patients suffering from chemotherapy-induced peripheral neuropathy (CIPN). This umbrella review aims to summarize and evaluate the evidence from current systematic reviews/meta-analyses (SRs/MAs) on the effectiveness of acupuncture treatment for CIPN. METHODS We conducted a comprehensive search in eight electronic databases for SRs/MAs that included RCTs on acupuncture treatment for CIPN. Two separate researchers independently evaluated the methodological quality, reporting quality, and evidence quality of the SRs/MAs that were included in the study. Additionally, we examined the extent of overlap among the included RCTs by calculating the corrected covered area (CCA). Furthermore, we assessed the dependability of the effect sizes by conducting excess significance tests. We conducted a quantitative synthesis of all RCTs included in the SRs/MAs to obtain objective and updated conclusions. Furthermore, we also conducted an analysis of the acupuncture points used in RCTs. RESULTS This umbrella review includes 9 SRs/MAs, and their methodological quality, risk of bias, reporting quality, and evidence quality were all deemed unsatisfactory. Out of the 9 SRs/MAs, 28 RCTs were included, with a total CCA of 25.4%, indicating a high degree of overlap. The test of super-significance did not yield any significant results. Our updated meta-analysis suggests that CIPN patients can benefit from acupuncture therapy, as indicated by effectiveness in measures including BPI-SF, VAS, FACT-NTX, NRS, SCV, and NCI-CTCAE. Egger's test and sensitivity analysis demonstrate the reliability and stability of this conclusion. The commonly used acupuncture points in the current RCTs include ST36, LI11, LI4, LR3, and SP6. CONCLUSION Based on the existing evidence, acupuncture is effective and safe for patients with CIPN, as it can significantly improve effective rate, pain symptoms, quality of life, and nerve conduction velocity. However, given the low quality of current evidence, we should be cautious in interpreting this conclusion.
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Affiliation(s)
- Hongshuo Shi
- Department of Peripheral Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xin Yuan
- Department of Peripheral Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Weijing Fan
- Department of Peripheral Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Xiao Yang
- Department of Peripheral Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Guobin Liu
- Department of Peripheral Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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El Ansari W, El-Ansari K, Lock M. Mind the Overlap! Meta-Analyses That Synthesize the Findings of Primary Studies Based on Large Data Registries: the Case of Metabolic and Bariatric Surgery. Obes Surg 2023; 33:3689-3691. [PMID: 37796374 DOI: 10.1007/s11695-023-06819-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 08/27/2023] [Accepted: 09/12/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Walid El Ansari
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar.
- Clinical Public Health Medicine, College of Medicine, Qatar University, Doha, Qatar.
- Clinical Population Health Sciences, Weill Cornell Medicine-Qatar, Doha, Qatar.
| | | | - Merilyn Lock
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
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Contri A, Paltrinieri S, Torreggiani M, Chiara Bassi M, Mazzini E, Guberti M, Campanini I, Ghirotto L, Fugazzaro S, Costi S. Patient-reported outcome measure to implement routine assessment of cancer survivors' unmet needs: An overview of reviews and COSMIN analysis. Cancer Treat Rev 2023; 120:102622. [PMID: 37713972 DOI: 10.1016/j.ctrv.2023.102622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 09/17/2023]
Abstract
As the number of cancer survivors (CSs) is increasing worldwide, providing services relevant to the specific, unmet needs of these individuals is crucial. There are currently various patient-reported outcome measures (PROMs) whose aim is to identify the unmet needs of CSs. Still, limited guidance supports healthcare providers in choosing the most valid and reliable PROMs for this purpose. We conducted this overview of systematic reviews (SRs) on the psychometric properties of PROMs addressing the unmet needs of adult CSs suffering from non-cutaneous cancers. We searched databases for SRs published between 2012 and January 2023. Two SRs were included, covering 14 PROMs tested on 19,151 CSs. These were assessed according to the COSMIN methodology for SRs of PROMs for the quality of their measurement properties and risk of bias, thus providing guidance in selecting PROMs that appropriately reflect the unmet needs of CSs.
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Affiliation(s)
- Angela Contri
- Clinical and Experimental Medicine PhD Program, Via del Pozzo n.74, 41100 Modena, Italy.
| | - Sara Paltrinieri
- Public Health Sciences PhD Program, Department of Clinical Sciences and Community Health, University of Milan, Via Commenda, 19, 20122 Milan, Italy; Physical Medicine and Rehabilitation Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, via Amendola 2, 42122 Reggio Emilia, Italy.
| | - Martina Torreggiani
- Nursing and Allied Profession Research Unit, Azienda USL-IRCCS Reggio Emilia, Via Giovanni Amendola, 2, 42122 Reggio Emilia, Italy.
| | - Maria Chiara Bassi
- Medical Library, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola, 2, 42122 Reggio Emilia, Italy.
| | - Elisa Mazzini
- Medical Directorate Hospital Network, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola, 2, 42122 Reggio Emilia, Italy.
| | - Monica Guberti
- Research and EBP Unit, Health Professions Department, Azienda USL-IRCCS Reggio Emilia, Via Giovanni Amendola, 2, 42122 Reggio Emilia, Italy.
| | - Isabella Campanini
- LAM-Motion Analysis Laboratory, S. Sebastiano Hospital, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Via Circondaria 29, 42015 Correggio, Italy.
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL - IRCCS Di Reggio Emilia, Via Giovanni Amendola, 2, 42122 Reggio Emilia, Italy.
| | - Stefania Fugazzaro
- Physical Medicine and Rehabilitation Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, via Amendola 2, 42122 Reggio Emilia, Italy.
| | - Stefania Costi
- Physical Medicine and Rehabilitation Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, via Amendola 2, 42122 Reggio Emilia, Italy; Department of Surgical, Medical, Dental and Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, via del Pozzo, 71, 41124 Modena, Italy
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Favril L, Yu R, Geddes JR, Fazel S. Individual-level risk factors for suicide mortality in the general population: an umbrella review. Lancet Public Health 2023; 8:e868-e877. [PMID: 37898519 PMCID: PMC10932753 DOI: 10.1016/s2468-2667(23)00207-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/17/2023] [Accepted: 09/05/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Deaths by suicide remain a major public health challenge worldwide. Identifying and targeting risk factors for suicide mortality is a potential approach to prevention. We aimed to summarise current knowledge on the range and magnitude of individual-level risk factors for suicide mortality in the general population and evaluate the quality of the evidence. METHODS In this umbrella review, five bibliographic databases were systematically searched for articles published from database inception to Aug 31, 2022. We included meta-analyses of observational studies on individual-level risk factors for suicide mortality in the general population. Biological, genetic, perinatal, and ecological risk factors were beyond the scope of this study. Effect sizes were synthesised and compared across domains. To test robustness and consistency of the findings, evidence for small-study effects and excess significance bias (ie, the ratio between the overall meta-analysis effect size and that of its largest included study) was examined, and prediction intervals were calculated. Risk of bias was assessed by the Risk of Bias in Systematic Reviews instrument. The protocol was pre-registered with PROSPERO (CRD42021230119). FINDINGS We identified 33 meta-analyses on 38 risk factors for suicide mortality in the general population. 422 (93%) of the 454 primary studies included in the meta-analyses were from high-income countries. A previous suicide attempt and suicidal ideation emerged as strong risk factors (with effect sizes ranging from 6 to 16). Psychiatric disorders were associated with a greatly elevated risk of suicide mortality, with risk ratios in the range of 4-13. Suicide risk for physical illnesses (such as cancer and epilepsy) and sociodemographic factors (including unemployment and low education) were typically increased two-fold. Contact with the criminal justice system, state care in childhood, access to firearms, and parental death by suicide also increased the risk of suicide mortality. Among risk factors for which sex-stratified analyses were available, associations were generally similar for males and females. However, the quality of the evidence was limited by excess significance and high heterogeneity, and prediction intervals suggested poor replicability for almost two-thirds of identified risk factors. INTERPRETATION A wide range of risk factors were identified across various domains, which underscores suicide mortality as a multifactorial phenomenon. Prevention strategies that span individual and population approaches should account for the identified factors and their relative strengths. Despite the large number of risk factors investigated, few associations were supported by robust evidence. Evidence of causal inference will need to be tested in high-quality study designs. FUNDING Wellcome Trust.
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Affiliation(s)
- Louis Favril
- Institute for International Research on Criminal Policy, Faculty of Law and Criminology, Ghent University, Ghent, Belgium
| | - Rongqin Yu
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK.
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Sufrate-Sorzano T, Di Nitto M, Garrote-Cámara ME, Molina-Luque F, Recio-Rodríguez JI, Asión-Polo P, Durante Á, Gea-Caballero V, Juárez-Vela R, Pérez J, Santolalla-Arnedo I. Media Exposure of Suicidal Behaviour: An Umbrella Review. NURSING REPORTS 2023; 13:1486-1499. [PMID: 37987404 PMCID: PMC10660843 DOI: 10.3390/nursrep13040125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/14/2023] [Accepted: 10/19/2023] [Indexed: 11/22/2023] Open
Abstract
AIM To analyse recommended interventions for the safe and responsible dissemination of suicidal behaviour in the media for preventive purposes. BACKGROUND Suicide is a serious public health problem that leads to more than 700,000 deaths per year, which translates into one death every forty seconds. The media play a significant role in shaping public perceptions and reflecting societal issues. Because of its active role in the construction of reality, the way in which the media report and expose suicidal behaviour has the capacity to influence the population in either a preventive or harmful way. DESIGN An umbrella review was carried out and a report was written according to the Preferred Reporting Items for Overviews of Reviews. METHODS We systematically searched for reviews published from inception to February 2023 in MEDLINE (PubMed), CINAHL and PsycInfo (via EBSCOhost), Web of Science, Embase, Cochrane Library of Systematic Reviews, Scopus, and Google Scholar. A narrative synthesis of the results was conducted. RESULTS Six systematic reviews with a moderate to high quality level were selected. Among the recommended interventions were the inclusion of positive messages of hope, resilience, or of overcoming the event, narratives with information on available resources or the promotion of support-seeking attitudes as an effective prevention mechanism, as well as the avoidance of repetitive reporting of the same suicide. The appropriate and responsible dissemination of information on suicidal behaviour in the media with complete and up-to-date information on available centres, organisations, institutions, and resources has proven to be effective, especially in vulnerable populations. CONCLUSION Educating and training the media in an appropriate approach to disseminating suicidal behaviour helps to reduce the number of suicidal behaviours. Knowing what information is advisable to include in the news item as well as what information to avoid is a strong point. Guidelines to promote responsible media reporting are a key component of suicide prevention strategies. This study was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) on 23 April 2022 with the registration number CRD42022320393.
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Affiliation(s)
- Teresa Sufrate-Sorzano
- Care and Health Research Group, GRUPAC, Nursing Deparment, University of La Rioja, 26006 Logroño, Spain; (T.S.-S.); (M.E.G.-C.); (I.S.-A.)
- Biomedical Research Centre of La Rioja, CIBIR, 26006 Logroño, Spain
| | - Marco Di Nitto
- Department of Health Sciences, University of Genoa, 16126 Genova, Italy;
| | - María Elena Garrote-Cámara
- Care and Health Research Group, GRUPAC, Nursing Deparment, University of La Rioja, 26006 Logroño, Spain; (T.S.-S.); (M.E.G.-C.); (I.S.-A.)
- Biomedical Research Centre of La Rioja, CIBIR, 26006 Logroño, Spain
| | - Fidel Molina-Luque
- Faculty of Education, Psychology and Social Work, University of Lleida, 25001 Lleida, Spain;
- Group for the Study of Society, Health, Education and Culture (GESEC), University of Lleida, 25001 Lleida, Spain
- Research Institute in Social and Territorial Development (INDEST), University of Lleida, 25001 Lleida, Spain
| | - José Ignacio Recio-Rodríguez
- Faculty of Nursing and Physiotherapy, University of Salamanca, 37008 Salamanca, Spain;
- Primary Care Research Unit of Salamanca (APISAL), Institute of Biomedical Research of Salamanca (IBSAL), 37008 Salamanca, Spain
| | | | - Ángela Durante
- Department of Translational Medicine, University of East Piedmonet, 13100 Vercelli, Italy;
| | - Vicente Gea-Caballero
- Faculty of Health Sciences, International University of Valencia, 46002 Valencia, Spain;
| | - Raúl Juárez-Vela
- Care and Health Research Group, GRUPAC, Nursing Deparment, University of La Rioja, 26006 Logroño, Spain; (T.S.-S.); (M.E.G.-C.); (I.S.-A.)
- Biomedical Research Centre of La Rioja, CIBIR, 26006 Logroño, Spain
- Prevention and Early Intervention in Mental Health (PRINT), Institute of Biomedical Research of Salamanca (IBSAL), 37008 Salamanca, Spain;
| | - Jesús Pérez
- Prevention and Early Intervention in Mental Health (PRINT), Institute of Biomedical Research of Salamanca (IBSAL), 37008 Salamanca, Spain;
- Faculty of Medicine, University of Salamanca, 37008 Salamanca, Spain
- Department of Psychiatry, University of Cambridge, Cambridge CB2 1TN, UK
| | - Iván Santolalla-Arnedo
- Care and Health Research Group, GRUPAC, Nursing Deparment, University of La Rioja, 26006 Logroño, Spain; (T.S.-S.); (M.E.G.-C.); (I.S.-A.)
- Biomedical Research Centre of La Rioja, CIBIR, 26006 Logroño, Spain
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