Quality Control in Systematic Reviews and Meta-analyses

Linking the inner and outer mental representations of the body to social cognition skills: A systematic review and meta-analysis

An interesting interpretation of embodiment highlights the critical role of mental body representations (BR), including motor, somatosensory, and interoceptive formats, for social cognition. However, the nature of this relationship is still debated at the empirical level, with various studies arriving at different conclusions. Here, we present a systematic review and meta-analysis aimed to summarize data from 3466 participants in 21 studies to provide a more comprehensive understanding of the relationship between inner and outer BR and social cognition. We focused on two core social cognition aspects: empathy and Theory of Mind (ToM). Concerning the inner BR, our meta-analytic findings reveal a significant correlation between specific interoceptive dimensions (i.e., interoceptive sensibility and accuracy) and social cognition, which was stronger for empathy than ToM. Conversely, although further research is needed, functional BR that mainly involve the outer body processing (i.e., nonaction-oriented BR) may show positive links with ToM. These findings point to specific interactions between BR and social cognition skills, supporting multi-faceted and embodied social cognition models. However, we also identified critical knowledge gaps and highlighted the need for further investigation to deepen our theoretical understanding of these relationships and their implications for clinical practice.

Effects of technology-based interventions on chemotherapy-induced nausea, vomiting, and quality of life in pediatric patients: A systematic review and meta-analysis

PURPOSE

This study aims to synthesize and analyze the impact of technology-based interventions on chemotherapy-induced nausea, vomiting, and quality of life in pediatric patients.

DESIGN AND METHODS

Seven electronic databases were searched: PubMed, Web of Science, Cochrane, MEDLINE, CINAHL, Scopus, and Google Scholar. The JBI checklist assessed the studies' methodological quality. This study was performed based on the PRISMA checklist.

RESULTS

This review incorporated five published studies, exploratory randomized controlled trials, and non-randomized pre and post-test control group studies involving 232 pediatric oncology patients receiving chemotherapy. The meta-analysis revealed a significant impact of technology-based interventions on alleviating chemotherapy-induced nausea and vomiting (Hedge's g = -0.707, Q = 9.61, I2 = 47.97%, p < 0.001). It was found that a significant effect of technology-based interventions on the patient's quality of life was observed (Hedge's g = -0.745, Q = 5.431, I2 = 63.74%, p < 0.001).

CONCLUSIONS

These findings indicated that technology-based interventions have significant potential in managing chemotherapy-induced nausea and vomiting and quality of life.

PRACTICE IMPLICATIONS

Future research endeavors should explore this aspect further, employing a broader range of outcome measures and longer-term follow-up assessments better to understand their impact on pediatric oncology patients' well-being.

Cutting-Edge Methodological Guidance for Authors in Conducting the Systematic Review and Meta-Analysis

The landscape of systematic reviews and meta-analyses (SRMA) in biomedicine has expanded exponentially, driven by the growing demand for evidence-based healthcare decision-making. However, the rapid increase of SRMAs has often outpaced the development of rigorous methodological standards, resulting in variability in quality and potentially limiting their effectiveness in informing healthcare practices. This gap highlights the critical need for advanced methodological guidance to enhance the quality and impact of SRMAs. Our contribution aims to provide comprehensive methodological direction for authors to conduct robust SRMAs. By effectively integrating qualitative and quantitative evidence, SRMAs can address complex healthcare questions more thoroughly than traditional reviews. Furthermore, these step-by-step guidelines will help researchers to address the challenges of synthesizing diverse types of evidence, thereby improving the rigor, relevance, and applicability of their findings in healthcare decision-making processes.

Efficacy and Safety of Low-Dose Bisoprolol/Hydrochlorothiazide Combination for the Treatment of Hypertension: A Systematic Review and Meta-Analysis

Objectives: This systematic review and meta-analysis aimed to assess the blood pressure (BP)-lowering effect and the safety profile of low-dose bisoprolol/hydrochlorothiazide combination treatment in patients with hypertension. Methods: Multiple electronic databases were systematically searched, and five clinical studies were included in the meta-analysis. Results: Treatment with bisoprolol/hydrochlorothiazide significantly reduced systolic BP (SBP) [mean difference (MD): -8.35 mmHg, 95% confidence interval (CI): -11.44, -5.25 mmHg versus control; MD: -9.88 mmHg, 95%CI: -12.62, -7.14 mmHg versus placebo] and diastolic BP (DBP) [MD: -7.62 mmHg, 95%CI: -11.20, -4.04 mmHg, versus control; MD: -8.79 mmHg, 95%CI: -11.92, -5.67 mmHg versus placebo]. Moreover, BP response rate and BP control rate after low-dose bisoprolol/hydrochlorothiazide combination treatment were significantly greater compared to control [odd ratio (OR) for response rate: 4.86, 95%CI: 2.52, 9.37; OR for control rate: 1.67, 95%CI: 1.11, 2.51]. Finally, treatment with low-dose bisoprolol/hydrochlorothiazide was associated with a reduced risk of any adverse event (AE) and peripheral edema compared to control. Conclusions: Overall, our results reaffirm the safety and efficiency of prescribing bisoprolol/hydrochlorothiazide combination treatment in stage I and II hypertension.

The effect of virtual reality simulation on nursing students' communication skills: a systematic review and meta-analysis

Virtual reality simulation (VRS) allows individuals to experience a sense of presence in a virtual environment, and it has been increasingly adopted as a novel teaching method in nursing education. VRS can have positive effects, such as patient safety, privacy assurance in healthcare, and enhanced interest and immersion in education. It is important to synthesize the results to date to determine if VRS has the potential to improve communication skills in practical nursing students. This systematic literature review and meta-analysis investigated the effect of VRS on the enhancement of communication skills among nursing students. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were employed for systematic review and meta-analysis. The following "PICO" details were considered: population-nursing students, intervention-VRS targeting communication skills enhancement, comparator-control groups without intervention or those undergoing general classes, and outcomes-communication skills. The search strategy yielded 301 results from nine databases, and 10 studies were selected for inclusion in our analysis. To calculate the overall effect sizes of the primary and secondary outcomes in the included studies, we used MIX 2.0 Pro (Version 2.0.1.6, BiostatXL, 2017) for the meta-analysis. The overall effect size for communication skills was 0.44, signifying a significant effect. A meta-regression analysis examining communication skills revealed significant results for the following factors: Fund (Ref.: No), outcome measurement time (Ref.: Immediately), outcome follow-up (Ref.: No), and debriefing (Ref.: No). Considering factors such as variations in sample size, research approaches, and the effects of independent studies on communication skills, this systematic literature review and meta-analysis suggests that VRS significantly improves nursing students' communication skills overall.

Systematic review registration

https://www.crd.york.ac.uk/prospero, identifier CRD42023439064.

Community readiness and acceptance for the implementation of a novel malaria vaccine among at-risk children in sub-saharan Africa: a systematic review protocol

BACKGROUND

The World Health Organization novel malaria vaccine for at-risk children has the potential to greatly reduce the current malaria burden in sub-Saharan Africa. However, most studies have reported contradictory findings regarding community willingness for the vaccine, which could easily undermine the expected benefits of the vaccine. This study aims to ascertain the current state of community readiness and acceptance for the implementation of a novel malaria vaccine (RTS,S/ASO1) among at-risk children in sub-Saharan Africa, based on available evidence.

METHODS

This study will follow the Preferred Reporting Items for Systematic Reviews and Meta-analyses protocol (PRISMA-P) guidelines. Relevant studies will be comprehensively searched from PubMed, ScienceDirect, Web of Science, Google Scholar, and African journals online, in accordance with the Cochrane search guidelines. Two independent reviewers will screen titles, abstracts and full texts of eligible studies based on some specified eligibility criteria. When it is feasible to conduct a meta-analysis, a random effects model will be employed to estimate the common effect due to anticipated high heterogeneity of the data. The effect measure for readiness or acceptance will be reported as a pooled proportion with corresponding 95% confidence interval. Additionally, odds ratios with 95% confidence interval will be estimated to assess factors associated with readiness. These will be presented on a forest plot.

DISSEMINATION PLANS

The findings of the study will be peer-reviewed and published in a scientific journal. Conference presentations will also be made to the different stakeholders in the malaria vaccination campaigns.

SYSTEMATIC REVIEW REGISTRATION

The protocol has been registered with PROSPERO Registration Number: CRD42023480528.

Extracorporeal vs. conventional CPR for out-of-hospital cardiac arrest: A systematic review and meta-analysis

BACKGROUND

Out-of-hospital cardiac arrest (OHCA) remains a significant cause of mortality and morbidity worldwide. Extracorporeal cardiopulmonary resuscitation (ECPR) is a potential intervention for OHCA, but its effectiveness compared to conventional cardiopulmonary resuscitation (CCPR) needs further evaluation.

METHOD

We systematically searched PubMed, Embase, the Cochrane Library, Web of Science, and ClinicalTrials.gov for relevant studies from January 2010 to March 2023. Pooled meta-analysis was performed to investigate any potential association between ECPR and improved survival and neurological outcomes.

RESULTS

This systematic review and meta-analysis included two randomized controlled trials enrolling 162 participants and 10 observational cohort studies enrolling 4507 participants. The pooled meta-analysis demonstrated that compared to CCRP, ECPR did not improve survival and neurological outcomes at 180 days following OHCA (RR: 3.39, 95% CI: 0.79 to 14.64; RR: 2.35, 95% CI: 0.97 to 5.67). While a beneficial effect of ECPR was obtained regarding 30-day survival and neurological outcomes. Furthermore, ECPR was associated with a higher risk of bleeding complications. Subgroup analysis showed that ECPR was prominently beneficial when exclusively initiated in the emergency department. Additional post-resuscitation treatments did not significantly impact the efficacy of ECPR on 180-day survival with favorable neurological outcomes.

CONCLUSIONS

There is no high-quality evidence supporting the superiority of ECPR over CCPR in terms of survival and neurological outcomes in OHCA patients. However, due to the potential for bias, heterogeneity among studies, and inconsistency in practice, the non-significant results do not preclude the potential benefits of ECPR. Further high-quality research is warranted to optimize ECPR practice and provide more generalizable evidence. Clinical trial registration PROSPERO, https://www.crd.york.ac.uk/prospero/, registry number: CRD42023402211.

Maternal folic acid supplementation to prevent preeclampsia: a systematic review and meta-analysis

OBJECTIVE

The purpose of this systematic review was to examine the association between folic acid supplementation during pregnancy and the risk of preeclampsia.

METHODS

Relevant studies were included by searching Embase, PubMed, Scope, Web of science, Cochrane Library databases. Studies were reviewed according to prespecified inclusion and exclusion criteria. Study characteristics were summarized, and study quality was assessed. Risk ratios (RR) and 95% confidence intervals (CI) were used as indicators of effect to assess the relationship between folic acid supplementation and risk of preeclampsia.

RESULTS

The protocol of this study was prospectively registered with the PROSPERO (registration No. CRD42022380636). A total of nine studies were included, divided into three groups according to the type of study, containing a total of 107 051 and 105 222 women who were supplemented and not supplemented with folic acid during pregnancy. The results showed that folic acid supplementation during pregnancy could not be proven to reduce the risk of preeclampsia.

CONCLUSION

The results of the study suggest that folic acid supplementation alone is not associated with a decreased risk of pre-eclampsia,but the inferences are somewhat limited by the low methodological quality of the included literature, and therefore higher quality studies are needed to prove this point.

Effects of Respiratory Muscle Training on Functional Ability, Pain-Related Outcomes, and Respiratory Function in Individuals with Low Back Pain: Systematic Review and Meta-Analysis

Objectives: The aim of this meta-analysis was to determine the effects of respiratory muscle training (RMT) on functional ability, pain-related outcomes, and respiratory function in individuals with sub-acute and chronic low back pain (LBP). Methods: The study selection was as follows: (participants) adult individuals with >4 weeks of LBP; (intervention) RMT; (comparison) any comparison RMT (inspiratory or expiratory or mixed) versus control; (outcomes) postural control, lumbar disability, pain-related outcomes, pain-related fear-avoidance beliefs, respiratory muscle function, and pulmonary function; and (study design) randomized controlled trials. Results: 11 studies were included in the meta-analysis showing that RMT produces a statistically significant increase in postural control (mean difference (MD) = 21.71 [12.22; 31.21]; decrease in lumbar disability (standardized mean difference (SMD) = 0.55 [0.001; 1.09]); decrease in lumbar pain intensity (SMD = 0.77 [0.15; 1.38]; increase in expiratory muscle strength (MD = 8.05 [5.34; 10.76]); and increase in forced vital capacity (FVC) (MD = 0.30 [0.03; 0.58]) compared with a control group. However, RMT does not produce an increase in inspiratory muscle strength (MD = 18.36 [-1.61; 38.34]) and in forced expiratory volume at the first second (FEV1) (MD = 0.36 [-0.02; 0.75]; and in the FEV1/FVC ratio (MD = 1.55 [-5.87; 8.96]) compared with the control group. Conclusions: RMT could improve expiratory muscle strength and FVC, with a moderate quality of evidence, whereas a low quality of evidence suggests that RMT could improve postural control, lumbar disability, and pain intensity in individuals with sub-acute and chronic LBP. However, more studies of high methodological quality are needed to strengthen the results of this meta-analysis.

Comprehensive assessment of exposure and environmental risk of potentially toxic elements in surface water and sediment across China: A synthesis study

China faces a serious challenge with water pollution posed by potentially toxic elements (PTEs). Comprehensive and reliable environmental risk assessment is paramount for precise pollution prevention and control. Previous studies generally focused on a single environmental compartment within small regions, and the uncertainty in risk calculation is not fully considered. This study revealed the current exposure status of 11 PTEs in surface water and sediment across China using previously reported concentration data in 301 well-screened articles. Ecological and human health risks were evaluated and the uncertainty related to calculation parameters and exposure dataset were quantified. PTEs of high concern were further identified. Results showed Mn and Zn had the highest concentration levels, while Hg and Cd had the lowest concentrations in both surface water and sediment. Risk assessment of individual PTE showed that high-risk PTEs varied by risk receptors and environmental compartments. Nationwide, the probability of aquatic organisms being affected by Mn, Zn, Cu, and As in surface water exceeded 10 %. In sediment, Cd and Hg exhibited high and considerable risk, respectively. As was identified as the major PTE threatening human health as its carcinogenic risk was 1.45 × 10-4 through direct ingestion. Combined risk assessment showed the PTE mixture in surface water and sediment posed medium and high ecological risk with the risk quotient and potential ecological risk index of 1.76 and 558.36, respectively. Adverse health effects through incidental ingestion and dermal contact during swimming were negligible. This study provides a nationwide risk assessment of PTEs in China's aquatic environment and the robustness is verified, which can serve as a practical basis for policymakers to guide the early warning and precise management of water pollution.

Association between problematic social networking use and anxiety symptoms: a systematic review and meta-analysis

A growing number of studies have reported that problematic social networking use (PSNU) is strongly associated with anxiety symptoms. However, due to the presence of multiple anxiety subtypes, existing research findings on the extent of this association vary widely, leading to a lack of consensus. The current meta-analysis aimed to summarize studies exploring the relationship between PSNU levels and anxiety symptoms, including generalized anxiety, social anxiety, attachment anxiety, and fear of missing out. 209 studies with a total of 172 articles were included in the meta-analysis, involving 252,337 participants from 28 countries. The results showed a moderately positive association between PSNU and generalized anxiety (GA), social anxiety (SA), attachment anxiety (AA), and fear of missing out (FoMO) respectively (GA: r = 0.388, 95% CI [0.362, 0.413]; SA: r = 0.437, 95% CI [0.395, 0.478]; AA: r = 0.345, 95% CI [0.286, 0.402]; FoMO: r = 0.496, 95% CI [0.461, 0.529]), and there were different regulatory factors between PSNU and different anxiety subtypes. This study provides the first comprehensive estimate of the association of PSNU with multiple anxiety subtypes, which vary by time of measurement, region, gender, and measurement tool.

Effectiveness of simulation-based interventions on empathy enhancement among nursing students: a systematic literature review and meta-analysis

BACKGROUND

This study aimed to secure and analyze evidence regarding the enhancement of nursing students' empathy through simulation-based interventions. It comprehensively analyzed self-reported emotions and reactions as primary outcomes, along with the results reported by nursing students who experienced simulation-based interventions, including empathy.

METHODS

This systematic literature review and meta-analysis investigated the effects of simulation-based interventions on enhancing empathy among nursing students. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for the systematic review and meta-analysis. The following details were considered: population, nursing students; intervention, simulation-based interventions targeting empathy enhancement; comparators, control groups without intervention or those undergoing general non-simulation-based classes; and outcomes, self-reported empathy.

RESULTS

In the systematic review of 28 studies, it was found that the use of simulation-based interventions among nursing students led to an increase in empathy, albeit with a small effect size. This was demonstrated through a pooled, random-effects meta-analysis, yielding an effect size (Hedge's g) of 0.35 (95% CI: 0.14, 0.57, p = 0.001). The results of meta-regression and subgroup analysis significantly increased in empathy for studies published after 2019 (Hedge's g = 0.52, 95% CI: 0.31 to 0.73, p < 0.001), quasi-experimental research design (Hedge's g = 0.51, 95% CI: 0.27 to 0.74, p < 0.001), more than 60 participants (Hedge's g = 0.31, 95% CI: 0.02 to 0.59, p = 0.034), and simulation-based interventions in nursing education (Hedge's g = 0.43, 95% CI: 0.22 to 0.65, p < 0.001).

CONCLUSIONS

Considering factors such as variations in sample size, research approaches, and the effects of independent studies on empathy, this systematic literature review and meta-analysis suggests that simulation-based education can significantly improve nursing students' overall empathy skills.

Enhancing nursing competency through virtual reality simulation among nursing students: a systematic review and meta-analysis

Aim

Studies on the effectiveness of virtual reality (VR) in nursing education have explored its impact on learning outcomes, emotional immersion and engagement, learner self-confidence, and satisfaction, generally showing positive aspects. However, there is a need for a systematic review to examine the specific influence of VR-based education on nursing students' practical competency.

Method

According to the PRISMA 2020 guidelines, 22 studies were selected based on inclusion criteria from 579 articles, published from January 1, 2018, to March 31, 2024, across nine major databases including PubMed and EMbase. The target population comprised nursing students, and the intervention focused on VR-based simulations aimed at enhancing competency, compared to control groups receiving either no intervention or conventional non-virtual simulation. The primary outcome, nursing competency, was analyzed using MIX 2.0 Pro (Ver. 2.0.1.6, BiostatXL, 2017) to calculate pooled effect sizes.

Result

The pooled effect size for nursing competency was determined to be large, with Hedge's g = 0.88 (95% CI, 0.47 to 1.29). Meta-regression analysis identified several factors associated with an increase in nursing competency. These included studies published after 2022, approval of an IRB, absence of funding, randomized controlled trials (RCTs), interventions reported as shorter than 4 weeks or not reported, sessions fewer than 4 or not reported, session duration under 1 h or not reported, and observational measurement methods. Additional factors enhancing nursing competency were the inclusion of a pre-briefing before simulations, the absence of a debriefing afterward, and the exclusion of other activities during the simulation.

Conclusion

By combining the results of the included studies, the systematic review and meta-analysis accounted for variations in sample size, study methodology, and independent intervention effects, providing an overall evaluation of the effectiveness of simulation-based education in improving nursing students' competency.

Limitation

The selection criteria for the studies analyzed, which included only those published in English or Korean and reported precise means, standard deviations, and sample sizes, could lead to selection bias and limit the generalization of our study results.

Systematic review registration

PROSPERO International Prospective Register of Systematic Reviews: http://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023446348.

The effect of music therapy on language communication and social skills in children with autism spectrum disorder: a systematic review and meta-analysis

Background

Studies have shown that music therapy can be used as a therapeutic aid for clinical disorders. To evaluate the effects of music therapy (MT) on language communication and social skills in children with autism spectrum disorder (ASD), a meta-analysis was performed on eligible studies in this field.

Methods

A systematic search was conducted in eight databases: PubMed, Embase, Web of Science, Cochrane Library databases, the China National Knowledge Infrastructure (CNKI), Wanfang Data, the Chinese Biomedical Literature (CBM) Database, and the VIP Chinese Science and Technology Periodicals Database. The standard mean difference (SMD) values were used to evaluate outcomes, and the pooled proportions and SMD with their 95% confidence intervals (CIs) were also calculated.

Results

Eighteen randomized controlled trial (RCT) studies were included, with a total of 1,457 children with ASD. This meta-analysis revealed that music therapy improved their language communication [SMD = -1.20; 95%CI -1.45, -0.94; χ2 (17) = 84.17, I2 = 80%, p < 0.001] and social skills [SMD = -1. 13; 95%CI -1.49, -0.78; χ2 (17) = 162.53, I2 = 90%, p < 0.001]. In addition, behavior [SMD = -1.92; 94%CI -2.56, -1.28; χ2 (13) = 235.08, I2 = 95%, p < 0.001], sensory perception [SMD = -1.62; 95%CI -2.17, -1.08; χ2 (16) = 303.80, I2 = 95%, p < 0.001], self-help [SMD = -2. 14; 95%CI -3.17, -1.10; χ2 (6) = 173.07, I2 = 97%, p < 0.001] were all improved.

Conclusion

Music therapy has a positive effect on the improvement of symptoms in children with ASD.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/.

Practice patterns, role and impact of advanced practice nurses in stroke care: A mixed-methods systematic review

AIM(S)

To undertake a systematic review of the practice patterns and roles of advanced practice nurses (APNs) in inpatient and outpatient stroke-care services; and to evaluate the impact of APN-led inpatient and outpatient stroke-care services on clinical and patient-reported outcomes.

DESIGN

A mixed-methods systematic review.

METHODS

A systematic search was conducted across six electronic databases for primary studies. Data were synthesised using a convergent integrated approach. DATA SOURCES (INCLUDE SEARCH DATES) *FOR REVIEWS ONLY: A systematic search was conducted across PubMed, CINAHL, Cochrane Library, Embase, PsycInfo and ProQuest Dissertations & Theses Global, for primary studies published between the inception of the databases and 3 November 2022.

RESULTS

Findings based on the 18 included primary studies indicate that the APNs' roles have been implemented across the continuum of stroke care, including pre-intervention care, inpatient care and post-discharge care. Practicing at an advanced level, the APNs engaged in clinical, operational and educational undertakings across services and disciplines. Positive clinical and patient-reported outcomes have been attributed to their practice.

CONCLUSION

The review highlights the critical role of APNs in improving stroke care, especially in the pre-intervention phase. Their clinical expertise, patient-centered approach and collaboration can transform stroke care. Integrating APNs into stroke care teams is essential for better management and outcomes in light of the increasing stroke burden.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Healthcare institutions should integrate APNs to enhance pre-intervention stroke care, improve diagnostic accuracy and expedite treatment. APNs can prioritise patient-centric care, including assessments, coordination and education. Medication reconciliation, timely rehabilitation referrals and lifestyle modifications for secondary stroke prevention are crucial. Implementing advanced practice nursing frameworks ensures successful APN integration, leading to improved stroke care and better patient outcomes in response to the growing stroke burden.

IMPACT (ADDRESSING)

What problem did the study address? Poor clarity of the role of advanced practice nurses among patients, physicians, healthcare professionals, health policymakers and nurses. What were the main findings? Advanced practice nurses practise across the continuum of stroke care, mainly in pre-intervention care which takes place before initiating treatment, inpatient care and post-discharge care. The implementation of the advanced practice nurse role in stroke care has contributed positively to clinical and patient-reported outcomes. Where and on whom will the research have an impact? Insights from the review are envisioned to inform healthcare policymakers and leaders in the implementation and evaluation of the APN role in stroke care.

REPORTING METHOD

Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution. TRIAL AND PROTOCOL REGISTRATION: https://figshare.com/ndownloader/files/41606781; Registered on Open Science Framework osf.io/dav8j.

Effects of Respiratory Muscle Training on Exercise Capacity, Quality of Life, and Respiratory and Pulmonary Function in People With Ischemic Heart Disease: Systematic Review and Meta-Analysis

OBJECTIVE

This systematic review and meta-analysis aimed to evaluate the effects of respiratory muscle training (RMT) on functional exercise capacity, health-related quality of life (HRQoL), respiratory muscle function, and pulmonary function in individuals with ischemic heart disease (IHD).

METHODS

The MEDLINE, Web of Science, Scopus, PEDro, CINAHL, Science Direct, and CENTRAL electronic databases were searched in January 2023. Randomized controlled trials published in English, Spanish, or Portuguese that were conducted to determine the effect of RMT versus passive control and/or sham RMT on the target variables in individuals with IHD, irrespective of age or sex were included. Two reviewers performed the searches and extraction of the most relevant data. The quality and risk of bias for each included study were examined with the PEDro scale and Cochrane risk-of-bias tool.

RESULTS

Thirteen studies (849 participants) were included. The meta-analysis showed a significant increase in peak oxygen consumption (mean difference [MD] = 2.18 mL·kg-1·min-1 [95% CI = 0.54 to 3.83]), inspiratory muscle strength (MD = 16.62 cm H2O [95% CI = 12.48 to 20.77]), inspiratory muscle endurance (standardized mean difference = 0.39 [95% CI = 0.19 to 0.60]), and expiratory muscle strength (MD = 14.52 cm H2O [95% CI = 5.51 to 23.53]). There were no benefits in 6-minute walking distance (MD = 37.57 m [95% CI = -36.34 to 111.48]), HRQoL (standardized mean difference = 0.22 [95% CI = -0.16 to 0.60]), pulmonary function (forced vital capacity; MD = 2.07% of predicted value [95% CI = -0.90 to 5.03], or forced expiratory volume at the first second (MD = -0.75% of predicted value [95% CI = -5.45 to 3.95]).

CONCLUSION

This meta-analysis provided high- and moderate-quality evidence that inspiratory muscle training (IMT) improves inspiratory muscle strength and endurance, respectively; and very low-quality evidence for effects on peak oxygen consumption and expiratory muscle strength in individuals with IHD. No superior effects were found in the 6-minute walking test, HRQoL, or pulmonary function compared with the control group.

IMPACT

The results shown in this systematic review with meta-analysis will provide clinicians a better understanding of the effects of IMT in people with IHD. IMT could be integrated into the cardiac rehabilitation management, although more research is needed.

The effects of respiratory muscle training on respiratory function and functional capacity in patients with early stroke: a meta-analysis

BACKGROUND

Respiratory muscle training is a continuous and standardized training of respiratory muscles, but the evidence of the effects on early stroke patients is not clear. This meta-analysis aimed to investigate the effects of respiratory muscle training on respiratory function and functional capacity in patients with early stroke.

METHODS

PubMed, Embase, PEDro, ScienceDirect, AMED, CINAHL, and China National Knowledge Infrastructure databases were searched from inception to December 8, 2023 for articles about studies that 1) stroke patients with age ≥ 18 years old. Early stroke < 3 months at the time of diagnosis, 2) respiratory muscle training, including inspiratory and expiratory muscle training, 3) the following measurements are the outcomes: respiratory muscle strength, respiratory muscle endurance, pulmonary function testing, dyspnea fatigue score, and functional capacity, 4) randomized controlled trials. Studies that met the inclusion criteria were extracted data and appraised the methodological quality and risk of bias using the Physiotherapy Evidence Database scale and the Cochrane Risk of Bias tool by two independent reviewers. RevMan 5.4 with a random effect model was used for data synthesis and analysis. Mean differences (MD) or standard mean differences (SMD), and 95% confidence interval were calculated (95%CI).

RESULTS

Nine studies met inclusion criteria, recruiting 526 participants (mean age 61.6 years). Respiratory muscle training produced a statistically significant effect on improving maximal inspiratory pressure (MD = 10.93, 95%CI: 8.51-13.36), maximal expiratory pressure (MD = 9.01, 95%CI: 5.34-12.69), forced vital capacity (MD = 0.82, 95%CI: 0.54-1.10), peak expiratory flow (MD = 1.28, 95%CI: 0.94-1.63), forced expiratory volume in 1 s (MD = 1.36, 95%CI: 1.13-1.59), functional capacity (SMD = 0.51, 95%CI: 0.05-0.98) in patients with early stroke. Subgroup analysis showed that inspiratory muscle training combined with expiratory muscle training was beneficial to the recovery of maximal inspiratory pressure (MD = 9.78, 95%CI: 5.96-13.60), maximal expiratory pressure (MD = 11.62, 95%CI: 3.80-19.43), forced vital capacity (MD = 0.87, 95%CI: 0.47-1.27), peak expiratory flow (MD = 1.51, 95%CI: 1.22-1.80), forced expiratory volume in 1 s (MD = 0.76, 95%CI: 0.41-1.11), functional capacity (SMD = 0.61, 95%CI: 0.08-1.13), while inspiratory muscle training could improve maximal inspiratory pressure (MD = 11.60, 95%CI: 8.15-15.05), maximal expiratory pressure (MD = 7.06, 95%CI: 3.50-10.62), forced vital capacity (MD = 0.71, 95%CI: 0.21-1.21), peak expiratory flow (MD = 0.84, 95%CI: 0.37-1.31), forced expiratory volume in 1 s (MD = 0.40, 95%CI: 0.08-0.72).

CONCLUSIONS

This study provides good-quality evidence that respiratory muscle training is effective in improving respiratory muscle strength, pulmonary function, and functional capacity for patients with early stroke. Inspiratory muscle training combined with expiratory muscle training seems to promote functional recovery in patients with early stroke more than inspiratory muscle training alone.

TRIAL REGISTRATION

Prospero registration number: CRD42021291918.

Seroprevalence of pathogenic Leptospira serogroups in asymptomatic domestic dogs and cats: systematic review and meta-analysis

Leptospirosis is a neglected zoonotic disease transmitted by contact with the urine of animals infected with pathogenic species of the bacteria Leptospira or by contact with environments contaminated with the bacteria. Domestic dogs and cats may act as reservoirs or as sentinels of environmental contamination with leptospires, posing a public health concern. There is a great diversity of leptospires, and one common way to classify them is into serogroups that provide some information on the host species they are associated with. The aims of this study were: (1) to quantitatively summarize the overall prevalence and serogroup-specific prevalence of antibodies against pathogenic leptospires in asymptomatic dogs and cats and (2) to identify environmental and host characteristics that may affect the prevalence. Three electronic databases and the reference lists of eligible articles were screened, for epidemiological studies conducted between the years 2012-2022. We estimated overall and serogroup-specific prevalence using three-level meta-analysis models and assessed potential sources of heterogeneity by moderator analysis and meta-regression. Eighty-four studies met the inclusion criteria (dog studies 66.7%, cat studies 26.2%, and both species 7.1%). There were significant differences between dogs and cats in the overall prevalence model (P < 0.001), but not in the serogroup-specific model (P>0.05). In dogs, the prevalence of Leptospira interrogans serogroup Canicola was significantly higher than the other pathogenic serogroups (P < 0.001), while in cats there were no significant differences among serogroups (P = 0.373). Moderator analysis showed that the prevalence of L. kirschneri serogroup Grippotyphosa was significantly higher in stray/sheltered dogs than in domiciled dogs (P = 0.028). These results suggest that pathogenic serogroups associated with small mammals are circulating among asymptomatic pets and should be taken into account in the transmission cycle of leptospires, as well as in the standard MAT panel for diagnosis in dogs and cats. It also highlights the importance of including both dogs and cats as potential reservoirs when conducting eco-epidemiological studies in different geographical and ecological areas.

Effectiveness of technology-based psychosocial interventions on diabetes distress and health-relevant outcomes among type 2 diabetes mellitus: A systematic review and meta-analysis

BACKGROUND

Poor management of type 2 diabetes mellitus may affect individuals' physical and emotional health. Access to ongoing psychosocial interventions through technological platforms may potentially minimise diabetes complications and improve health-related outcomes. However, little is known about the effectiveness of such interventions on diabetes distress and health-related outcomes.

OBJECTIVE

To synthesise the best available evidence concerning the effectiveness of technology-based psychosocial interventions on diabetes distress, self-efficacy, health-related quality of life, and HbA1c level in adults with type 2 diabetes mellitus.

METHODS

A search of eleven databases was conducted to identify randomised controlled trials that examined the effects of technology-based psychosocial interventions on the outcomes. Randomised controlled trials reported in English from 2010 to 2020 were included. Selection of studies, quality appraisal, and data extraction were conducted by two reviewers independently. Meta-analyses, subgroup analyses and sensitivity analysis were performed using Review Manager. Intervention effects was measured using standardise mean difference.

RESULTS

Twenty randomised controlled trials fulfilled the eligibility criteria and 18 randomised controlled trials were included in meta-analysis. technology-based psychosocial interventions improved diabetes distress, self-efficacy and HbA1c levels with significant and small effect sizes. Subgroup analyses revealed greater improvement in health-related quality of life for participants with comorbid depression and lower HbA1c levels for studies with lesser than 100 participants.

CONCLUSION

The findings of this review increase knowledge on the effectiveness of technology-based psychosocial interventions on diabetes distress and self-efficacy. However, evidence to support the effects of technology-based psychosocial interventions on HbA1c and health-related quality of life was not strong. More research is needed to examine the effectiveness of the psychosocial interventions delivered through mobile applications or virtual reality.

Effective strategies for increasing the uptake of modern methods of family planning in South Asia: a systematic review and meta-analysis

BACKGROUND

Family planning (FP) interventions have improved the use of modern contraceptives, yet a high unmet need for contraception still exists in South Asia. This systematic review of existing research was conducted to identify effective FP interventions that led to an increase in the uptake of modern methods of contraception in South Asia.

METHODS

Five electronic databases were searched for relevant studies published between January 1st, 2000 and May 4, 2023. Experimental studies that reported data on the impact of FP interventions on modern contraceptive use among women of reproductive age (15-49 years) in the South Asian region were included. A random-effects Inverse Variance weighted model was employed to pool the adjusted odds ratio (OR) on modern contraceptive use and unmet need for contraception. In addition, we computed subgroup meta-estimates based on intervention type and the urban-rural divide.

RESULTS

Among 643 studies identified, 21 met the inclusion criteria. The overall pooled odds ratio for modern contraceptive use was significantly higher (OR 1.51; 95% CI 1.35-1.70; heterogeneity; I2 = 81%) for FP interventions with a significant reduction in unmet need for contraception (OR 0.86; 95% CI 0.78-0.94, I2 = 50%). The subgroup analysis revealed demand-generation (OR 1.61; 95% CI 1.32-1.96), health system integrated (OR 1.53; 95% CI 1.07-2.20), and franchised FP clinic interventions (OR 1.32; 95% CI 1.21-1.44) had promoted the modern contraceptive uptake. Further, FP interventions implemented in urban settings showed a higher increase in modern contraceptive use (OR 1.73; 95% CI 1.44-2.07) compared to rural settings (OR 1.46; 95% CI 1.28-1.66). Given the considerable heterogeneity observed across studies and the low degree of certainty indicated by the GRADE summary for the primary outcome, caution is advised when interpreting the results.

CONCLUSION

The review collated experimentally evaluated FP interventions that increased modern contraception use and reduced the unmet need in South Asia. The demand generation interventions were the most effective in increasing the uptake of modern contraceptive methods. Furthermore, the urban environment provides a conducive environment for interventions to improve contraceptive usage. However, further studies should assess which aspects were most effective on attitudes towards contraception, selection of more effective methods, and contraceptive behaviors.

Recognition and participation of colorectal cancer screening in Turkiye: A systematic review and meta-analysis study

Colorectal cancers (CRCs) have an important share in the prevalence and mortality among all cancers. It was aimed to make a systematic review and meta-analysis of researches about the prevalence of knowing fecal occult blood test (FOBT) and colonoscopy, which are among the CRC screening methods, and the prevalence of having these tests at any time in life. A literature search using five different databases were screened both in Turkish and English language and a total of 1176 studies were reached. Of these, 22 studies were selected to be included in this study. In the evaluation of the researches included in the study, the studies were read in a way to look for answers to PICOS questions. Open Meta-analyst demo program and random effects model was used. The prevalence rate and 95% confidence interval of knowing and having FOBT and colonoscopy were calculated. According to the meta-analysis results, the prevalence of knowing the FOBT among the CRC screening tests was 19.3%, the prevalence of having the FOBT was 13.2%, the prevalence of knowing colonoscopy was 31.7%, and the prevalence of having colonoscopy was 10.0%. As a conclusion prevalence of knowing and having FOBT and colonoscopy was low in risky individuals in Turkiye.

Population dynamics of Listeria spp., Salmonella spp., and Escherichia coli on fresh produce: A scoping review

Collation of the current scope of literature related to population dynamics (i.e., growth, die-off, survival) of foodborne pathogens on fresh produce can aid in informing future research directions and help stakeholders identify relevant research literature. A scoping review was conducted to gather and synthesize literature that investigates population dynamics of pathogenic and non-pathogenic Listeria spp., Salmonella spp., and Escherichia coli on whole unprocessed fresh produce (defined as produce not having undergone chopping, cutting, homogenization, irradiation, or pasteurization). Literature sources were identified using an exhaustive search of research and industry reports published prior to September 23, 2021, followed by screening for relevance based on strict, a priori eligibility criteria. A total of 277 studies that met all eligibility criteria were subjected to an in-depth qualitative review of various factors (e.g., produce commodities, study settings, inoculation methodologies) that affect population dynamics. Included studies represent investigations of population dynamics on produce before (i.e., pre-harvest; n = 143) and after (i.e., post-harvest; n = 144) harvest. Several knowledge gaps were identified, including the limited representation of (i) pre-harvest studies that investigated population dynamics of Listeria spp. on produce (n = 13, 9% of pre-harvest studies), (ii) pre-harvest studies that were carried out on non-sprouts produce types grown using hydroponic cultivation practices (n = 7, 5% of pre-harvest studies), and (iii) post-harvest studies that reported the relative humidity conditions under which experiments were carried out (n = 56, 39% of post-harvest studies). These and other knowledge gaps summarized in this scoping review represent areas of research that can be investigated in future studies.

Effect of virtual reality on pain during burn dressing in children: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Burn dressing, a necessary and regular procedure for burn management, causes significant pain and distress for children. Recent technological advancements in VR have opened up new possibilities for pain management in children undergoing burn dressing. However, there is limited evidence regarding their efficacy in burn dressing specifically. This study aims to synthesize and analyze the effect of VR on pain during burn dressing in children.

METHODS

In this review, we investigated studies from PubMed, Web of Science, Cochrane, MEDLINE, CINAHL, Scopus and Google Scholar databases that met inclusion criteria. We also assessed the studies' methodological quality with the Cochrane and JBI checklists. This study was performed based on the Guidelines of Systematic Reporting of Examination presented in the PRISMA checklist. The search protocol has been registered at the PROSPERO International Prospective Register of Systematic Reviews.

RESULTS

A total of six published studies including 241 pediatric patients were included in this review. The meta-analysis results showed a significant effect of VR intervention on the pain levels of children (Hedge's g = -1199, Q = 31,106, I2 = 83,926%, p < 0.001).

CONCLUSION

Findings from this study show that VR is a promising and effective intervention for reducing pain scores in children undergoing dressing changes for burn injuries.

IMPLACATION TO PRACTICE

Our meta-analysis suggest that the significant potential of integrating VR into clinical practice, presenting a non-pharmacological intervention to reduce pain during dressing changes in pediatric burn patients. Implementing VR in healthcare settings can lead to improved pain management and better patient outcomes for pediatric population.

Effect of lower limb resistance training on ICF components in chronic stroke: A systematic review and meta-analysis of RCTs

BACKGROUND

Resistance training (RT) effectively promotes functional independence after stroke.

OBJECTIVES

To investigate the effect of lower limb RT on body structure and function (muscle strength, postural balance), activity (mobility, gait) and participation (quality of life, impact of stroke on self-perceived health) outcomes in individuals with chronic stroke.

METHODS

Six databases were searched from inception until September 2022 for randomized controlled trials comparing lower limb RT to a control intervention. The random-effects model was used in the meta-analyses. Effect sizes were reported as standardized mean differences (SMD). Quality of evidence was assessed using the GRADE approach.

RESULTS

Fourteen studies were included. Significant improvements were found in body structure and function after lower limb RT: knee extensors (paretic side - SMD: 1.27; very low evidence), knee flexors (paretic side - SMD: 0.51; very low evidence; non-paretic side - SMD: 0.52; low evidence), leg press (paretic side - SMD: 0.83; very low evidence) and global lower limb muscle strength (SMD: -1.47; low evidence). No improvement was found for knee extensors (p = 0.05) or leg press (p = 0.58) on the non-paretic side. No improvements were found in the activity domain after lower limb RT: mobility (p = 0.16) and gait (walking speed-usual: p = 0.17; walking speed-fast: p = 0.74). No improvements were found in the participation domain after lower limb RT: quality of life (p > 0.05), except the bodily pain dimension (SMD: 1.02; low evidence) or the impact of stroke on self-perceived health (p = 0.38).

CONCLUSION

Lower limb RT led to significant improvements in the body structure and function domain (knee extensors and flexors, leg press, global lower limb muscle strength) in individuals with chronic stroke. No improvements were found in the activity (mobility, gait [walking speed]) or participation (quality of life, impact of stroke on self-perceived health) domains.

PROSPERO REGISTRATION NUMBER

CRD42021272645.

Meta-analysis of soluble tumour necrosis factor receptors in severe mental illnesses

Tumour necrosis factor (TNF), as an innate immune defense molecule, functions through binding to TNF receptor 1 (TNFR1) or TNF receptor 2 (TNFR2). Peripheral levels of soluble TNFR1 (sTNFR1) and soluble TNFR2 (sTNFR2) were widely measured in severe mental illnesses (SMIs) including schizophrenia (SCZ), bipolar disorder (BD) and major depressive disorder (MDD) but inconsistencies existed. Hence, the present meta-analysis was conducted to identify the overall association between plasma/serum sTNFR1 and sTNFR2 levels and SMIs. Published studies were searched using Pubmed and Scopus. Data were analysed using Comprehensive Meta-Analysis version 2. Hedges's g effect sizes and 95% confidence intervals were pooled using fixed-effect or random-effects models. Heterogeneity, publication bias and study quality were assessed. Sensitivity analysis and subgroup analysis were performed. Our findings revealed that sTNFR1 level was significantly higher in SMI, particularly in BD. The sTNFR2 level significantly elevated in SMI but with smaller effect size. These findings further support the association between altered immune system and inflammatory abnormalities in SMI, especially in patients with BD. Subgroup analysis showed that younger age of onset, longer illness duration and psychotropic medication raised both sTNFR levels, especially sTNFR1, as these factors may contribute to the activation of inflammation. Future studies were suggested to identify the causality between TNFR pathway and SCZ, BD and MDD respectively using homogenous group of each SMI, and to determine the longitudinal effect of each psychotropic medication on TNFR pathway.

Prevalence of sleep disturbance among adolescents with substance use: a systematic review and meta-analysis

PURPOSE

Sleep disturbance has become a major challenge among adolescents worldwide. Substance use is among the most common factors contributing to sleep disturbance. This systematic review and meta-analysis examined the prevalence and categories of sleep disturbance among adolescents with substance use.

METHODS

We comprehensively searched for relevant studies published in the following databases from inception to August 2022: CINHAL (via EBSCOhost), PubMed, Scopus, Ovid Medline, Embase, ProQuest, and Web of Science. Data analysis was performed using Comprehensive Meta-Analysis version 3 software. We used a random-effects model to pool prevalence rates with 95% confidence intervals (CIs). Forest plots and p values for the Cochran Q statistic were used to evaluate heterogeneity among studies. Subgroup and meta-regression analyses were performed to compare the groups and identify the sources of heterogeneity.

RESULTS

We examined 18 studies that reported insomnia, hypersomnolence, sleep-related breathing disorders as sleep disturbances among adolescents with the use of alcohol, smoking, marijuana, and coffee. The total sample was 124,554. The overall prevalence rate of sleep disturbance was 29% (95% CI: 0.201-0.403). Subgroup analysis revealed that the prevalence rates of insomnia and hypersomnolence were higher among alcohol users (31%; 95% CI: 0.100-0.654) and smokers (46%; 95% CI: 0.232-0.700). The study design and method of assessment groups were the significant moderators that showed the source of variation in the included studies.

CONCLUSION

Sleep disturbance is highly prevalent among adolescents with substance use. Insomnia and hypersomnolence are more prevalent among alcohol users and smokers, respectively. On the basis of our findings, health-care providers can develop effective targeted interventions to reduce substance use, prevent sleep disturbance, and promote healthy sleep habits among adolescents.

Antimicrobial Susceptibility Profile of Listeria monocytogenes Isolated from Meat Products: A Systematic Review and Meta-Analysis

The objective of this study was to conduct a systematic review to comprehensively understand antimicrobial resistance (AMR) in Listeria monocytogenes (LM) isolated from meat and meat products. The study was performed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Published articles from 2000 to 2022 were collected from six widely used online databases, including AGRICOLA, PubMed, Web of Science (WoS), Scopus, Cochrane Library, and CINAHL-EBSCO. Prevalence rates and AMR of pathogen isolates were analyzed using MedCalc software, including the I2 statistic and Cochrane Q test for heterogeneity. Sensitivity analysis, subgroup analysis, and meta-regression were conducted to analyze potential sources of heterogeneity at a 95% significance level. The distribution and prevalence of multidrug resistance (MDR) were examined using a random-effect model. The pooled frequency of bacterial MDR was 22.97% (95% confidence interval [CI] = 14.95-32.13). The studies exhibited high heterogeneity (I2 = 94.82%, 95% CI = 93.74-95.71, p < 0.0001). Furthermore, the most prevalent antibiotics resistance found in the majority of included studies were tetracycline, clindamycin, penicillin, ampicillin, and oxacillin (I2 = 86.66%, 95% CI = 73.20-93.36, p < 0.0001). This meta-analysis provides a comprehensive understanding of AMR in LM isolates, and the results indicate that none of the variable factors, including sampling location, sampling size, or methodology, significantly influenced the outcome of LM isolates resistant to multidrug.

Gait and Falls in Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-analysis

BACKGROUND AND PURPOSE

Benign paroxysmal positional vertigo (BPPV) is one of the most common vestibular disorders, and is treated effectively with particle repositioning maneuvers (PRM). The aim of this study was to assess the influence of BPPV and treatment effects of PRM on gait, falls, and fear of falling.

METHODS

Three databases and the reference lists of included articles were systematically searched for studies comparing gait and/or falls between (1) people with BPPV (pwBPPV) and controls and (2) pre- and posttreatment with PRM. The Joanna Briggs Institute critical appraisal tools were used to assess risk of bias.

RESULTS

Twenty of the 25 included studies were suitable for meta-analysis. Quality assessment resulted in 2 studies with high risk of bias, 13 with moderate risk, and 10 with low risk. PwBPPV walked slower and demonstrated more sway during tandem walking compared with controls. PwBPPV also walked slower during head rotations. After PRM, gait velocity during level walking increased significantly, and gait became safer according to gait assessment scales. Impairments during tandem walking and walking with head rotations did not improve. The number of fallers was significantly higher for pwBPPV than for controls. After treatment, the number of falls, number of pwBPPV who fell, and fear of falling decreased.

DISCUSSION AND CONCLUSIONS

BPPV increases the odds of falls and negatively impacts spatiotemporal parameters of gait. PRM improves falls, fear of falling, and gait during level walking. Additional rehabilitation might be necessary to improve gait while walking with head movements or tandem walking.Video Abstract available for more insights from the authors (see the Supplemental Digital Content Video, available at: http://links.lww.com/JNPT/A421 ).

Meta-Analyses of Reading Intervention Studies Including Students With Learning Disabilities: A Methodological Review

Learning disabilities (LD) may affect a range of academic skills but are most often observed in reading. Researchers and policymakers increasingly recommend addressing reading difficulties encountered by students with LD using evidence-based practices, or interventions validated through multiple, high-quality research studies. A valuable tool in identifying evidence-based practices is the meta-analysis, which entails statistically aggregating the results obtained through primary studies. Specific methods used in meta-analyses have the potential to influence their findings, with ramifications for research and practice. This review assessed the methodological features of the systematic reviews and analytic procedures featured in meta-analyses of reading intervention studies that included students with LD written between 2000 and 2020. Identified articles (N = 23) suggest that meta-analyses have become more prevalent and transparent over time, notwithstanding issues related to publication bias and the opacity of coding procedures. A discussion of implications follows a description of results.

Need for Training in Research Methodology Prior to Conducting Systematic Reviews and Meta-Analyses, and the Effectiveness of an Online Training Program: The Global Andrology Forum Model

PURPOSE

Systematic reviews and meta-analyses (SRMAs) are used to generate evidence-based guidelines. Although the number of SRMAs published in the literature has increased dramatically in the last decade, the training and the experience of the researchers performing the SRMAs are usually not explained in the SRMAs' methodology, and this may be a source of bias. Although some studies pointed out the need for quality control of SRMAs and training in proper statistical methods, to the best of our knowledge, no study has reported the importance of training the researchers that conduct the SRMAs. The aim of this study is to describe a training program designed to impart the essential knowledge and skills required for the conduct of an SRMA and to assess the need for, and outcome of, such a training.

MATERIALS AND METHODS

Researchers were trained for use of Scopus, study eligibility, assessment of the quality of evidence (QoE) through the Cambridge Quality Checklist for observational studies, as well as the Cochrane Risk of Bias tool, the Consolidated Standards of Reporting Trials (CONSORT) guidelines, and the Jadad score for randomized controlled trials (RCTs), Population, Intervention, Comparison, Outcome (PICO) questions and data extraction. A total of 35 of them were approved to join a planned SRMA. At the end of the SRMA, they were administered 43 multiple-choice questions (MCQs) on demographics, motivation for participation in the SRMA, self-perceived change in knowledge before and after conducting the SRMA, and self-assessment of performance. The senior researchers then revised the spreadsheet of the SRMA and, based on the mistakes found, organized a training focused on the correct assessment of the study design, where 43 researchers (9 joined midway) and 11 trainees with no experience in conducting SRMA attended. They all were tested through a 5 MCQ assessment that was administered before and after the training. Those scoring poorly were re-trained and re-tested, and only those scoring satisfactorily were admitted to further SRMAs.

RESULTS

Approximately 54.3% of the participants were medical doctors (MD), 31.4% were urologists and 48.6% had previous experience with SRMAs. Joining an international collaborative study was the main motivation, chosen by 19.7% of researchers. The results of the self-perceived change in knowledge showed a significant improvement in the use of Scopus, checklists for QoE, PICO questions, data required to perform a meta-analysis, and critical reading of scientific articles. Also, the majority of the researchers ranked the quality of their work as high. The pre-test results of the 5 MCQ showed a low score, which was not different from that achieved by a group of fresh trainees (median, 2; IQR 1-3 vs. median, 1; IQR, 1-2; p=0.3). Post-training there was significant improvement in both groups (researchers: median, 4; IQR, 3-5 vs. median, 2; IQR, 1-3; p<0.001; trainees: median, 4; IQR, 3-4 vs. median, 1; IQR, 1-2; p=0.02). Out of the 44 researchers, 12 (27.3%) scored poorly (≤3). After re-training, all of them scored satisfactorily (>3) and were admitted to subsequent SRMAs.

CONCLUSIONS

At the end of our model, 100% of researchers participating in this study were validated to be included in a meta-analysis. This validation required the involvement of the MT, two meetings, a self-evaluation survey, and one or two sets of objective tests with explanations and corrections. Our results indicate that even well-trained clinicians are naïve when it comes to the methodology of SRMA. All the researchers performing an SRMA need comprehensive training that must cover each aspect of the SRMA methodology. This paper provides a replicable training program that could be used by other investigators to train the researchers to perform high-quality SRMAs.

Health information needs and dissemination methods for individuals living with ischemic heart disease: A systematic review

OBJECTIVES

This review aimed to identify the health information needs and preferred approaches to receive health information of individuals with Ischaemic Heart Disease (IHD).

METHODS

A systematic review was conducted. Relevant literature, published in English (January 2011 to October 2021), was identified across six databases. Guided by Coulter et al.'s framework for developing patient information materials, thematic analysis was performed. The findings were presented in tables and prose.

RESULTS

Fifty-nine studies were included. Eleven themes summarised the information needs of individuals with IHD. Each theme was supported with subthemes. Forty-five studies included information on preferred methods of dissemination.

CONCLUSIONS

Our review has characterised the diverse information needs of individuals living with IHD and dissemination methods for outreach to this population. Such insights inform healthcare providers in formulating patient-centred educational interventions to empower patients to undertake successful behavioural modification.

PRACTICE IMPLICATIONS

Patient education should be personalised and delivered according to individuals' risks for IHD and modifiable risk factors. The use of web-based dissemination of patient education has gained popularity among healthcare providers but sub-optimal adherence to these web-based interventions limits behavioural modification. Adding elements of in-person patient education session to complement web-based interventions may be more propitious to effecting behavioural modification.

Leptospiral infection in domestic cats: Systematic review with meta-analysis

The role of domestic cats in the transmission of Leptospira is controversial, being considered either as a protective factor or a potential source of infection for humans. The aims of this study were to obtain an integrated estimate of the prevalence of leptospiral infection in domestic cats, and to characterize those individuals most susceptible to infection. For this systematic review and meta-analysis, five electronic databases, as well as the reference lists of eligible reports were screened for observational studies published during 1979-2022. The overall prevalence of leptospiral antibodies and of pathogenic Leptospira in kidney/urine was estimated using three-level meta-analysis models. To investigate potential sources of heterogeneity, moderator analyses was performed using the sampling year, health status, living environment, and origin of the cats. The odds-ratio (OR) of potential risk factors was estimated using random-effects meta-analysis models for binary outcomes. The literature search identified 61 eligible publications, containing 114 effect estimates. The overall seroprevalence was 11.7 % (95 % CI: 9.3-14.6 %), the prevalence of leptospires in urine was 3.7 % (95 % CI: 1.7-8.1 %), and the prevalence of leptospires in kidney tissue was 12.8 % (95 % CI: 3.2-39.9 %). There were no significant differences in the estimated prevalence after removing articles with medium risk of bias. Seroprevalence was higher in Europe when compared to Latin America and the Caribbean (P = 0.047) and showed a mild decrease over time (P = 0.023). Outdoor cats had almost three times greater probabilities of infection with Leptospira (OR: 2.74, 95 % CI: 1.10-6.84). No other significant effect was detected among the tested moderators or potential risk factors (P > 0.05). Results suggest that feline leptospirosis should receive particular attention in veterinary care, as exposure to leptospires can occur in approximately 1 in every 10 cats, and more frequently in cats with street access. Domestic cats should be considered as potential Leptospira carriers when designing public health strategies for the control and prevention of leptospirosis. Further investigation is required to improve knowledge of the role of these animals in the environmental transmission cycle.

Is physical exercise effective at improving body structure & function and activity outcomes in individuals with Mild Cognitive Impairment? a systematic review with quality of evidence assessment

PURPOSE

To investigate the effect of physical exercise on body structure & function and activity outcomes in individuals with Mild Cognitive Impairment (MCI).

METHODS

Six databases were searched from inception until January 2021. Randomized controlled trials (RCTs) comparing physical exercise with a control group were included.

RESULTS

Fourteen RCTs were included. Three types of physical exercise were identified: aerobic (AE), resistance (RE), and multimodal (ME). Regarding body structure & function outcomes, evidence for RE was very low and with effect for improvement in upper limb muscle strength and very low and without effect for lower limbs. For improvement in postural balance, evidence was very low and with effect with AE and very low and without effect with RE and ME. Evidence for cardiorespiratory function was very low and without effect with AE and RE. Regarding activity outcomes, evidence was low and without effect for mobility with AE and very low and without effect with RE and ME.

CONCLUSIONS

Physical exercise promoted improvements in body structure & function outcomes in individuals with MCI. Resistance exercise improvement upper limb muscle strength and AE enhanced postural balance. In contrast, physical exercise did not promote a significant benefit in activity outcomes.Implications for rehabilitationResults of this systematic review have shown that physical exercise promoted improvements in body structure & function outcomes in individuals with Mild Cognitive Impairment (MCI).Resistance exercise with elastic bands for approximately 60 minutes twice a week for a total of three months improved upper limb muscle strength.Aerobic exercise with walking for approximately 60 minutes twice per week for a total of six months enhanced postural balance.Considering the potential benefits identified in this systematic review, physical exercise can be recommended for individuals with MCI.We also highlight the importance of the use of the International Classification of Functioning, Disability and Health for rehabilitation planning.

Barriers and enablers to implementing clinical practice guidelines in primary care: an overview of systematic reviews

OBJECTIVES

To identify the barriers and enablers to implementing clinical practice guidelines (CPGs) recommendations in primary care and to provide recommendations that could facilitate the uptake of CPGs recommendations.

DESIGN

An overview of systematic reviews.

DATA SOURCES

Nine electronic databases (PubMed, Cochrane Library, CINAHL, MEDLINE, PsycINFO, Web of Science, Journals @Ovid Full Text, EMBase, JBI) and three online data sources for guidelines (Turning Research Into Practice, the National Guideline Clearinghouse and the National Institute for Health and Care Excellence) were searched until May 2021.

ELIGIBILITY CRITERIA

Systematic reviews, meta-analyses or other types of systematic synthesis of quantitative, qualitative or mixed-methods studies on the topic of barriers and/or enablers for CPGs implementation in primary care were included.

DATA EXTRACTION AND SYNTHESIS

Two authors independently screened the studies and extracted the data using a predesigned data extraction form. The methodological quality of the included studies was appraised by using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. Content analysis was used to synthesise the data.

RESULTS

Twelve systematic reviews were included. The methodological quality of the included reviews was generally robust. Six categories of barriers and enablers were identified, which include (1) political, social and culture factors, (2) institutional environment and resources factors, (3) guideline itself related factors, (4) healthcare provider-related factors, (5) patient-related factors and (6) behavioural regulation-related factors. The most commonly reported barriers within the above-mentioned categories were suboptimal healthcare networks and interprofessional communication pathways, time constraints, poor applicability of CPGs in real-world practice, lack of knowledge and skills, poor motivations and adherence, and inadequate reinforcement (eg, remuneration). Presence of technical support ('institutional environment and resources factors'), and timely education and training for both primary care providers (PCPs) ('healthcare provider-related factors') and patients ('patient-related factors') were the frequently reported enablers.

CONCLUSION

Policy-driven strategies should be developed to motivate different levels of implementation activities, which include optimising resources allocations, promoting integrated care models, establishing well-coordinated multidisciplinary networks, increasing technical support, encouraging PCPs and patients' engagement in guideline development, standardising the reporting of guidelines, increasing education and training, and stimulating PCPs and patients' motivations. All the activities should be conducted by fully considering the social, cultural and community contexts to ensure the success and sustainability of CPGs implementation.

An appraisal of the methodology and quality of evidence of systematic reviews on the efficacy of prone positional ventilation in adult patients with acute respiratory distress syndrome: an umbrella review

The objective of the study was to evaluate all available systematic reviews on the use of prone positional ventilation in adult patients with acute respiratory distress syndrome (ARDS). An umbrella review on the efficacy of prone positional ventilation in adult patients ventilation in adult patients with acute respiratory distress syndrome was conducted. We performed a systematic search in the database of Medline (Pubmed), Scopus, Cochrane Library, Web of Science, and Epistemonikos. The ROBIS tools and GRADE methodology were used to assess the risk of bias and certainty of evidence. We estimated the necessary number of patients to be treated to have benefit. For the synthesis of the result, we selected the review with the lowest risk of bias. Sixteen systematic reviews including 64 randomized clinical trials and evaluating the effect of prone positional ventilation, with or without other ventilation strategies were included. Aoyama 2019 observed prone positioning, without complementary ventilation strategies, leading to a reduction in the 28-day mortality only when compared to high-frequency oscillatory ventilation (RR 0.61; 95% CI 0.39-0.95) and lung-protective ventilation in the supine position (RR 0.69; 95% CI 0.48-0.98), with an ARR of 9.32% and 14.94%, an NNTB of 5.89 and 8.04, and a low and moderate certainty of evidence, respectively. Most reviews had severe methodological flaws that led to results with very low certainty of evidence. The review with the lowest risk of bias presented results in favor of prone positional ventilation compared with high-frequency oscillatory ventilation and lung-protective ventilation. There is a need to update the available reviews to obtain more accurate results.

Impact of anti-oestrogen therapy on lipoprotein(a) in postmenopausal women: a systematic review and meta-analysis of double-blind placebo-controlled clinical studies

PURPOSE

The potential mechanisms of endocrine therapy for thrombosis remain currently unclear, and more studies are warranted for further investigation and elucidation. However, high plasma concentration of lipoprotein(a) (Lp(a)) is a recognized prothrombotic factor. The aim of our study was to systematically evaluate the effect of different anti-oestrogen therapy on plasma Lp(a) level in postmenopausal women.

METHODS

A systematic literature search was conducted in multiple electronic databases to identify the randomized, double-blind, placebo-controlled clinical studies on this topic. Effect size for changes in Lp(a) was expressed as mean difference (MD) and 95% confidence intervals (CI).

RESULTS

Data were pooled from 10 clinical trials comprising 24 treatment arms, which included 2049 women (1128 women in the active-treated arms and 921 women in the control arms). Meta-analysis of data suggested that anti-oestrogen therapy in women significantly reduced Lp(a) [MD = -5.92% (95%CI: -9.05%,-2.8%)].

CONCLUSIONS

This observation is of both clinical and pathophysiological relevance, also in view that the identification of molecular determinants and cellular pathways implicated in Lp(a) synthesis and metabolism is still of concern as a critical issue in lipidology and CV prevention.

The Effect of Nurse Support Programs on Job Satisfaction and Organizational Behaviors among Hospital Nurses: A Meta-Analysis

The purpose of this study was to calculate the combined effect size of nurse support programs on job satisfaction among hospital nurses. The PICO framework was used in this methodological study of systematic review and meta-analysis. Using nine electronic databases of four international and five Korean databases and applying the eligibility criteria, articles published from database inception through October 2022 were collected. A total of 24 Korean and international articles were selected following the PRISMA guidelines. The keywords of nurse, mentoring (preceptorship, internship, or residency) program, and job satisfaction were selected based on the PICO. The checklists for RCTs and quasi-experimental studies provided in the Joanna Briggs Institute of Critical Appraisal Tool were used for the quality assessment. The coded data were analyzed using MIX 2.0 statistical software. We analyzed the combined effect sizes, heterogeneity, funnel plot, Egger's regression test, Begg's test, subgroup analyses, and univariate meta-regression. The overall effects of the program on job satisfaction and organizational behavior such as organizational commitment, interpersonal relationships, self-efficacy, motivation, burnout, and turnover intention for hospital nurses were statistically significant. The results of this study may explain the effect of the nurse support program on job satisfaction and organizational behaviors for hospital nurses.

Effects of Low-Load Blood Flow Restriction Resistance Training on Muscle Strength and Hypertrophy Compared with Traditional Resistance Training in Healthy Adults Older Than 60 Years: Systematic Review and Meta-Analysis

BACKGROUND

There is clinical interest in determining the effects of low-load blood flow restriction (LL-BFR) resistance training on muscle strength and hypertrophy compared with traditional high- and low-load (HL and LL) resistance training in healthy older adults and the influence of LL-BFR training cuff-pressure on these outcomes.

METHODS

A search was performed on the MEDLINE, PEDro, CINHAL, Web of Science, Science Direct, Scopus, and CENTRAL databases.

RESULTS

The analysis included 14 studies. HL resistance training produces a small increase in muscle strength (eight studies; SMD, -0.23 [-0.41; -0.05]) but not in muscle hypertrophy (six studies; (SMD, 0.08 [-0.22; 0.38]) when compared with LL-BFR resistance training. Compared with traditional LL resistance training, LL-BFR resistance training produces small-moderate increases in muscle strength (seven studies; SMD, 0.44 [0.28; 0.60]) and hypertrophy (two studies; SMD, 0.51 [0.06; 0.96]). There were greater improvements in muscle strength when higher cuff pressures were applied versus traditional LL resistance training but not versus HL resistance training.

CONCLUSIONS

LL-BFR resistance training results in lower muscle strength gains than HL resistance training and greater than traditional LL resistance training in healthy adults older than 60 years. LL-BFR resistance training promotes a similar muscle hypertrophy to HL resistance training but is greater than that of traditional LL resistance training. Applying cuff pressures above the limb occlusion pressure could enhance the increases in muscle strength compared with traditional LL resistance training.

The effectiveness of compassion-based interventions among cancer patients: A systematic review and meta-analysis

Objectives

This study examined the effects of compassion-based intervention on mental health in cancer patients by using systematic review and meta-analysis of randomized controlled trials (RCTs).

Methods

Eleven bibliographic databases were searched from their earliest data available date up to March 1, 2022. The databases were PubMed, CINAHL, MEDLINE, PsycINFO, WOS, Cochrane, Embase, Scopus, ProQuest Dissertations, Airiti Library, and the National Digital Library of Theses and Dissertations in Taiwan.

Results

Ten studies from 2015 to 2021 were included with a total of 771 cancer patients. Most were targeted at women with breast cancer. Brief compassion-based interventions of approximately 30 minutes were conducted by audio file, paper, and web-based self-guided writing prompts. Most were conducted after the completion of active treatment. Anxiety was the most measured outcome. Constructive compassion-based interventions with 4- to 12-week sessions were conducted by a trained facilitator. Most were conducted for patients who had undergone treatment, and depression was the most measured outcome. The meta-analysis indicated that compassion-based interventions had a significant effect of reducing depression and increasing self-compassion. Moderation analysis indicated that constructive intervention showed more benefits of increased self-compassion than brief intervention. Both face-to-face and non-face-to-face web-delivered formats had benefits for increasing self-compassion compared with the control condition.

Significance of results

Compassion-based interventions might provide an effective strategy for improving self-compassion and depression among patients with breast cancer. Suggestions for further research and health-care providers follow.

Association of breastfeeding with undernutrition among children under 5 years of age in developing countries: A systematic review and meta-analysis

OBJECTIVE

This meta-analysis was conducted to examine the association between breastfeeding and undernutrition among children under 5 years of age in developing countries.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

A comprehensive literature search was conducted of datasets from Embase, CINHAL, PubMed, Cochrane Library, and Indonesian databases to include eligible studies. Comprehensive Meta-Analysis 3.0 statistical software was used to perform data entry and data analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were extracted from each study or were calculated based on the reported number of cases and controls in each study. Random-effects models or fixed-effects models were used to demonstrate overall risk estimates. A moderator analysis was conducted to examine possible moderators explaining the heterogeneity across studies.

FINDINGS

In total, 33 studies were included which examined the association of breastfeeding with undernutrition. A random-effects model showed that breastfeeding had inverse correlations with overall undernutrition (OR = 0.82, 95% CI = 0.68, 0.99) and the stunting type of undernutrition (OR = 0.73, 95% CI = 0.55, 0.95). A moderator analysis showed that studies which included exclusive breastfeeding and unclear birth weights had low risks of overall undernutrition (p < 0.05). Moreover, studies which included exclusive breastfeeding and adopted a case-control study design exhibited a low risk of the stunting type of undernutrition (p < 0.05).

CONCLUSIONS

Providing breastfeeding or exclusive breastfeeding can benefit children under 5 years of age in developing countries reduce overall undernutrition and the stunting type of undernutrition.

CLINICAL RELEVANCE

Healthcare professionals should develop and implement suitable strategies to increase awareness regarding the importance of breastfeeding and enhance breastfeeding and exclusive breastfeeding adherence.

Under-Nutrition and Associated Factors Among Lactating Mothers in Ethiopia: A Systematic Review and Meta-analysis

INTRODUCTION

Under-nutrition (body mass index < 18.5 kg/m²) is a global problem with an increasing trend in recent years. The burden is high in low and middle-income countries, especially in Africa. Lactating mothers are among the most vulnerable groups for under nutrition; particularly in sub-Saharan Africa. In Ethiopia, the prevalence of under-nutrition among this group is inconsistent and inconclusive. Therefore, we aimed to assess the pooled prevalence of under-nutrition and its associated factors among lactating mothers in Ethiopia.

METHODS

To write this review and meta-analysis, we followed the preferred reporting items for systematic review and meta-analysis guidelines. Primary articles were searched from PubMed, Hinari, Cochrane Library, science direct databases, Google, and Google scholar. STATA version 16 software and a standardized Microsoft excel format were used for analysis and data extraction, respectively. Heterogeneity between studies was checked. To determine the pooled prevalence of under-nutrition, we used a random-effect model. Begg's and Egger's tests were done to detect publication bias. Subgroup analysis was also steered and association was uttered by a pooled odds ratio with 95% CI.

RESULTS

The pooled prevalence of under-nutrition among lactating mothers was 23.84% [95% CI (19.40, 28.27)]. Educational status (no formal education) {Pooled OR 2.30 [95% CI (1.34, 3.96)]} was significantly associated with under-nutrition.

CONCLUSION

The pooled prevalence of under-nutrition was high. Maternal educational status was significantly associated with under-nutrition. Therefore, the federal ministry of health and the concerned stakeholders should give attention to these most vulnerable groups and strengthen the implementation of the previously designed strategies.

Biomechanical characteristics and muscle function in individuals with patellofemoral osteoarthritis: A systematic review of cross-sectional studies

BACKGROUND

Our objective was to investigate kinematic and kinetic characteristics and changes in muscle function in individuals with patellofemoral osteoarthritis compared to healthy individuals.

METHODS

Searches were performed of the Medline, Embase, Web of Science, The Cochrane Library, LILACS, and SciELO databases until May of 2022 for observational studies comparing individuals with patellofemoral osteoarthritis to a control group. The PRISMA guidelines and recommendations of the Cochrane Collaboration were followed. The GRADE approach was used to analyze and synthesize the level of evidence.

FINDINGS

Fourteen studies were included, involving a total of 594 participants (360 with patellofemoral osteoarthritis and 234 controls). The level of evidence for pelvis, hip adduction and knee abduction angles at 45° of knee flexion during the single-leg squat, and knee flexion angle during the task of walking was very low. Regarding muscle strength, the level of evidence for isometric strength of the hip abductors, extensors and external rotators, and concentric strength of the knee extensors and flexors was very low. It was not possible to synthesize any type of evidence for kinetic, electromyography, or muscle volume variables.

INTERPRETATION

The level of evidence was very low for all synthesized evidence for kinematic and muscle strength variables. However, individuals with patellofemoral osteoarthritis have lower isometric strength of the hip abductor muscles. Further studies with adequate adjustment for confounding factors, such as the non-inclusion of individuals with osteoarthritis in the tibiofemoral compartment concomitant to patellofemoral osteoarthritis, are needed to gain a better understanding of the clinical characteristics of patellofemoral osteoarthritis.

Public knowledge toward Epilepsy and its determinants in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Epilepsy is a global problem that affects all countries and people of all ages. However, the disease burden is high in low- and middle-income countries. Poor public knowledge of epilepsy increases the rate of stigma and discrimination. However, in our country, there is a scarcity of summarized evidence about the level of public knowledge toward epilepsy. Therefore, to fill this gap, conducting this review and meta-analysis has a preponderant significance.

METHODS

Articles were explored from PubMed, PsycINFO, Hinari, Science Direct, web of science, and African journal of online (AJOL) databases, Google, and Google scholar. For data extraction and analysis purposes, Microsoft Excel spreadsheet and STATA software version 16 were used. To write this report, we used the Preferred Reporting Items for systematic reviews and Meta-Analysis. To assess the pooledmagnitudeof public knowledge toward epilepsy, we used arandom-effects meta-analysis model. We checked the Heterogeneity by I². To detect publication bias, Begg's test, Egger's test, and funnel plot were conducted. Furthermore, subgroup analysis was conducted. Association was expressed through a pooled odds ratio with a 95% confidence interval.

RESULT

Our review and meta-analysis included 9 studies with 5658 participants. The pooled magnitude of poor knowledge toward epilepsy was 48.54% [95% CI (33.57, 63.51)]. I² was 99.4% (P < 0.01). Begg's and Egger's test results were 0.92 and 0.06, respectively. Cannot read and write OR: 2.86 [95 CI (2.04, 4.00]) and not witnessing seizure episode OR: 3.00 [95% CI (2.46, 3.66)]) were significant determinants of poor knowledge.

CONCLUSION

In this review and meta-analysis, around half of the participants had poor knowledge about epilepsy. Individuals who cannot read and write, and could not witness seizure episodes had more likely to have poor knowledge toward epilepsy as compared to their counterparts. Health education through different methods should be provided to the public, and our educational system should focus on this global problem. Furthermore, it is better to give training for community key informants.

Respiratory dysfunction in patients with chronic neck pain: systematic review and meta-analysis

PURPOSE

To determine the differences in respiratory muscle strength and pulmonary function between patients with chronic neck pain (CNP) and asymptomatic individuals.

METHODS

Databases were MEDLINE, CINAHL, Scopus, Web of Science and EMBASE up to the end of September 2021. Studies with cross-sectional and longitudinal design were selected, with adult patients with CNP and asymptomatic individuals with reports respiratory function.

RESULTS

11 studies met the inclusion criteria and 10 were included in the meta-analysis showing a statistically significant reduction in inspiratory/expiratory muscle strength (MIP/MEP) in the patients with CNP compared with the asymptomatic individuals (mean difference (MD) for MIP, -11.67 [-14.57 to -8.77]; MD for MEP, -11.80 [-14.99 to -8.60]) and pulmonary function: vital capacity (standardized mean difference (SMD), -0.31 [-0.56 to -0.06]); maximum voluntary ventilation (SMD, -0.36 [-0.59 to -0.14]); forced vital capacity (SMD, -0.53 [-0.99 to -0.06]); peak expiratory flow (SMD, -0.58 [-1.03 to -0.12]); and forced expiratory volume in the first second (SMD, -0.28 [-0.51 to -0.05]).

CONCLUSIONS

Patients with CNP have reduced respiratory muscle strength and pulmonary function compared with asymptomatic individuals, and this difference could be clinically meaningful. However, more studies of high methodological quality and longitudinal studies are needed to strengthen the results of this meta-analysis. IMPLICATIONS FOR REHABILITATIONRespiratory dysfunction has been observed in patients with chronic neck pain.Patients with chronic neck pain present a decrease in respiratory muscle strength and pulmonary function compared with asymptomatic individuals.Respiratory pattern disorders should be considered in the clinical context of chronic neck pain.Interventions focused on respiratory muscle training could be helpful for this population.

Quantitative Meta-analyses of Cognitive Abilities in Children With Pediatric-onset Multiple Sclerosis

Pediatric-onset multiple sclerosis (POMS), is the manifestation of multiple sclerosis in individuals before 18 years of age. About a third of children with POMS show some form of lower cognitive performance. The purpose of this study is to examine using quantitative meta-analyses the effect size of altered performance between children with and without POMS on overall intelligence quotient (IQ), information processing speed, and language functions. We searched the literature for studies that reported scores on cognitive tests administered to children with and without POMS. Studies were systematically reviewed using PRISMA guidelines. We analyzed data from 14 studies that examined 1283 children with and without POMS when cognitive categories consisted of five or more studies. Effect sizes, publication bias and potential confounds were considered. Significant cognitive differences are revealed for all categories with the strongest effect observed for overall IQ. A moderate effect is observed for information processing speed, and small effects for verbal fluency and verbal memory. Cognitive abilities present differently in children with POMS and a better understanding of this manifestation will inform intervention and remediation tools that can improve clinical and educational practice for the benefit of children with POMS.

The Comprehensive Meta-Analyses of the Nomological Network of Psychological Capital (PsyCap)

This paper presents the most rigorous meta-analysis undertaken to date of empirical literature examining antecedents and outcomes related to psychological capital (PsyCap), and moderators of these relationships. We investigated seven leadership styles as antecedents of PsyCap (authentic, ethical, servant, empowering, transactional, transformational, and abusive leadership), five outcomes (burnout, turnover intentions, work engagement, performance, and satisfaction), and the impact of four moderators (country of sample origin, cultural characteristics, industry type, and research design). Our analysis of PsyCap research (2007–2020) examined 244 studies (254 independent samples and over 96000 participants), which is over twice as large as previous PsyCap meta-analyses. To optimize the quality and reliability of findings, we corrected for artefacts and included heterogeneity, sensitivity, and publication bias analyses. Our results provide several new findings beyond previous PsyCap meta-analyses. We found that empowering, servant, transformational, and transactional leadership were all positively associated with PsyCap, with empowering and transformational leadership being the strongest antecedents of PsyCap and abusive and transactional leadership being the weakest. The findings demonstrated PsyCap was positively associated with work engagement, and negatively associated with burnout. Country of sample origin moderated all the relationships, except for servant and transactional leadership. Additionally, cultural characteristics (e.g., power distance, masculinity, long-term orientation, and uncertainty avoidance) moderated several conceptual relationships. Study design was also found to moderate the PsyCap—work engagement relationship. Collectively, these findings offer new and extended insights into the antecedents, outcomes, and moderators related to PsyCap, beyond previous meta-analyses. The theoretical and practical implications of these new findings are also discussed.

Genito Pelvic Pain/Penetration Disorder (GPPPD) in Spanish Women-Clinical Approach in Primary Health Care: Review and Meta-Analysis

Sexuality is a component of great relevance in humans. Sexual disorders are a major public health problem representing a high prevalence in the general population. DSM-5 genito-pelvic pain/penetration disorder (GPPPD) includes dyspareunia and vaginismus (DSM-IV-TR). To assess the importance of research on these disorders in Spain, we evaluated the Spanish scientific publications of primary and community care. The objective was to quantify the magnitude of the publications of GPPPD in Spanish women in primary and community care. For this, we used the method of conducting a systematic review and meta-analysis of studies evaluating GPPPD. As main results, of the 551 items found, we selected 11 studies that met the inclusion criteria. In primary care in Spain, one in nine women has these disorders; the percentage of women with GPPPD in this study (raw data) was 11.23% (95% CI: 0-29%) (vaginismus 5%; penetration pain 8.33%; dyspareunia 16.45%). These percentages can differ of those from other countries, and they are at the top of the data of the European countries (9-11.9%). There is much variability in the studies found in the world with respect to the prevalence of these health problems.

Comparing the use of conventional and three-dimensional printing (3DP) in mandibular reconstruction

Background

There are a number of clinical disorders that require mandibular reconstruction (MR). Novel three-dimensional (3D) printing technology enables reconstructions to be more accurate and beneficial to the patient. However, there is currently no evidence identifying which techniques are better suited for MR, based on the type of clinical disorder the patient has. In this study, we aim to compare 3D techniques with conventional techniques to identify how best to reconstruct the mandible based on the clinical cause that necessitates the reconstructive procedure: cancerous or benign tumours, clinical disorders, infection or disease and trauma or injury.

Methods

PubMed, Scopus, Embase and Medline were searched to identify relevant papers that outline the clinical differences between 3D and conventional techniques in MR. Data were evaluated to provide a clear outline of suitable techniques for surgery.

Results

20 of 2749 papers met inclusion criteria. These papers were grouped based on the clinical causes that required MR into four categories: malignant or benign tumour resection; mandibular trauma/injury and other clinical disorders.

Conclusions

The majority of researchers favoured 3D techniques in MR. However, due to a lack of standardised reporting in these studies it was not possible to determine which specific techniques were better for which clinical presentations.

How to Interpret and Evaluate a Meta-Analysis in the Field of Speech-Language Pathology: A Tutorial for Clinicians

PURPOSE

This tutorial will provide speech-language pathologists with practical considerations and pragmatic tools for interpreting and critically evaluating a meta-analysis. Meta-analysis, which is a statistical procedure that involves combining research data across multiple high-quality research studies, is often considered the highest level of research evidence. Although meta-analyses are commonly deployed in clinical research after completing a systematic review, few clinicians or clinician scientists within the field of speech-language pathology receive formal training to conduct, interpret, or assess meta-analyses to determine the effectiveness of a treatment or procedure for evidence-based practice.

CONCLUSION

Clinicians within the field of speech-language pathology may use the foundational knowledge and practical guidelines outlined in this tutorial about meta-analyses to expand their knowledge of research methods and to shape their clinical practice.

Prevalence of dementia in ischaemic or mixed stroke populations: systematic review and meta-analysis

An understanding of the epidemiology of poststroke dementia (PSD) is necessary to inform research, practice and policy. With increasing primary studies, a contemporary review of PSD could allow for analyses of incidence and prevalence trends. Databases were searched using a prespecified search strategy. Eligible studies described an ischaemic or mixed stroke cohort with prospective clinical assessment for dementia. Pooled prevalence of dementia was calculated using random-effects models at any time after stroke (primary outcome) and at 1 year (range: 6-18 months), stratified for inclusion of prestroke dementia. Meta-regression explored the effect of year of study. Sensitivity analyses removed low-quality or outlier studies. Of 12 505 titles assessed, 44 studies were included in the quantitative analyses. At any time point after stroke, the prevalence of PSD was 16.5% (95% CI 10.4% to 25.1%) excluding prestroke dementia and 22.3% (95% CI 18.8% to 26.2%) including prestroke dementia. At 1 year, the prevalence of PSD was 18.4% (95% CI 7.4% to 38.7%) and 20.4% (95% CI 14.2% to 28.2%) with prestroke dementia included. In studies including prestroke dementia there was a negative association between dementia prevalence and year of study (slope coefficient=-0.05 (SD: 0.01), p<0.0001). Estimates were robust to sensitivity analyses. Dementia is common following stroke. At any point following stroke, more than one in five people will have dementia, although a proportion of this dementia predates the stroke. Declining prevalence of prestroke dementia may explain apparent reduction in PSD over time. Risk of dementia following stroke remains substantial and front-loaded, with high prevalence at 1 year post event.