The revised Cochrane risk of bias tool for randomized trials (RoB 2) showed low interrater reliability and challenges in its application

Effectiveness of Virtual Reality Technology Interventions in Improving the Social Skills of Children and Adolescents With Autism: Systematic Review

BACKGROUND

Virtual reality (VR) technology has shown significant potential in improving the social skills of children and adolescents with autism spectrum disorder (ASD).

OBJECTIVE

This study aimed to systematically review the evidence supporting the effectiveness of VR technology in improving the social skills of children and adolescents with ASD.

METHODS

The search for eligible studies encompassed 4 databases: PubMed, Web of Science, IEEE, and Scopus. Two (XY and JW) researchers independently assessed the extracted studies according to predefined criteria for inclusion and exclusion. These researchers also independently extracted information regarding gathered data on the sources, samples, measurement methods, primary results, and data related to the main results of the studies that met the inclusion criteria. The quality of the studies was further evaluated using the Physiotherapy Evidence Database scale.

RESULTS

This review analyzed 14 studies on using VR technology interventions to improve social skills in children and adolescents with ASD. Our findings indicate that VR interventions have a positive effect on improving social skills in children and adolescents with ASD. Compared with individuals with low-functioning autism (LFA), those with high-functioning autism (HFA) benefited more from the intervention. The duration and frequency of the intervention may also influence its effectiveness. In addition, immersive VR is more suitable for training complex skills in individuals with HFA. At the same time, nonimmersive VR stands out in terms of lower cost and flexibility, making it more appropriate for basic skill interventions for people with LFA. Finally, while VR technology positively enhances social skills, some studies have reported potential adverse side effects. According to the quality assessment using the Physiotherapy Evidence Database scale, of the 14 studies, 6 (43%) were classified as high quality, 4 (29%) as moderate quality, and 4 (29%) as low quality.

CONCLUSIONS

This systematic review found that VR technology interventions positively impact social skills in children and adolescents with ASD, with particularly significant effects on the enhancement of complex social skills in individuals with HFA. For children and adolescents with LFA, progress was mainly observed in basic skills. Immersive VR interventions are more suitable for the development of complex skills. At the same time, nonimmersive VR, due to its lower cost and greater flexibility, also holds potential for application in specific contexts. However, the use of VR technology may lead to side effects such as dizziness, eye fatigue, and sensory overload, particularly in immersive settings. These potential issues should be carefully addressed in intervention designs to ensure user comfort and safety. Future research should focus on optimizing individualized interventions and further exploring the long-term effects of VR interventions.

TRIAL REGISTRATION

International Platform of Registered Systematic Review and Meta-analysis Protocols INPLASY202420079U1; https://inplasy.com/inplasy-2024-2-0079/.

Psychosocial wellbeing in people with melanoma in-situ: a systematic review

This systematic review aims to evaluate the prevalence of reductions in psychosocial wellbeing among patient with melanoma in situ (MIS). It also aims to identify factors associated with psychosocial reactions, the instruments used to measure psychosocial outcomes, and to evaluate existing intervention programs for supporting this population. Search strategies for different databases including PubMed, Embase, Scopus, PsycINFO, and Web of Science were designed and implemented. A total of 2378 records were identified, resulting in 22 included papers. Various aspects of psychosocial wellbeing were evaluated in the reviewed articles, with fear of cancer recurrence being the most frequently investigated among patients diagnosed with melanoma. Only 2 of the 22 studies reported data for MIS patients, indicating no significant difference in psychosocial welling between patients with MIS and those at higher stages. Regarding interventional support, there is a notable lack of interventions specifically addressing the psychosocial needs of MIS patients. Our findings highlight a significant research gap on psychosocial wellbeing following a MIS diagnosis and suggest a shortage of targeted psychosocial interventions for this growing patient population. The observed variability in measuring psychosocial aspects presents challenges in identifying the essential components of effective interventions. Future research should prioritize employing mixed methodologies and addressing the unique needs of MIS patients.

Stereotactic radiosurgery versus whole-brain radiotherapy for intracranial metastases: A systematic review and meta-analysis

Background

Brain metastasis has a negative influence on the morbidity and mortality of cancer patients. Conventionally, whole-brain radiotherapy (WBRT) was favored as the standard treatment for brain metastases. However, it has been linked to a significant decline in neuro-cognitive function and poor quality of life. Stereotactic radiosurgery (SRS) has recently gained prominence as an alternative modality, considering that it provides targeted high-dose radiation while minimizing adverse effects. This study evaluates the efficacy and safety of SRS versus WBRT in patients with intracranial metastases.

Methods

According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, through July 2024, we searched PubMed, Scopus, and Web of Science for articles comparing WBRT and SRS in patients with intracranial metastases. Outcomes included local and distant recurrence, leptomeningeal disease (LMD), and survival. We also used a random-effect model to perform a meta-analysis.

Results

The findings revealed no significant differences in local (risk ratio [RR] = 0.70, 95% confidence interval [CI] [0.46, 1.06]) or distant recurrence rates (RR = 0.83, 95% CI [0.54, 1.28], P = 0.41) between WBRT and SRS. However, SRS was associated with a greater risk of post-radiation LMD (hazard ratio [HR] = 3.09, 95% CI [1.47, 6.49], P = 0.003). Survival rates at 1 year (RR = 1.03, 95% CI [0.83, 1.29], P = 0.76) and 5 years (RR = 0.89, 95% CI [0.39, 2.04], P = 0.78) demonstrated no significant differences.

Conclusion

SRS and WBRT exhibited similar recurrence rates and overall survival (OS) at 1 and 5 years, with WBRT being more effective in managing post-radiation LMD. SRS patients, on the other hand, had longer OS when measured in months.

Taichi on the brain: an activation likelihood estimated meta-analysis of functional neuroimaging data

Introduction

Tai Chi Chuan (TCC) is an exercise regimen renowned for its comprehensive benefits to both physical and mental health. The present research endeavor aims to elucidate the neurocognitive impacts of TCC compared to alternative exercise modalities or therapeutic interventions.

Methods

A systematic meta-analysis was undertaken, encompassing a rigorous review of diverse datasets, wherein 422 scholarly articles were examined, with a subset of 18 articles meeting the stringent criteria for inclusion in the analytical framework.

Results

The study cohort comprised 677 participants, characterized by a mean age of 56.52 ± 14.89 years and an average educational attainment of 11.06 ± 3.32 years. Noteworthy alterations in functional neural activity were identified within the superior frontal gyrus.

Discussion

This comprehensive analysis provides significant insights into the enduring neural modifications and the distinctive contributions of TCC to cognitive health. Nevertheless, it is imperative to acknowledge the potential for bias in smaller functional magnetic resonance imaging studies owing to their inconclusive outcomes. This observation underscores the critical need for collaborative, multicenter research initiatives with expanded sample sizes to enhance the robustness and generalizability of future findings.

Optimal dose and type of exercise improve walking velocity in adults with Parkinson's disease: a systematic review and Bayesian network meta-analysis

To examine the dose-response relationship between specific types of exercise for improving walking velocity in Parkinson's disease (PD). This systematic review and network meta-analysis included searches of PubMed, Medline, Embase, PsycINFO, Cochrane Library, and Web of Science were searched from inception until February 18th, 2024. Data analysis was performed using R software with the MBNMA and RJAGS packages. Outcome indicators were measured as mean standard deviation (SMD) along with 95% confidence intervals (95% CrI). The network's risk of bias was independently evaluated by two reviewers employing the ROB2 tool. Our review encompassed 54 studies with 2,828 PD patients, examining the dose-response effects of different exercises on walking velocity. Aerobic Exercise (AE) demonstrated the greatest improvement at an optimal dose of 1,400 METs-min/week (SMD:1.215, 95% Crl: 0.113 to 2.306). Both Multicomponent Exercise (Mul) (SMD: 1.202, 95% Crl: 0.193 to 2.231) and Sensory Exercise (SE) (SMD: 0.649, 95% Crl: 0.139 to 1.183) showed optimal outcomes at a dose of 1,000 METs-min/week. Resistance Training (RT) was most effective at 750 METs-min/week (SMD:0.778, 95% Crl: 0.062 to 1.549), while Mind-Body Exercise (MBE) yielded significant improvements at a lower optimal dose of 500 METs-min/week (SMD: 0.580, 95% Crl: 0.218 to 1.137), offering valuable insights for exercise prescription in PD management. Various types of exercise showed specific optimal benefits at corresponding doses, among which AE was the most effective in improving the walking speed of PD patients at 1,400 Mets*min/week.Trial registration: PROSPERO (CRD42024506919).

Supervised vs. Self-Managed Exercise Therapy for Improving Shoulder Function After Traumatic Dislocation and Sprain: A Systematic Review and Meta-Analysis

Trauma-induced shoulder dislocations and sprains rank among the most common upper extremity injuries, with contact sports accounting for the majority of cases. These injuries often lead to substantial impairments in joint function and long recovery times, requiring targeted therapeutic interventions to restore mobility and prevent recurrent injuries. Given the pivotal role of exercise therapy in restoring shoulder function, this study systematically reviews the literature on the comparative effectiveness of supervised versus self-managed exercise therapy following acute shoulder trauma. PubMed, Cochrane CENTRAL, Embase, Web of Science, and Science Direct were searched up to 13 December 2024. Conservative and post-surgical treatment modes were analyzed separately. Five studies with a total 689 participants were included (conservative: n = 538 across two studies; post-surgical: n = 151 across three studies). Both treatment modes showed similar pooled effects (standardized mean difference, SMDconservative: -0.35, 95% CI [-1.39, 0.69]; SMDpost-surgical: -0.23, 95% CI [-1.21, 0.75]), with a marginal improvement in shoulder function favoring supervised therapy. Four studies had some risk of bias, and one had serious risk; GRADE certainty was low. Supervised exercise therapy may offer slightly greater functional improvements over self-managed training, but evidence is limited by heterogeneity and low certainty. Further high-quality trials with standardized protocols and improved adherence tracking are needed to establish more definitive conclusions and guide clinical decision-making.

Effectiveness of Massage Therapy for Cancer Pain, Quality of Life and Anxiety Levels: A Systematic Review and Meta-Analysis

AIM

To synthesise the effectiveness of massage therapy for cancer pain, quality of life and anxiety among patients with cancer.

DESIGN

Systematic review and meta-analysis.

METHODS

This review was reported according to the PRISMA guidelines. Studies evaluating the effects of massage therapy on cancer pain, quality of life or anxiety in patients with cancer pain were eligible. The Cochrane Risk of Bias tool and Grading of Recommendations Assessment, Development and Evaluation were used to assess the quality of studies. Outcomes were pooled using standardised mean differences and narratively synthesised when meta-analysis was not possible.

DATA SOURCES

Pubmed, EMBASE, Web of Science, CINAHL, CENTRAL, Google Scholar, ProQuest Theses and Dissertations were searched for English peer-reviewed studies and grey literature published from inception to 8 January 2024.

RESULTS

Thirty-six RCTs involving 3671 participants were included. Massage therapy significantly improved pain (pooled SMD = -0.51, 95% CI -0.68 to -0.33), quality of life (pooled SMD = 0.48, 95% CI 0.19-0.78 when higher scores indicate better quality of life; pooled SMD = -0.52, 95% CI -0.88 to -0.16 when higher scores indicate poorer quality of life) and anxiety (pooled SMD = -0.38, 95% CI: -0.57 to -0.18) post-intervention. All outcomes had very low certainty of evidence. Most studies had unclear or high risk of bias.

CONCLUSION

This review found that massage therapy is beneficial to patients with cancer in improving pain, quality of life and anxiety. Healthcare institutions and healthcare professionals should recognise the value of massage therapy to enhance the care of patients with cancer pain.

REPORTING METHOD

PRISMA guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

REGISTRATION

PROSPERO CRD42023407311.

Effects of intermittent dieting with break periods on body composition and metabolic adaptation: a systematic review and meta-analysis

CONTEXT

Intermittent dieting incorporated with break periods (INT-B) has recently been promoted as an alternative dietary approach for optimal weight management.

OBJECTIVE

This study assessed the effectiveness of INT-B compared with that of conventional continuous energy restriction (CER) for improving body composition and attenuating metabolic adaptation.

DATA SOURCES

A systematic search was conducted on 6 databases using all available records until July 2023.

DATA EXTRACTION

The extracted data included the lead author, year of publication, population characteristics, intervention protocols, duration, and adherence.

DATA ANALYSIS

Random-effects meta-analyses were conducted for within-group and between-group comparisons of anthropometric and metabolic outcomes. Subgroup moderator analysis was performed for the types of INT-B, intervention duration, and population characteristics.

RESULTS

Of the 1469 records, 12 randomized trials (with 881 participants) were included. Within-group analyses demonstrated significant improvements in body mass, fat mass, body mass index, body fat percentage, and waist circumference following both INT-B and CER, with no significant group differences. However, resting metabolic rate (RMR) was significantly reduced following CER only. The compensatory reduction in RMR was significantly smaller following INT-B compared with CER, suggesting a lesser degree of metabolic adaptation. INT-B had a more significant effect on RMR retention in individuals with overweight/obesity compared with resistance-trained individuals.

CONCLUSION

This review provides up-to-date evidence for INT-B as a viable dietary strategy to improve body composition and attenuate metabolic adaptation.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023448959.

Safety and efficacy of ensifentrine in COPD: A systemic review and meta-analysis

BACKGROUND

Chronic obstructive pulmonary disease (COPD) significantly impacts global health due to persistent airflow limitation and inflammation. Despite standard therapies, symptoms persist. Ensifentrine, targeting both bronchoconstriction and inflammation as a dual phosphodiesterase 3 and 4 inhibitor, offers a promising therapeutic advancement for COPD management. This meta-analysis evaluates the safety and efficacy of ensifentrine in improving lung function, dyspnea, and quality of life in COPD patients.

METHODS

We searched PubMed, Embase, and Web of Science through August 2024 for randomized controlled trials evaluating ensifentrine in COPD patients over a minimum of four weeks. Data extraction and screening utilized Knowledge software, and meta-analyses were performed using R v4.4 with a random-effects model.

RESULTS

From 206 studies identified, four met our inclusion criteria. Ensifentrine improved FEV1 significantly at a dose of 3 mg (LS mean difference: 40.90 mL; 95 % CI: 19.65-62.15). It also improved dyspnea as measured by the Transition Dyspnea Index (TDI) (LS mean difference: 0.91; 95 % CI: 0.61-1.21) and quality of life according to the St. George's Respiratory Questionnaire-C (SGRQ-C) scores (LS mean difference: -1.92; 95 % CI: -3.28 to -0.55). Safety profiles were comparable between the ensifentrine and placebo groups, with no significant increase in treatment-emergent adverse events (TEAEs) (RR: 1.02; 95 % CI: 0.94-1.10).

CONCLUSION

Ensifentrine significantly enhances lung function, reduces dyspnea, and improves quality of life in COPD patients, especially at a 3 mg dose. These benefits, coupled with a stable safety profile, support its use as an adjunctive therapy in COPD management.

The impact of exercise during radiotherapy on treatment-related side effects in breast cancer patients: A systematic review and meta-analysis

PURPOSE

Radiation therapy for breast cancer often causes side effects like cancer-related fatigue, depression, and sleep disorders, impacting health-related quality of life, psychosocial aspects, and physical function. Exercise therapy is commonly used to manage cancer-related fatigue, but its effectiveness remains uncertain due to varying patient conditions and adherence. This systematic review aims to assess exercise interventions during radiotherapy for their effects on physiological and psychological side effects in breast cancer patients, clarifying efficacy and exploring different intervention types.

METHODS

Randomized controlled trials were searched in PubMed, EBSCO, Scopus, Web of Science, and the Cochrane Library up to April 24, 2024. Trials included breast cancer patients undergoing exercise therapy (e.g., running, yoga, Qi Gong, resistance training). Primary outcomes were cancer-related fatigue levels and quality of life; secondary outcomes included sleep quality and depressive symptoms.

RESULTS

Sixteen trials with 1373 stage 0 to III breast cancer patients were analyzed. The results indicate that exercise during radiation therapy has a significant positive impact on reducing cancer-related fatigue compared to the control group (SMD = --0.29, 95% CL: -0.56 to -0.02, P = 0.032), subgroup analysis showed that compared to treadmill exercise, Tai Chi, and resistance training with equipment, yoga is more effective in improving cancer-related fatigue in breast cancer patients. Regarding improvement in quality of life (SMD = 0.29, 95 % CI: -0.08 to 0.66, P = 0.121), sleep quality (SMD: -0.27, 95 % CI: -0.62 to 0.07, P = 0.116), and depression (SMD: -0.01, 95 % CI: -0.35 to 0.34, P = 0.977), the three groups did not show significant statistical differences, but they demonstrated beneficial effects in alleviation, which require further studies for confirmation.

CONCLUSION

Exercise therapy can effectively alleviate cancer-related fatigue in breast cancer patients, with yoga being the most recommended form of exercise. Exercise therapy shows potential for improving quality of life, sleep, and depressive symptoms, necessitating more clinical studies for validation.

Implementability of opioid deprescribing interventions at transitions of care: A scoping review

Continuation of opioids at transitions of care increases the risk of long-term opioid use and related harm. To our knowledge, no study has examined the implementability of opioid deprescribing interventions at transitions of care. Our scoping review aimed to identify the type of opioid deprescribing interventions employed at transitions of care and assess the implementability of tested interventions. Nine electronic databases were searched on 15 May 2023 for English-language studies of adults transitioning between care settings, where opioid deprescribing interventions targeting patients, clinicians or health systems were implemented. Implementability was assessed using the Cochrane Intervention Complexity Assessment Tool for Systematic Reviews to determine intervention complexity, and mapped to the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to understand the process evaluation. A total of 79 studies were identified, with 94.0% (n = 74) examining hospital-to-home transitions. Mixed interventions (combination of pharmacological and nonpharmacological) were tested in 49.0% (n = 39) of studies. Pharmacological interventions were identified in 31.0% (n = 24) of studies, and the remaining 20.0% (n = 16) applied nonpharmacological interventions. Mixed interventions comprising multiple components were the most complex and resulted in reduced opioid use across transitions of care in 28.0% (n = 22) of studies. Few studies reported on RE-AIM dimensions including implementation (5.0% of studies), reach (4.0%), adoption (4.0%) and maintenance (0%). Most opioid deprescribing interventions targeted hospital to home care transition with mixed results in opioid deprescribing. Further research should consider the implementability of interventions during transitions of care to elucidate the impact of opioid deprescribing interventions across care settings.

Optimal exercise dose-response improves health-related quality of life in cancer survivors: a systematic review and Bayesian network meta-analysis of RCTs

Objective

Cancer survivors often face significant health-related quality of life (HRQoL) challenges. Although exercise has been proven to improve HRQoL in cancer survivors, the optimal dose and intensity of exercise for this population has not been fully determined. Adherence to exercise may vary based on exercise intensity, affecting results. This study explored the dose-response relationship of different exercise types and intensities to better understand their impact on HRQoL in cancer survivors.

Methods

We searched five databases-PubMed, Embase, the Cochrane Library, Web of Science, and Scopus-from their inception until 1 December 2023. Data analysis was performed using R software with the MBNMA and RJAGS packages. Due to combining data from different scales, effect sizes were reported as standardized mean differences (SMD) with 95% credible intervals (95% CrI). The risk of bias was assessed independently by three reviewers using the RoB2 tool.

Results

A total of 48 studies involving 3050 cancer survivors. Across all exercise types, the most beneficial exercise dose was identified to be 850 metabolic equivalents of task (METs)-min/week (SMD: 0.753, 95%Crl: 0.463 to 1.096), with diminishing returns observed beyond 1,100 METs-min/week. Among the various types of exercises, mixed training (MT) emerged as the optimal choice, demonstrating its efficacy at 970 METs-min/week (SMD: 0.883, 95% Crl: 0.455 to 1.345). Aerobic exercise (AE) at a dose of 430 METs-min/week (SMD: 0.681, 95% Crl: 0.206 to 1.099) and resistance training (RT) at 450 METs-min/week (SMD: 0.695, 95% Crl: 0.227 to 1.203) also showed significant benefits. Additionally, mind-body exercises, such as tai chi, qigong, or yoga, exhibited optimal effects at a dose of 390 METs-min/week (SMD: 0.672, 95% Crl: 0.259 to 1.087).

Conclusion

Our study sheds light on the intricate relationship between exercise interventions and health-related quality of life in cancer survivors, as elucidated through a systematic review and Bayesian network meta-analysis. The identified optimal exercise dose of 850 METs-min/week resulted in a significant improvement in health-related quality of life, underscoring the importance of regular exercise in cancer survivorship. MT emerged as the most effective modality, closely followed by RT, AE, and MBE.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=493328, identifier CRD42024493328.

Systematic review of peri-implant conditions and aesthetic outcomes of customized versus conventional healing abutments

PURPOSE

Customized healing abutments are utilized to enhance aesthetics and peri-implant soft and hard tissue health, and play a crucial role in the implant-prosthetic workflow. This systematic review was performed to assess and compare the clinical outcomes of customized healing abutments with conventional ones.

METHODS

The review was registered with PROSPERO (ID: CRD42024532449) and followed the PRISMA-guidelines. The PICO-question addressed was: "In patients with dental implants, do customized healing abutments result in beneficial peri-implant conditions compared with conventional healing abutments?" Clinical trials involving immediate and late implant placement that compared different healing abutments based on quantifiable outcomes were included. The "PubMed", "PubMed Central", "Cochrane Library", and "Web of Science databases" were screened for eligible studies until 4/20/2024.

RESULTS

Of 1,396 titles retrieved, 5 studies met the inclusion criteria and were analyzed. The included studies showed a low risk of bias as assessed by the RoB2 tool and Joanna Briggs Institute Critical Assessment questionnaire. Compared to conventional healing abutments, customized abutments were associated with a trend toward better clinical outcomes in peri-implant soft and hard tissue, as well as aesthetics. Several results within the cohorts using customized healing abutments showed significantly improved values in soft and hard tissue results as well as aesthetic parameters. Importantly, none of the included studies reported biological or aesthetic disadvantages associated with the use of customized healing abutments.

CONCLUSIONS

Customized healing abutments maintain stability of peri-implant hard and soft tissue. However, further studies with larger sample sizes and longer follow-up periods are needed to validate these findings.

Home Use Therapies for Pain, Disability, and Quality of Life in Military Service Members with a Musculoskeletal Injury: An Updated Systematic Review Meta-Analysis

INTRODUCTION

Musculoskeletal (MSK) injury can negatively affect service members by compromising job performance and readiness. These injuries can impact the service member's physical health, functional abilities, and quality of life (QoL). Rehabilitation therapies for MSK injuries can reduce these impacts. One approach is home use rehabilitative therapy, usable during deployment and at home stations. The purpose of this updated systematic review with meta-analysis was to broaden our scope of pain/symptoms, disability, and QoL as outcome measures for nonpharmaceutical MSK therapies in a military population versus controls.

MATERIALS AND METHODS

An updated systematic literature search was conducted from inception to September 2022 using electronic databases. From 2790 retrievals, 22 reports were identified from 21 randomized or nonrandomized control trials. Interventions included exercise, electrotherapy, bracing, and other devices compared to a standard control treatment. Outcomes for MSK pain/symptoms, disability, and QoL were summarized as (1) standardized change from baseline for both intervention and control by time and (2) standardized mean differences (SMDs) in the time change between the intervention and control.

RESULTS

Relative to baseline, pain improved during treatment and follow-up (P < .0001) with differences between intervention and control groups (P < .0001) but no significant interactions between group and time (P = .11). Overall, interventions showed modest (0.33 SMD, 95% CI, 0.11 to 0.54) improvement relative to controls across body regions and time. On average, disability exhibited an SMD of 0.12 (95% CI, -0.20 to 0.44) across all measures with substantial heterogeneity (I2 = 0.93). Time (P = .02) but not intervention (P = .87) was a significant moderator with no clear pattern of change over time and no time by group interaction (P = .84). Quality of life had an overall modest effect with an SMD of 0.10 (95% CI, -0.04 to 0.24) with no evidence supporting a difference between the intervention and control groups (P = .10) and no significant interaction between time and group (P = .41). The QoL measures were primarily derived using the Short Form Health Survey (SF12/36), which provide a mental and physical component summary score. For the mental component, there was either no change or a small decline during the study (P(time) = .80), with a difference between the intervention and control (P = .04) but no interaction between groups over time (P = .40). For the physical component scale, there was improvement during the study (P = .01), with the intervention showing better improvement than the control (P = .005), with no interaction between the time and treatment/control group (P = .80). The report considers responses by region and individual treatments.

CONCLUSIONS

This analysis demonstrated modest improvement in pain and physical well-being with therapy, with low certainty across diverse military cohorts. The impact on overall health-related disability and QoL was limited, with little change in mental well-being. The substantial heterogeneity and low certainty across diverse military cohorts limit generalizability, suggesting that further research in homogeneous environments is important for guiding clinical decisions. The study's findings suggest that nonpharmacological home use interventions may offer modest improvements in pain relief, particularly early in treatment, and in strength and function, according to our previous report. These interventions could complement standard care, providing options that may benefit service members during deployment and at home.

Quality appraisal of systematic reviews on high-intensity laser therapy for musculoskeletal pain management: an umbrella review

Musculoskeletal pain (MSP) remains one of the leading causes of disability worldwide. Recent approaches to treating this condition have prompted the development of several systematic reviews investigating the efficacy of high-intensity laser therapy (HILT), whose analgesic mechanisms are based on photobiomodulation neural inhibition, endorphin and serotonin release and anti-inflammatory effects. To assess the methodological quality, reliability, and validity of the systematic reviews (SRs) on HILT in MSP. This study is an overview of SRs (umbrella review) with an observational, retrospective, and secondary design. The search considered PubMed, Scopus, Web of Science, CINAHL, Embase, Cochrane Library, ScienceDirect, and Google Scholar databases (updated October 23, 2024). The primary focus was on the methodological quality of the reviews and their reporting of pain intensity results. The HILT effects on pain intensity were reported using mean differences (MD) or standardized mean differences (SMD). The quality assessment was conducted using the A Measurement Instrument to Assess Systematic Reviews 2 checklist (AMSTAR-2), and the findings were synthesized narratively. The MD and SMD obtained from all reviews were presented using forest plots. The Shapiro-Wilk normality test assessed MD and SMD distributions for pain intensity across meta-analyses. The average MD and SMD, along with their respective confidence intervals (CI), were estimated and presented based on the aggregate study outcomes. Twenty SRs were included, fourteen of which conducted meta-analyses covering diverse musculoskeletal disorders such as knee osteoarthritis, epicondylalgia, myofascial pain, frozen shoulder, plantar fasciitis, neck, and low back pain. The primary databases used were PubMed, Web of Science, and the Cochrane Library. The AMSTAR-2 average score was 12.9 points (± 1.8), indicating varying methodological quality with one or two criteria resulting in low or critically low. HILT's best analgesic effects are observed in frozen shoulder disorder (MD = -2.23 cm; 95% CI:-3.3,-1.2; p < 0.01), knee osteoarthritis (MD = -1.9 cm; 95% CI:-2.0,-1.8;p < 0.01), low back pain (MD = -1.9 cm; 95% CI = -2.9,-1.0; p < 0.01), and myofascial pain (MD = -1.9 cm; 95% CI:-2.6,-1.2; p < 0.01). Largest effect sizes are for neck pain (SMD = 2.1; 95% CI = 1.2,3.0, p < 0.05) and low back pain (SMD = 1.1 (95% CI = 1.4,0.8; p < 0.01). This review underscores the generally low to critically low methodological quality of SRs on HILT, as assessed by AMSTAR-2. Key areas for improvement for future SRs of RCTs include addressing publication bias, disclosing funding sources, and enhancing search strategies and discussions on heterogeneity. The scarcity of RCTs for conditions such as temporomandibular disorders, carpal tunnel syndrome, and myofascial pain highlights the need for further research. SRs on spinal disorders, frozen shoulder, and neck pain demonstrated the most favorable analgesic effects, providing valuable insights for clinical practice and future RCTs.

Effectiveness of preoperative ketamine gargle to reduce postoperative sore throat in adult patients undergoing surgery with endotracheal tube; systematic review and meta-analysis of randomized control trials

BACKGROUND

Postoperative sore throat is a frequent and distressing complication caused by airway instrumentation during general anesthesia. The discomfort can lead to immediate distress, delayed recovery and reduce patient satisfaction. The objective of this study was to determine the effectiveness of preoperative ketamine gargle on the occurrence of postoperative sore throat among adult patients who underwent surgery under general anesthesia with endotracheal tube.

METHOD

PubMed, Cochrane Library, Google Scholar, and World Clinical Trial Registry were searched to find the eligible randomized control trials comparing the effect of preoperative ketamine gargle and placebo gargle on the occurrence of postoperative sore throat after surgery with endotracheal tube in adult patients. We utilized Review Manager Version 5.4 to perform statistical analyses. Cochrane risk of bias tool for randomized control trials was used to assess the risk of bias of included studies. We explored heterogeneity using the I2 test. In addition to this, subgroup analysis, and sensitivity analysis was conducted to confirm the robustness of findings. The risk of publication bias was tested using funnel plot Pooled risk ratio along with 95% confidence interval (CI) was used to analyze the outcome.

RESULT

In the present systematic review and metanalysis, seventeen [17] randomized controlled trials (RCTs) with 1552 participants were included. Compared with placebo, preoperative ketamine gargle is effective to reduce postoperative sore throat (RR = 0.48; 95%CI [0.45, 0.52] in adult patients undergoing surgery under general anesthesia with endotracheal tube.

CONCLUSION

Preoperative ketamine gargle before induction of general anesthesia is effective to reduce the occurrence of postoperative sore throat in adult patients undergoing surgery under general anesthesia with an endotracheal tube. Further studies with large sample size, better study quality and optimal reporting could be conducted to determine the long-term efficacy and safety of ketamine gargle in different surgical populations.

Non-fixation versus fixation of mesh in laparoscopic transabdominal preperitoneal repair of inguinal hernia: A systematic review and meta-analysis of randomized controlled trials

PURPOSE

The impact of non-fixation of mesh in transabdominal preperitoneal (TAPP) inguinal hernia repair has not been fully assessed. The aim of this meta-analysis was to comprehensively compare the clinical outcomes of non-fixation and fixation of mesh in TAPP to determine whether non-fixation could affect the outcomes.

METHODS

PubMed, Embase and CENTRAL were searched for studies on TAPP repair of inguinal hernia and mesh fixation published up to June 2023. The literature search was completed on June 22, 2023. Randomized controlled trials that compared perioperative outcomes between mesh fixation and non-fixation without using self-gripping mesh were included. The primary outcome measures were recurrence and evaluation of postoperative pain, while secondary outcome measures included time to normal activity, infection rate and formation of seroma. Subgroup analyses and sensitivity analysis were also conducted.

RESULTS

Six randomized controlled trials were included, involving 679 patients who underwent TAPP with non-fixation and 964 patients with fixation of mesh. There was no significant difference in recurrence between the two groups (RR: 0.83; 95% CI, 0.29-2.39, P = 0.73). The non-fixation group had less pain than the fixation group at 6 months postoperatively (MD: -0.16; 95% CI, -0.23--0.10, P < 0.0001). Additionally, there was no significant difference in the time to return to normal activity or rates of infection or seroma formation between the two groups (MD: -4.95; 95% CI, -11.36-1.45, P = 0.13; RR: 1.18; 95% CI, 0.39-3.62, P = 0.77; RR: 0.94; 95% CI, 0.63-1.40, P = 0.75).

CONCLUSION

Based on the current evidence, non-fixation without using self-gripping mesh may not affect the efficacy of TAPP. It does not increase recurrence rate and may result in less postoperative pain in inguinal hernia with small hernia defect (less than 3cm).

Overview of Effects of Motor Learning Strategies in Neurologic and Geriatric Populations: A Systematic Mapping Review

Objective

To provide a broad overview of the current state of research regarding the effects of 7 commonly used motor learning strategies to improve functional tasks within older neurologic and geriatric populations.

Data Sources

PubMed, CINAHL, and Embase were searched.

Study Selection

A systematic mapping review of randomized controlled trials was conducted regarding the effectiveness of 7 motor learning strategies-errorless learning, analogy learning, observational learning, trial-and-error learning, dual-task learning, discovery learning, and movement imagery-within the geriatric and neurologic population.

Data Extraction

Two thousand and ninety-nine articles were identified. After screening, 87 articles were included for further analysis. Two reviewers extracted descriptive data regarding the population, type of motor learning strategy/intervention, frequency and total duration intervention, task trained, movement performance measures, assessment time points, and between-group effects of the included studies. The risk of bias 2 tool was used to assess bias; additionally, papers underwent screening for sample size justification.

Data Synthesis

Identified articles regarding the effects of the targeted motor learning strategies started around the year 2000 and mainly emerged in 2010. Eight populations were included, for example, Parkinson's and stroke. Included studies were not equally balanced: analogy learning (n=2), errorless learning and trial-and-error learning (n=5), mental practice (n=19), observational learning (n=11), discovery learning (n=0), and dual-tasking (n=50). Overall studies showed a moderate-to-high risk of bias. Four studies were deemed sufficiently reliable to interpret effects. Positive trends regarding the effects were observed for dual-tasking, observational learning, and movement imagery.

Conclusions

Findings show a skewed distribution of studies across motor learning interventions, especially toward dual-tasking. Methodological shortcomings make it difficult to draw firm conclusions regarding the effectiveness of motor learning strategies to improve functional studies. Future researchers are strongly advised to follow guidelines that aid in maintaining methodological quality. Moreover, alternative designs fitting the complex practice situation should be considered.

A systematic review and meta-analysis of efficacy and safety of compound glycyrrhizin combined with second-generation non-sedated antihistamine for the treatment of chronic urticaria

BACKGROUND

Chronic urticaria (CU) is a prevalent dermatologic disease that negatively affects life, current therapies remain suboptimal. Hence, there is an urgent need to identify effective and safe treatment.

OBJECTIVE

Assess the efficacy and safety of compound glycyrrhizin (CG) combined with second-generation nonsedated antihistamine for the treatment of CU.

METHODS

Nine databases were queried to screen RCTs related. Two reviewers independently assessed the risk of bias using Cochrane Collaboration. Primary objective was the total efficiency rate, while secondary was rate of recurrence, adverse events, and cure. Statistical analyses using Review Manager 5.4 and Stata17.

RESULTS

Twenty-four RCTs were identified. Significant differences were noted in rate of total efficiency (n = 2649, RR = 1.36, 95%CI:1.30-1.43, p < 0.00001), cure (n = 2649, RR = 1.54, 95%CI:1.42-1.66, p < 0.00001) and recurrence (n = 446, RR = 0.34, 95%CI:0.20-0.58, p < 0.00001) between the combination of CG with second-generation non-sedated antihistamine and antihistamine monotherapy. Contrastingly, adverse events rate (n = 2317, RR = 0.76, 95% CI:0.59-0.97, p = 0.03) was comparable between the two groups. Our results indicated that CG combined with second-generation non-sedated antihistamine could significantly mitigate the symptoms in CU compared with antihistamine monotherapy. No serious adverse events were reported.

CONCLUSIONS

CG combined with second-generation nonsedated antihistamine is effective for CU. Nevertheless, higher-quality studies are warranted to validate our results.

Drug therapy versus placebo or usual care for comatose survivors of cardiac arrest; a systematic review with meta-analysis

BACKGROUND

In Europe, approximately 291,000 cardiac arrests occur annually. Despite critical care therapy, hospital mortality remains high. This systematic review assessed whether, in comatose survivors of cardiac arrest, any drug therapy, compared to placebo or usual care, improves outcomes.

METHODS

We searched Medline, EMBASE, the Cochrane Central Register of Controlled Trials, and The International Clinical Trials Registry Platform for randomized controlled trials of drug therapy in comatose survivors of cardiac arrest (last searched 20th October 2024). The primary outcome was mortality at 30 days/hospital discharge. Other outcomes reflected those of the Core Outcome Set for Cardiac Arrest. Risk of bias was assessed using Cochrane Risk-Of-Bias Version 1. Studies of steroids, coenzyme Q10 and thiamine were meta-analysed.

RESULTS

From 2562 records, 207 full texts were screened and 45 studies (5800 patients) investigating 30 therapies were included. Studies were grouped thematically as supportive drug therapies (n = 10), neuroprotective agents (n = 19), and anti-inflammatory/antioxidants (n = 16). Four studies reported reduced mortality at 30 days/hospital discharge: one of the anticholinergic penehyclidine hydrochloride, two of intra-arrest vasopressin and methylprednisolone plus hydrocortisone for post resuscitation shock, and one of the traditional Chinese medicine, shenfu. Studies of steroids, coenzyme Q10 and thiamine were meta-analysed. We could not detect an effect on mortality with steroids (n = 739, risk ratio (RR), 0.93; 95 % CI 0.83-1.04, p = 0.21; I2 = 60 %, low certainty), coenzyme Q10 (n = 107, RR, 0.91; 95 % CI 0.61-1.37, p = 0.65; I2 = 0 %, low certainty), or thiamine (n = 149, RR, 1.11; 95 % CI 0.88-1.40, p = 0.39; I2 = 0 %, very low certainty).

CONCLUSION

In comatose survivors of cardiac arrest, the majority of trials of drug therapy reported no effect on mortality. Meta-analyses of steroids, coenzyme Q10 and thiamine demonstrated no evidence of an effect on mortality. However, the low certainty of evidence warrants further research.

The effectiveness of peer support on the recovery and empowerment of people with schizophrenia: A systematic review and meta-analysis

BACKGROUND

People with schizophrenia have a shorter life span and high mortality and morbidity rates. Peer support is an important strategy that can improve outcomes for people with schizophrenia. Peer support involves people with a lived experience of recovery who help and support others experiencing mental health problems.

AIMS

The main aim of this systematic literature review was to examine the effectiveness of peer support on the recovery and empowerment outcomes of service users with schizophrenia disorders. The objectives were to contribute to evidence-based practice and promote peer support interventions in mental health services.

DATA SOURCES

We searched for randomised controlled trials (RCTs) on peer support in MEDLINE, CINAHL, AMED, Academic Search Premier, PubMed, PsycArticles, PsycINFO, Cochrane, and Psychology and Behavioural Sciences Collection. We identified additional trials from the citations of previous studies.

METHODS

We assessed the trials' methodological quality and biases using the risk of bias (RoB) and grading of recommendations, assessment, development, and evaluation (GRADE) tools. We performed a meta-analysis in the RevMan application and extracted data from the clinical trials using narrative synthesis. This systematic review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) procedures.

RESULTS

A total of 17 trials with 5974 participants were included in this review. The most common peer support was peer-led self-management interventions. The RE model (SMD = 0.29, 95 % CI = 0.13 to 0.45, p-value = 0.0004) shows that peer support interventions significantly improved the recovery outcome compared to standard care provided to service users with schizophrenia. The RE model (SMD = 0.22, 95 % CI = 0.11 to 0.33, p-value = 0.0001) also shows that peer support interventions significantly empowered service users with schizophrenia. However, the positive effects were small. A sub-group analysis found moderate effects on the recovery outcome among the emerging peer support interventions. The quality of the evidence was moderate.

CONCLUSIONS

Peer support interventions effectively improved the recovery and empowerment outcomes. Current clinical trials indicate that peer support is an essential psychosocial intervention in improving empowerment and recovery in service users with schizophrenia.

Artificial intelligence in food and nutrition evidence: The challenges and opportunities

Science-informed decisions are best guided by the objective synthesis of the totality of evidence around a particular question and assessing its trustworthiness through systematic processes. However, there are major barriers and challenges that limit science-informed food and nutrition policy, practice, and guidance. First, insufficient evidence, primarily due to acquisition cost of generating high-quality data, and the complexity of the diet-disease relationship. Furthermore, the sheer number of systematic reviews needed across the entire agriculture and food value chain, and the cost and time required to conduct them, can delay the translation of science to policy. Artificial intelligence offers the opportunity to (i) better understand the complex etiology of diet-related chronic diseases, (ii) bring more precision to our understanding of the variation among individuals in the diet-chronic disease relationship, (iii) provide new types of computed data related to the efficacy and effectiveness of nutrition/food interventions in health promotion, and (iv) automate the generation of systematic reviews that support timely decisions. These advances include the acquisition and synthesis of heterogeneous and multimodal datasets. This perspective summarizes a meeting convened at the National Academy of Sciences, Engineering, and Medicine. The purpose of the meeting was to examine the current state and future potential of artificial intelligence in generating new types of computed data as well as automating the generation of systematic reviews to support evidence-based food and nutrition policy, practice, and guidance.

Aortic Valve Replacement vs Clinical Surveillance in Asymptomatic Severe Aortic Stenosis: A Systematic Review and Meta-Analysis

BACKGROUND

Current guidelines recommend a strategy of clinical surveillance (CS) for patients with asymptomatic severe aortic stenosis (AS) and a normal left ventricular ejection fraction.

OBJECTIVES

The aim of this study was to conduct a study-level meta-analysis of randomized controlled trials (RCTs) evaluating the effect of early aortic valve replacement (AVR) compared with CS in patients with asymptomatic severe AS.

METHODS

Studies were quantitatively assessed in a meta-analysis using random-effects modeling. Prespecified outcomes included all-cause and cardiovascular mortality, unplanned cardiovascular or heart failure (HF) hospitalization, and stroke. The meta-analysis is registered at the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY202490002).

RESULTS

Four RCTs were identified, including a total of 1,427 patients (719 in the early AVR group and 708 in the CS group). At an average follow-up time of 4.1 years, early AVR was associated with a significant reduction in unplanned cardiovascular or HF hospitalization (pooled rate 14.6% vs 31.9%; HR: 0.40; 95% CI: 0.30-0.53; I2 = 4%; P < 0.01) and stroke (pooled rate 4.5% vs 7.2%; HR: 0.62; 95% CI: 0.40-0.97; I2 = 0%; P = 0.03). No differences in all-cause mortality (pooled rate 9.7% vs 13.7%; HR: 0.68; 95% CI: 0.40-1.17; I2 = 61%; P = 0.17) and cardiovascular mortality (pooled rate 5.1% vs 8.3%; HR: 0.67; 95% CI: 0.35-1.29; I2 = 50%; P = 0.23) were observed with early AVR compared with CS, although there was a high degree of heterogeneity among studies.

CONCLUSIONS

In this meta-analysis of 4 RCTs, early AVR was associated with a significant reduction in unplanned cardiovascular or HF hospitalization and stroke and no differences in all-cause and cardiovascular mortality compared with CS.

Paclitaxel-Coated Balloon Versus Uncoated Balloon Angioplasty for Coronary In-Stent Restenosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

In-stent restenosis (ISR) accounts for 10% of percutaneous coronary intervention (PCI) in the United States. Paclitaxel-coated balloons (PCBs) have been evaluated as a therapy for coronary ISR in multiple randomized controlled trials (RCTs). We searched PubMed/MEDLINE, Cochrane Library, and ClinicalTrials.gov (from inception to April 1, 2024) for RCTs evaluating PCBs versus uncoated balloon angioplasty (BA) in patients with coronary ISR. The outcomes of interest were target lesion revascularization (TLR), major adverse cardiovascular events (MACEs), all-cause mortality, cardiovascular mortality, myocardial infarction (MI), and stent thrombosis. We pooled the estimates using an inverse variance random-effects model. The effect sizes were reported as risk ratio (RR) with 95% confidence interval (CI). A total of 6 RCTs with 1,343 patients were included. At a follow-up ranging from 6 to 12 months from randomization, the use of PCBs was associated with a statistically significant decrease in TLR (RR 0.28, 95% CI 0.11 to 0.68) and MACE (RR 0.35, 95% CI 0.20 to 0.64) compared with BA for coronary ISR. However, there was no significant difference in risk between PCBs and BA in terms of all-cause mortality (RR 0.56, 95% CI 0.14 to 2.31), cardiovascular mortality (RR 0.61, 95% CI 0.02 to 16.85), MI (RR 0.60, 95% CI 0.27 to 1.31), and stent thrombosis (RR 0.13, 95% CI 0.00 to 5.06). In conclusion, this meta-analysis suggests that PCBs compared with uncoated BA for the treatment of coronary ISR at intermediate-term follow-up of 1 year were associated with a significant decrease in TLR and MACE without any difference in mortality, MI, or stent thrombosis.

A Systematic Review and Meta-Analysis of Interventions Targeted to Parents for Improving the Oral Health of Children from Culturally and Linguistically Diverse (CALD) Backgrounds

A high prevalence of dental caries is a significant health problem, especially in the pediatric population. Low-income minority groups, including the refugee and immigrant populations, are at higher risk of compromised oral health. It has been suggested that migrant parents do not have enough understanding of oral health, risk factors associated with dental caries, or the progress of dental decay. This systematic review aims to study quantitative literature on oral health interventions, health promotion programs, or behaviour change interventions targeting the parents/ caregivers of culturally and linguistically diverse (CALD) children. A systematic search of electronic databases, including MEDLINE, EMBASE, PUBMED, CINAHL, SCOPUS, WEB OF SCIENCE, COCHRANE, and PROQUEST, was conducted until August 2023. Randomised (RCT) or non-randomised controlled trials (NRCTs) were included. Two reviewers independently assessed the quality of the included studies using the Cochrane Risk of Bias (RoB) 2.0 and ROBINS-I tools. Meta-analysis was performed as appropriate. The initial search from the databases retrieved 2073 articles. After the removal of duplicates, 1683 articles remained. Finally, 69 articles were reviewed in full text, and 15 articles were considered eligible in this review. The RoB assessment for RCTs rated three as low-risk and three as high-risk. The serious RoB in these NRCTs mostly pertained to measurement bias based on self-reporting oral health behaviours. The meta-analysis pooling of results (for RCTs and NRCTs) favoured interventions for CALD parents' oral health knowledge [0.73 (95% CI, 0.08 to 1.38) for RCTs, 1.73 (95% CI; 1.45 to 2.02) for NRCTs] and attitudes [0.86 (95% CI, 0.31 to 1.42)]. Relatively high heterogeneity was observed. Oral health educational interventions can be effective in improving the oral health literacy of CALD parents' oral health knowledge and attitudes, especially when facilitated by lay health advisors. However, the low quality of evidence due to high heterogeneity and high RoB further highlighted the need for well-designed RCTs targeting CALD parents.

Neural mobilisation effects in nerve function and nerve structure of patients with peripheral neuropathic pain: A systematic review with meta-analysis

OBJECTIVE

To assess the effects of neural mobilisation on nerve function and nerve structure of patients with peripheral neuropathic pain.

METHODS

A systematic review with meta-analysis was conducted. Medline, Embase, CINAHL, Cochrane Library, and World Health Organization International Clinical Trials Registry Platform were searched without restrictions. Eligibility criteria included controlled trials or quasi-experimental studies comparing neural mobilisation versus sham, active or inactive control in adults with peripheral neuropathic pain. Primary outcomes were the change in peripheral nerve cross-sectional area. Secondary outcomes included nerve echogenicity, nerve excursion and nerve conduction. Random effects meta-analysis was conducted. Risk of bias was assessed with the Cochrane Collaboration tool, and certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework.

RESULTS

Eleven randomised controlled trials and four quasi-experimental studies (total sample = 722 participants) were included. Thirteen studies included participants with carpal tunnel syndrome. Two studies examined the cross-sectional area, revealing improvements (i.e., a reduction) in the cross-sectional area after the neural mobilisation. Neural mobilisation improved motor [mean difference = 2.95 (95%CI 1.67 to 4.22)] and sensory conduction velocity in short-term [mean difference = 11.74 (95%CI 7.06 to 16.43)], compared to control. Neural mobilisation did not alter distal motor or sensory latency.

CONCLUSION

Neural mobilisation seems to improve (i.e., a reduced) the cross-sectional area (very low-quality evidence) and sensory conduction velocity (very low-quality evidence). Neural mobilisation was superior to control in improving motor conduction velocity in patients with peripheral neuropathic pain with moderate quality evidence. Distal motor or sensory latency presented similar results compared to other interventions. Our findings should be interpreted cautiously since most studies included patients with carpal tunnel syndrome.

Psychological well-being of travellers on long-distance shipping voyages: A systematic review protocol

The psychosocial well-being of every individual is as important as the well-being of long-distance voyages, especially that they have to spend longer hours and days travelling to their destinations with all the experiences of adventure and adversities characterizing the journey. The aim of this systematic review is to explore the psychosocial well-being of long-distance seafarers on board shipping vessels to gain an understanding of their psychological and social well-being with the objective of ameliorating the adversities associated with these travels. A systematic review will be conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (2020) statement. The databases to be searched for the data will be limited to Scopus, Web of Science, and Advanced Google Scholar using keywords selected by the reviewers. Meta-analysis, narrative synthesis, or both will be used depending on the extent of heterogeneity across eligible observational studies included in the review. Some specific countries will be selected for data extraction, and only data published in English will be included. It is expected that the findings from this review will bring to bear if these categories of seafarers are prone to risks that affect their psychosocial wellbeing and if so discovered. This protocol was registered with the PROSPERO. PROSPERO registration number: CRD42024517277(08/03/2024).

Effectiveness of technology-based psychosocial interventions for improving health-related outcomes of family caregivers of stroke survivors: A systematic review and meta-analysis

AIM

To synthesize evidence regarding the effectiveness of technology-based psychosocial interventions in improving health-related outcomes among family caregivers of stroke survivors.

DESIGN

A systematic review and meta-analysis was reported by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

METHODS

Randomized controlled trials that investigated the effects of psychosocial interventions delivered through information and communication technologies on self-efficacy, caregiving competence, caregiver burden, perceived social support, anxiety, depression, health-related quality of life and cost-effectiveness were included. Two researchers independently selected studies, extracted data, and appraised the quality of the included studies. Subgroup analysis, sensitivity analysis, and narrative synthesis were conducted.

DATA SOURCES

Ten electronic databases (PubMed, CENTRAL, Web of Science, Scopus, CINHAL, Embase, Institution of Electrical Engineers Xplore, Ovid Medline, PsycINFO, ProQuest Dissertations and Thesis) were searched up to February 2023.

RESULTS

Nineteen studies involving 1717 participants fulfilled the eligibility criteria. Technology-based psychosocial interventions significantly improved self-efficacy (SMD = .62), caregiving competence (SMD = .55), depression (SMD = -.25) and anxiety (SMD = -.35). However, perceived social support, caregiver burden, and health-related quality of life did not show significant improvements. Subgroup analyses revealed that the interventions, lasting from 4 to 6 weeks and encompassing comprehensive contents, exhibited larger effect sizes. None of the studies measured cost-effectiveness.

CONCLUSION

The technology-based psychosocial interventions are effective in enhancing self-efficacy and caregiving competence, as well as alleviating anxiety, and depression among family caregivers of stroke survivors. Future research should investigate interventions delivered through various digital platforms using well-designed RCTs with in-depth qualitative data collection and measurement of health and cost-effectiveness outcomes.

IMPACT

Through psychosocial interventions, healthcare providers in clinical and community settings, particularly nurses, could incorporate technologies into current stroke care practices.

PATIENT OR PUBLIC CONTRIBUTION

It is not applicable as this is a systematic review.

REGISTRATION

The protocol was registered on PROSPERO (CRD42023402871).

Effectiveness of Web-Based Cognitive Behavioral Therapy for Depression: A Systematic Review of Randomized Controlled Trials

Evidence-based practices were more effective in managing mental health disorders when compared to traditional, non-evidence-based approaches. Web-based cognitive behavioral therapy (CBT) interventions offer a wide variety of advantages among depressed patients as they offer a sense of anonymity, privacy, and accessibility. This systematic review of randomized controlled trials (RCTs) aims to estimate the efficacy of several types of web-based interventions among patients with depression symptoms. This review was conducted according to the principles of the Cochrane Handbook for Systematic Reviews of Interventions and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the literature using five databases: PubMed, Medline, Ovid, Cochrane CENTRAL, and Scopus. Key terms for depression and web-based CBT included "Depression", "Cognitive behavioral therapy", "CBT", "Effectiveness", "Internet", and "Web-based". The included studies were published between 2019 and 2024 and assessed the risk of bias (ROB) using the ROB2 tool for RCTs. This search strategy yielded 2902 records, of which 1946 were duplicates and removed. The remaining 956 records underwent screening of their titles and abstracts, and 900 records were excluded. The full texts of the remaining 56 records were retrieved; 45 of them were excluded since 13 had the wrong study design, 10 had inappropriate outcomes, 12 had inappropriate populations, and 10 were out of the date range. All the included studies were 11 RCTs. Most studies assessed the efficacy of internet-based CBT (ICBT) or web-delivered CBT (wCBT). Control groups included the waitlist control (WLC) group and the treatment as usual (TAU) group, and one study included an active control group. Six studies compared the effects of guided or self-guided ICBT with control, three compared wCBT with control, one used internet self-guided intervention, and one employed an internet-based Functional Depression (iFD) program. Interventions were generally self-guided or guided by laypersons, nonspecialists, or automated systems. It can be concluded that despite the significance of most interventions favoring internet-based interventions compared to control groups, many limitations existed in the included studies, making it unclear whether the interventions would prove conclusive and reliable benefits. Therefore, more studies should be conducted on larger sample populations with prolonged duration.

Zero- and few-shot prompting of generative large language models provides weak assessment of risk of bias in clinical trials

Existing systems for automating the assessment of risk-of-bias (RoB) in medical studies are supervised approaches that require substantial training data to work well. However, recent revisions to RoB guidelines have resulted in a scarcity of available training data. In this study, we investigate the effectiveness of generative large language models (LLMs) for assessing RoB. Their application requires little or no training data and, if successful, could serve as a valuable tool to assist human experts during the construction of systematic reviews. Following Cochrane's latest guidelines (RoB2) designed for human reviewers, we prepare instructions that are fed as input to LLMs, which then infer the risk associated with a trial publication. We distinguish between two modelling tasks: directly predicting RoB2 from text; and employing decomposition, in which a RoB2 decision is made after the LLM responds to a series of signalling questions. We curate new testing data sets and evaluate the performance of four general- and medical-domain LLMs. The results fall short of expectations, with LLMs seldom surpassing trivial baselines. On the direct RoB2 prediction test set (n = 5993), LLMs perform akin to the baselines (F1: 0.1-0.2). In the decomposition task setup (n = 28,150), similar F1 scores are observed. Our additional comparative evaluation on RoB1 data also reveals results substantially below those of a supervised system. This testifies to the difficulty of solving this task based on (complex) instructions alone. Using LLMs as an assisting technology for assessing RoB2 thus currently seems beyond their reach.

The Impact of the Fruit and Seed of Date on Childbirth Stages and Pregnancy Complications

This review aimed to investigate the effects of date fruit products on childbirth and pregnancy-related complications. MeSH keywords were systematically searched in scientific databases, and 16 articles were reviewed. It was found that consuming 7 date fruits (average of 80 g) per day for 2-4 weeks before the estimated date of delivery leads to a better cervical dilatation at admission or improvement of Bishop score, a decrease in the need for induction or stimulation of labour and an increase in effective uterine contractions, which, in turn, decreases the duration of pregnancy and the different stages of labour. Additionally, date fruit products can improve blood pressure parameters in pregnant women at risk of preeclampsia and accelerate episiotomy healing.

Innovations in Pain Management for Abdominoplasty Patients: A Systematic Review

Background/Objectives: Abdominoplasties are prevalent surgical procedures for improving lower abdominal contours, necessitating effective pain management. Insufficient management can increase opioid usage, dependency risks, and adverse effects. This review investigates various strategies in abdominoplasty pain management, aiming to reduce opioid dependence and improve patient care. Methods: A comprehensive systematic literature search (MEDLINE, Cochrane, PubMed, Web of Science, EMBASE) was conducted, spanning from their inception to January 2024, using keywords such as 'abdominoplasty' and 'postoperative pain management'. Included studies focused on nonopioid interventions in adults, encompassing various study designs. Non-English publications and those not meeting outcome criteria were excluded. Bias in studies was assessed using specific tools for randomized and non-randomized trials. Results: Thirty-five studies, published between 2005 and 2024, were included, involving 3636 patients with an average age of 41.8. Key findings highlighted the effectiveness of transversus abdominis plane blocks in reducing opioid use and pain. Pain pump catheters also showed promise in improving pain management and reducing opioid dependency. Local anesthetics demonstrated varying degrees of efficacy, while other alternatives like ketamine and NSAIDs successfully reduced postoperative pain and opioid requirements. The bias assessment of the RCTs revealed "low" and "some concerns" ratings, indicating a need for more detailed methodology reporting and management of missing data. The cohort studies generally attained "moderate" risks of bias, primarily due to confounding variables and outcome data reporting. Conclusions: Nonopioid analgesics show potential in postoperative pain management for abdominoplasties, but further research is needed to confirm their effectiveness and optimize patient care.

"Hands-On" and "Hands-Off" Physiotherapy Treatments in Fibromyalgia Patients: A Systematic Review and Meta-Analysis

Background: Physiotherapy plays a key role in managing fibromyalgia, a multifaceted disorder, through a combination of active and passive treatments. The purpose of this review is to compare the efficacy of "hands-off" treatments alone versus the combination of "hands-off" and "hands-on" therapies. Methods: MEDLINE (PubMed), CENTRAL, and Embase were searched. English-language randomized controlled trials involving adults with fibromyalgia were included. The included studies were divided into subgroups to reduce the possible heterogeneity. We calculated the standardized mean difference or mean difference with 95% confidence intervals for the continuous data according to the outcome measures. We used the risk ratio for dichotomous data of the drop-out rate of the studies. Results: We included and analyzed seven RCTs. The meta-analysis showed no significant results in the outcomes, pain, QoL, health status, and drop-out rate. We found significant results (p < 0.001) in favor of combining "hands-off" and "hands-on" treatments for the rest quality (SMD 0.72, 95% CI 0.35 to 1.09). Conclusions: This review increases the treatment options available for clinicians. Up to now, the main guidelines on managing fibromyalgia suggest only approaches based on "hands-off" treatments. These findings suggest that other approaches based on mixed interventions combining "hands-off" and "hands-on" treatments did not reduce the patient outcomes. Moreover, the mixed intervention led to better results for the patients' sleep quality than the "hands-off" treatments alone.

Reliability of the risk of bias assessment in randomized controlled trials for nursing: A cross-sectional study

AIM

To evaluate the percentage and reasons for disagreements in the risk of bias (RoB) assessments for randomized controlled trials (RCTs) included in more than one Cochrane review in the field of nursing.

BACKGROUND

Disagreement in RoB assessments reduces the credibility of the evidence summarized by systematic reviews (SRs). There is no study that evaluates the reliability of RoB assessments in nursing studies.

DESIGN

Secondary data analysis based on research reports.

METHODS

RCTs included in more than one review in the nursing have been included. The disagreement of the assessment was analysed, and the possible reasons for disagreements were investigated.

RESULTS

Twenty-three RCTs were included in more than one review. The agreement of assessment ranged from 36.84% for "selective reporting" to 91.30% for "random sequence generation". "Allocation concealment" showed the optimal agreement (84.21%). The items "blinding of participants and personnel", "blinding of outcome assessment" and "incomplete outcome data" showed poor agreement, with 50.00%, 58.82% and 66.67%, respectively. Most disagreements came from extracting incomplete or different RCTs' information.

CONCLUSIONS

The level of agreement of the assessment between reviews has varied greatly in the field of nursing. More complete and accurate information of RCTs needs to be collected when conducting a SR.

Assessment of the efficacy of autologous blood preparations in maxillary sinus floor elevation surgery: a systematic review and meta-analysis

OBJECTIVE

This study aimed to evaluate the efficacy of autologous blood preparations, namely Platelet-Rich Plasma (PRP), Platelet-Rich Fibrin (PRF), and Concentrated Growth Factor (CGF), in maxillary sinus floor elevation surgery. The focus was on their impact on new bone formation, maxillary sinus floor height, and soft tissue healing.

METHODS

A systematic search was conducted across PubMed/MEDLINE, Web of Science, Embase, and Scopus databases up to April 2024. This systematic review included both randomized clinical trials (RCTs) and controlled clinical trials (CCTs) that evaluated the efficacy of autologous blood preparations in maxillary sinus floor elevation surgery. The primary outcomes measured were the percentage of new bone formation, maxillary sinus floor height, and he percentage of soft tissue area. Data from the selected studies were extracted and analyzed to determine the impact of autologous blood preparations on these outcomes. The risk of bias was assessed using Cochrane's risk of bias tool and ROBINS-I, and meta-analyses were performed using Review Manager 5.4 software to calculate effect sizes and integrate results from multiple studies.

RESULTS

Among the 507 screened articles, 30 studies met the inclusion criteria. The results indicated that the application of PRP significantly increased new bone formation during maxillary sinus floor elevation surgery (primary outcome, MD = 4.40, CI = 0.37 to 8.44, P = 0.03), as well as improving maxillary sinus floor height elevation (secondary outcome, MD = 1.00, CI = 0.78 to 1.23, P < 0.00001). The absence of PRP during surgery had a statistically significant effect on the percentage of soft tissue area (secondary outcome, MD= -5.25, CI= -7.29 to 3.20, P < 0.00001). However, based on the research findings, PRF did not show significant effects on enhancing new bone formation, maxillary sinus floor height elevation, and promoting soft tissue regeneration.

CONCLUSIONS

PRP demonstrates efficacy in maxillary sinus floor elevation surgery by enhancing new bone formation and increasing sinus height. Further studies are needed to validate the outcomes of PRF and CGF.

Efficacy of yoga for posttraumatic stress disorder: A systematic review and meta-analysis of randomized controlled trials

Yoga is an increasingly popular complementary intervention to reduce posttraumatic stress disorder (PTSD) symptoms and related comorbidities, but its safety and treatment efficacy are not firmly established. We conducted a systematic review and meta-analysis of existing randomized control trials (RCTs) of yoga interventions for PTSD and related secondary outcomes (e.g., depression). Initial search results found over 668 potential papers. Twenty met inclusion criteria (e.g., RCTs on adult participants with PTSD that evaluated safety or efficacy outcomes). Meta-analysis indicated that, compared to control interventions, participation in yoga interventions significantly improved self-report PTSD (standardized mean difference [SMD]: -0.51; 95 % confidence interval [CI]: -0.68, -0.35) and immediate (SMD: -0.39; 95 % CI: -0.56, -0.22) and long-term (SMD: -0.44; 95 % CI: -0.74, -0.13) depression symptoms. However, using clinician-reported assessments, yoga interventions were not associated with improved PTSD symptoms. Type of yoga differentially predicted outcomes. Sensitivity analysis showed consistent effect sizes when omitting each study from main analyses. Six studies reported whether any serious adverse events occurred. None were indicated. No publication bias was found, although individual intervention studies tended to be high in bias. Results suggest yoga is likely a safe and effective complementary intervention for reducing PTSD and depressive symptoms in individuals with PTSD. More rigorous RCTs are warranted.

Cannabinoids for spasticity in patients with multiple sclerosis: A systematic review and meta-analysis

Background

One of the most disabling symptoms of patients with multiple sclerosis (MS) is spasticity which affects their quality of life. Nowadays, cannabinoids are used for spasticity control in patients with MS, while the efficacy and safety are not clearly understood. So, we designed this systematic review and meta-analysis to assess the efficacy of cannabinoids for controlling MS-related spasticity.

Methods

PubMed, Scopus, EMBASE, Web of Science, and Google Scholar were systematically searched by two independent researchers on 1 May 2023. They also searched gray literature (references of included studies, as well as conference abstracts).

Results

A literature search revealed 6552 records, 95 full-texts were evaluated, and finally, 31 studies remained for systematic review. Among included studies, six randomized trials were included. Nabiximols was the most commonly used medication for controlling MS-related spasticity. Mean Expanded Disability Status Scale ranged between 4.6 and 7. Most studies (17 studies) were done in Italy, followed by Germany (4 studies). The pooled standardized mean difference (SMD) of NRS (Numeric Rating Scale) (after-before) is estimated as -1.41 (95% confidence interval (CI): -1.65, -1.17) (I2 = 97%, p < 0.001). The pooled standardized mean difference (SMD) of Ashworth (after-before) is estimated as -0.39 (95% CI: -0.72, -0.06) (I2 = 69.9%, p = 0.005).

Conclusion

The results of this systematic review and meta-analysis showed that nabiximols was the most common cannabinoid which was used to control MS-related spasticity, and it was effective in controlling MS-related spasticity (significantly decreased SMD of NRS, and Ashworth after treatment).

The Efficacy of Botulinum Toxin Type A (BTA) in the Treatment of Hypertrophic Scars and Keloids: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Hypertrophic scars cause significant physical and emotional discomfort. Botulinum toxin type A (BTA) has shown promising outcomes in reducing scar formation. Research suggested its effectiveness in managing hypertrophic scars and keloids. This systematic review and meta-analysis were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including randomized controlled trials (RCTs). The included studies involved patients with hypertrophic scars treated with BTA. Five databases were searched from inception to August 2024. Studies were screened and selected by two independent reviewers. Data on study design, patient demographics, and interventions was extracted. The risk of bias (ROB) was assessed using the ROB revised tool developed by Cochrane (ROB2). Meta-analysis was performed using RevMan Web (The Cochrane Collaboration, London, UK) with a random-effects model due to high heterogeneity, calculating mean differences for the primary and secondary outcomes. Outcomes included Vancouver Scar Scale (VSS) scores, scar thickness, vascularity, pliability, and pigmentation. The systematic review identified 182 records from five databases. The screening process resulted in seven studies included in the final analysis after assessment for eligibility. The efficacy of BTA in treating hypertrophic scars and keloids was assessed. The meta-analysis showed that BTA significantly improved VSS scores, with a pooled mean difference of -1.69 (P = 0.01). However, BTA did not show a statistically significant effect on reducing scar height/thickness or improving vascularity. Scar pliability was significantly improved by BTA, with a pooled mean difference of -0.76 (P = 0.002), while there was no significant effect on pigmentation. High heterogeneity was observed across the studies. BTA could be used as an effective treatment for the components of hypertrophic scars and keloids, especially regarding their pliability and improving scar quality. However, for functions such as the change in scar height, vascularity, and pigmentation, more research is still required among larger RCTs. Future research should focus on refining the treatment regimens and the mode of action of BTA to the scar tissue.

Does flaxseed supplementation affect apo-lipoproteins? A GRADE-assessed systematic review and meta-analysis

Several studies indicated the ameliorating effects of flaxseed supplementation on apolipoproteins, although others have conflicting results. Therefore, the present research was conducted in order to accurately and definitively understand the effect of flaxseed on apolipoproteins in adults. All articles published up to Juan 2024 were systematically searched through PubMed, Scopus, Embase, and Web of Science to collect all randomized clinical trials (RCTs). A random effects model was used to measure the combined effect sizes. Also, standardized mean difference (SMD) and 95 % confidence interval (CI) were used to report the combined effect size. Our results showed that flaxseed supplementation significantly reduced apo-BI (SMD: -0.57; 95 % CI: -0.95, -0.19, p = 0.003; I2 = 83.2 %, heterogeneity p < 0.001) and lipo(a) decreased (SMD: -0.34; 95 % CI: -0.59, -0.09, p=0.007; I2=30.3 %, heterogeneity p=0.197). However, flaxseed did not change apo-AI levels (SMD: -0.37; 95 % CI: -0.87, 0.13, p = 0.146; I2 = 89.2 %, p-heterogeneity < 0.001). This meta-analysis has shown that flaxseed supplementation may have beneficial effects on apolipoproteins. Future high-quality, long-term clinical trials are needed to confirm our results.

Is there evidence on the optimal duration of aminoglycoside therapy in β-lactam/aminoglycoside combination regimens used for the treatment of gram-negative bacterial infections? A systematic review

BACKGROUND

The optimal duration of therapy of aminoglycosides in combination regimens is expected to be different from that of monotherapy regimens, and shorter durations could help minimize toxicity without compromising efficacy. The aim of this review was to assess the evidence for the optimal duration of aminoglycosides in β-lactam/aminoglycoside combinations used for the treatment of Gram-negative bacterial infections.

MATERIALS AND METHODS

PubMed, Cochrane, Embase, Scopus, Web of Science, and CINHAL databases were searched. Covidence software was used for article screening and management. Studies were included if they clearly reported the duration of therapy of aminoglycosides in β-lactam/aminoglycoside combinations used against Gram-negative bacteria. The protocol is registered with PROSPERO (CRD42023392709).

RESULTS

A total of 45 β-lactam/aminoglycoside combination courses from 32 articles were evaluated. The duration of therapy of aminoglycosides in combinations regimens ranged from 1 to 14 days, varying with the type of infection treated. In half (51.1%; (23/45) of the combinations, aminoglycosides were administered for a duration ranging from 6 to 9 days. In 26.7% (12/45) of the combinations, the duration of aminoglycoside therapy was ≤ 5 days. In the remaining 22.2% (10/45) of these combinations, the aminoglycosides were administered for a duration of ≥ 10 days. Aminoglycosides were administered for a longer duration of 7-14 days in 12 (75%) of the 16 combination courses that induced toxicity.

CONCLUSIONS

Long duration of aminoglycoside use is associated with increased risk of toxicity. However, there is a lack of evidence on defining an optimal duration of aminoglycoside therapy in β-lactam/aminoglycoside combination regimens that ensures clinical efficacy outcomes whilst minimizing toxicity outcomes.

Risperidone for the Treatment of Dementia-Related Psychosis: A Systematic Review and Meta-Analysis

INTRODUCTION

Risperidone is one of the atypical antipsychotics that has been used for the treatment of dementia-related psychosis (DRP). However, the findings concerning its efficacy and safety in DRP are contradictory.

METHODS

We conducted a systematic review and meta-analysis to address the effects of risperidone on the alleviation of DRP. We searched Medline via PubMed, Scopus, Web of Science, Google Scholar, and PsychINFO from the inception until May 2024. Appropriate statistical tests were used to test the study hypothesis.

RESULTS

The study included 17 articles and 2,311 patients with DRP. Risperidone alleviated DRP with a standardized mean difference (SMD) of 0.355 (95% CI: 0.170-0.541, p = 0.000). The impact of treatment was positively associated with treatment duration (slope p = 0.038) and dose (slope p = 0.000). Six studies (n = 354) reported the data for the effects of risperidone on cognitive function. Analysis showed that risperidone treatment deteriorated cognitive function in DRP patients with an SMD of -0.185 (95% CI: -0.349 to -0.020, p = 0.028). The mean effect size was 0.36 with a 95% CI of 0.17-0.54. However, the true effect size in 95% of all comparable populations fell in the interval of -0.37 to 1.08. This revealed a high heterogeneity among the included publications as the prediction interval showed a wider range of expected treatment effects than CI.

CONCLUSION

Our meta-analysis provides evidence for the effectiveness of risperidone in the management of DRP. However, because of safety concerns and high data heterogeneity, risperidone use should be individualized for each patient.

Types and Effects of Telenursing in Home Health Care: A Systematic Review and Meta-Analysis

Purpose: This systematic review aimed to identify the types and effectiveness of telenursing in home health care (HHC) compared to conventional HHC. Methods: This study followed the Preferred Reporting Items for Systematic Review and Meta-Analysis 2020 guidelines. A random-effects meta-analysis was performed. The risk of bias was assessed using the Risk of Bias 2.0 tool. The quality of bias was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation system. Results: A total of 17 studies published between 2003 and 2022 were included in the review. The majority of the targeted health conditions of the patients were chronic obstructive pulmonary disease or congestive heart failure (70%). We categorized telenursing interventions according to different technology (N = 4) and nursing (N = 7) types. Among the identified types of nursing, fundamental nursing to monitor patients' symptoms was the most representative. Telemonitoring was found to be the most common technology type, followed by synchronous technology using video or telephone. The telenursing outcomes, including health care utilization, physiological/psychological outcomes, and quality of life, varied. In the meta-analysis, participants who received telenursing reported fewer hospital admissions (standardized mean difference [SMD]: -0.18; confidence interval [95% CI]: -0.43 to -0.02) and emergency department visits (SMD: -0.28; 95% CI: -0.45 to -0.10). Conclusion: Telenursing in HHC tends to improve the quality of life and could result in many benefits, including a reduction in health care utilization and facilitating the management of chronic diseases. These results ultimately represent the potential effectiveness of telenursing in community health care settings.

Comparison of Drug Therapy Efficacy in Patients With Hypertrophic Cardiomyopathy: A Network Meta-Analysis

The aim of this network meta-analysis was to compare the efficacy of various commonly used drugs in treating patients with hypertrophic cardiomyopathy (HCM). Randomized controlled trials on drugs for HCM treatment were retrieved from PubMed, Embase, Cochrane Library, and Web of Science (search cutoff: January 10, 2024). Quality assessment was performed using the risk of bias tool, and data analysis used R software. Seventeen studies (1,133 patients with HCM) were included. The network meta-analysis indicated that mavacamten and perhexiline improved peak oxygen consumption compared with placebo. Mavacamten reduced N-terminal pro-B-type natriuretic peptide, left ventricular mass index, left atrial volume index, and septal E/e' ratio. Losartan decreased systolic blood pressure, whereas candesartan, mavacamten, and valsartan reduced maximum wall thickness. Perhexiline had better efficacy in increasing peak oxygen consumption, and candesartan in reducing maximum wall thickness. No drug significantly improved left ventricular ejection fraction compared with placebo. In conclusion, on the basis of current studies, commonly used drugs may effectively improve some of the outcome measures in patients with HCM, whereas the novel drug mavacamten showed significant therapeutic effects in most of the remaining outcome measures except for left ventricular ejection fraction.

Applications of artificial intelligence for surgical extraction in stomatology: a systematic review

OBJECTIVES

Artificial intelligence (AI) has been extensively used in the field of stomatology over the past several years. This study aimed to evaluate the effectiveness of AI-based models in the procedure, assessment, and treatment planning of surgical extraction.

STUDY DESIGN

Following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a comprehensive search was conducted on the Web of Science, PubMed/MEDLINE, Embase, and Scopus databases, covering English publications up to September 2023. Two reviewers performed the study selection and data extraction independently. Only original research studies utilizing AI in surgical extraction of stomatology were included. The Cochrane risk of bias tool for randomized trials (RoB 2) was selected to perform the quality assessment of the selected literature.

RESULTS

From 2,336 retrieved references, 35 studies were deemed eligible. Among them, 28 researchers reported the pioneering role of AI in segmentation, classification, and detection, aligning with clinical needs. In addition, another 7 studies suggested promising results in tooth extraction decision-making, but further model refinement and validation were required.

CONCLUSIONS

Integration of AI in stomatology surgical extraction has significantly progressed, enhancing decision-making accuracy. Combining and comparing algorithmic outcomes across studies is essential for determining optimal clinical applications in the future.

Overall survival with non-proportional hazards in first-line treatment for patients with metastatic colorectal cancer: Systematic review and network meta-analysis

This study aimed to identify the most effective first-line treatment for patients with metastatic colorectal cancer based on overall survival, identify the most commonly used treatment, and generate a meaningful ranking among all available treatments based on their relative effectiveness. Researchers used the ANOVA parametrization method to fit the second-order fractional polynomial network meta-analysis with a random-effect model. Using a non-proportional hazards network meta-analysis, 46 treatments were compared by considering a combination of direct and indirect evidence extracted from clinical trial studies. Included in the review were 46 trials involving 21350 patients. Between January 2000 and January 2023, researchers conducted a thorough search through Embase, PubMed/Medline, and Scopus. To undertake a secondary analysis of this data, we recreate individual patient data from published Kaplan-Meier (K-M) survival curves and assess the accuracy of that reconstruction. A random-effects model was used to evaluate the pooled overall survival and hazard ratio with a 95 percent confidence interval. The predicted survival curves for the network meta-analysis showed that GOLFIG and FOLFOX + Cetuximab treatments have higher survival, respectively. Our results provide moderate quality evidence and comparative effective estimates for various available first-line treatments for metastasis colorectal cancer based on network meta-analysis.

Nonpharmacological Therapies for Musculoskeletal Injury in Military Personnel: A Systematic Review/Meta-Analysis

INTRODUCTION

Musculoskeletal (MSK) injury is an inherent risk for military personnel that can potentially impact job performance, productivity, and military readiness. Evidence is needed to show the efficacy of nonpharmacological, self-managed therapies to reduce MSK symptoms at common injury sites that are feasible for use during expeditionary operations and home stations. This systematic review and meta-analysis identified, summarized, and synthesized available evidence from randomized and non-randomized trials on the effectiveness of self-managed, home-use therapies to improve pain, muscle strength, and physical performance in military personnel with MSK injuries, when compared to controls.

METHODS

The electronic databases of MEDLINE ALL Ovid, Embase.com, Cochrane Library, Scopus, Clinicaltrial.gov, and CINAHL Complete via EBSCO were systematically searched for relevant reports published in English. Utilizing the Covidence platform and consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, multiple reviewers, using pre-determined data fields, screened for eligibility, assessed risk of bias (RoB), and performed data extraction. Evaluation of treatment effectiveness was determined using multilevel mixed-effects meta-analysis.

RESULTS

The database and register search yielded 1,643 reports that were screened for eligibility. After screening of titles/abstracts and full texts, 21 reports were identified for evidence synthesis. Of these, two reports were excluded and two described the same study, resulting in a final list of 18 studies (19 reports). For quality assessment, the overall RoB for the 18 studies was categorized as 33.3% low risk, 55.6% with some concerns, and 11.1% high risk. Across the five domains of bias, 70% of the reports were classified as low risk. This systematic review found that the differences in interventions, outcome measures, and design between the studies were associated with a substantial degree of heterogeneity (I2 = 60.74%), with a small overall improvement in outcomes of the interventions relative to their specific control (standard mean difference 0.28; 95% CI, 0.12 to 0.45). There were varying degrees of heterogeneity for individual body regions. This was due, in part, to a small number of studies per bodily location and differences in the study designs. For the neck/shoulder, heterogeneity was moderate, with the clearest positive effect being for physical performance outcomes via other medical devices. For the back, there was substantial heterogeneity between studies, with modest evidence that pain was favorably improved by other medical devices and exercise interventions. For the leg, one study showed a clear large effect for other medical devices (shockwave treatment) on pain with substantial heterogeneity. The best evidence for positive effects was for the knee, with mainly negligible heterogeneity and some benefits from bracing, electrotherapy, and exercise.

CONCLUSION

Evidence showed small beneficial effects in pain, strength, and physical performance by individual body regions for some interventions, compared to controls. The best evidence for a positive effect was for the knee. The findings suggest that some benefit may be obtained by including several treatments during deployment in austere environments and prolonged casualty care scenarios of military personnel with MSK injuries. Further research is warranted to better assess the potential benefits of using these treatments during deployments in austere environments as part of an individualized, multimodal approach for MSK injuries.

Efficacy of Corticosteroids for Sore Throat Management in Adults: A Systematic Review and Meta-Analysis of Randomized Trials

Sore throat (acute pharyngitis) is among the most common complaints among adults and is a reason for seeking healthcare globally. Antibiotics are widely used among patients with infectious sore throat. Previous research has indicated that corticosteroids could offer an alternative symptomatic treatment for sore throats. To estimate the corticosteroid efficacy as an additional therapy for sore throat adult patients, the literature search included PubMed, Medline, OVID, Cochrane CENTRAL, and Scopus for articles published until July 1st, 2024. The outcomes included the onset of pain relief (average time), complete resolution of pain (average time), absolute reduction of pain at 24 and 48 hours, requirement of antibiotics, and adverse effects related to treatment. Standardized mean difference (SMD) and risk difference were used to report numerical and dichotomous results. Five studies were included. Among the five included studies, corticosteroids showed significant effectiveness in resolving pain at 24 hours (average risk difference: 0.2200, 95% CI: 0.0500 to 0.3899, p = 0.0112) but with notable heterogeneity (I² = 82.4255%). At 48 hours, the benefit was not statistically significant (average risk difference: 0.4063, 95% CI: -0.1857 to 0.9984, p = 0.1786, I² = 98.9219%). Corticosteroids also decreased the average time to onset of pain relief (average SMD: -0.6590, 95% CI: -1.2857 to -0.0323, p = 0.0393, I² = 89.7914%), although with high heterogeneity. Other findings indicated a possible reduction in antibiotic use and fewer days missed from work. Adverse effects were minimal and occurred at similar rates in both corticosteroid and placebo arms. Corticosteroids can decrease pain intensity and duration in adults with acute sore throats. However, significant heterogeneity among studies and methodological limitations render the overall evidence inconclusive. While some studies noted reduced antibiotic use and lower symptom recurrence, high-quality RCTs are needed to address these limitations and provide more definitive guidelines for corticosteroid use in treating acute pharyngitis.