The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: a systematic review

Effectiveness of infrastructural interventions to improve access to safe drinking water in Latin America and the Caribbean on the burden of diarrhoea in children <5 years: a systematic literature review and narrative synthesis

Globally, Latin America and the Caribbean (LAC) has one of the lowest rates of equitable access to safely managed drinking water. This systematic literature review assessed the effectiveness of infrastructure interventions to provide equitable access to safely managed drinking water in LAC on the burden of diarrhoea in children <5 years. The review was conducted in February 2024 using Ovid MEDLINE, Embase, Global Health, and the Cochrane Library with inclusion criteria: quantitative study designs of intervention effectiveness on burden of diarrhoea in children; conducted in LAC; studies published since 1 January 2000; and full-text available in English. Study quality was assessed via the US Agency for Healthcare Research and Quality scale. Reported quantitative data for diarrhoea burden of disease were extracted, and thematic analysis informed a narrative synthesis. Six studies from three countries in LAC with >110,000 data-points were included. Water supply infrastructure interventions were effective at reducing the burden of diarrhoea in children <5 years. Household level, rather than community level, access to a piped water supply, a continuous reliable service with <1 day of service interruption per month, and cash transfer programs for environmental public health programs, were identified as key contributors to water infrastructure intervention effectiveness. Previous water supply infrastructure interventions which include the provision of a safe drinking water supply are effective in reducing burden of diarrhoea in children. Future studies are needed to develop a comprehensive understanding of the unique features which contribute to water infrastructure effectiveness.

Prevalence and risk factors of falls in people on hemodialysis: a systematic review and meta-analysis

OBJECTIVES

This study aims to systematically quantify the prevalence of falls in people on hemodialysis and to assess risk factors associated with falls by synthesizing emerging best evidence.

METHODS

A comprehensive search was conducted across ten databases from their inception to February 27, 2025. The research team independently conducted study selection, quality assessments, data extraction, and analyses of all included studies. Meta-analysis was performed using random-effects and fixed-effects models. The PRISMA guidelines were used to report the systematic review and meta-analysis.

RESULTS

A total of 31 studies, comprising 191,800 individuals, were included in the analysis. The pooled prevalence of falls in people on hemodialysis was 27.1%. The meta-analysis of risk factors included 19 studies. After controlling for confounding variables, 12 risk factors were associated with falls, including older age, female gender, longer dialysis duration, diabetes mellitus, peripheral vascular disease, paralysis, antidepressant use, frailty, use of walking aids, malnutrition, intradialytic hypotension, and low hemoglobin levels.

CONCLUSIONS

This study provides an updated, evidence-based assessment of the prevalence and risk factors of falls in people on hemodialysis, confirming their multifactorial etiology. Screening and interventions should be implemented promptly to mitigate the adverse outcomes of falls in people on hemodialysis.

REGISTRATION NUMBER

PROSPERO CRD42024525375.

Efficacy and safety of empagliflozin for the acute myocardial infarction: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

This study aims to evaluate the efficacy and safety of empagliflozin in acute myocardial infarction (AMI) treatment by synthesizing evidence from published randomized controlled trials (RCTs).

METHODS

PubMed, Web of Science, Embase, and Cochrane databases were thoroughly retrieved from inception to November 30, 2024, to identify eligible RCTs comparing empagliflozin with placebo in AMI treatment. The Cochrane Risk of Bias tool was leveraged to detect potential bias. The robustness of the results was examined via sensitivity analyses. Publication bias was evaluated via funnel plots and Egger's test.

RESULTS

Data from 9 RCTs involving 7,237 AMI patients were analyzed. Meta-analysis revealed that empagliflozin significantly reduced the total hospitalization rate for heart failure (HF) in AMI patients in comparison to placebo (relative risk [RR] = 0.70, 95% confidence interval [CI] = 0.57-0.85). Additionally, empagliflozin significantly improved their ejection fraction (EF) (standard mean difference [SMD] = 1.01, 95% CI = 0.63-1.38), left ventricular global longitudinal strain (LVGLS) (SMD = -0.27, 95% CI = -0.48 to -0.06), body weight (SMD = -0.80, 95% CI = -1.15 to -0.45), and systolic blood pressure (SBP) (SMD = -0.54, 95% CI = -0.88 to -0.20). Statistically significant differences were not noted in other parameters (all p > 0.05). The incidence of adverse events (AEs), such as hepatic dysfunction, contrast-induced nephropathy, and urinary tract infections, did not differ significantly across groups (all p > 0.05). The GRADE rating indicated the evidence for HF hospitalization rate and body weight was of high certainty.

CONCLUSION

Empagliflozin lowers the total hospitalization rate for HF in AMI patients and significantly improves EF, LVGLS, body weight, and SBP without raising the likelihood of AEs.

Bidirectional association between atopic dermatitis and attention deficit hyperactivity disorder: a systematic review and meta-analysis

BACKGROUND

Our objective is to elucidate the reciprocal association between atopic dermatitis (AD) and attention deficit hyperactivity disorder (ADHD) by prespecified subgroups and determine potential modified factors.

MATERIALS AND METHODS

Adhering to PRISMA 2020, we conducted a comprehensive database search up until March 11, 2024. Observational studies reporting on AD and ADHD as either exposure or outcome variables were included. A random-effects model meta-analysis was conducted to calculate pooled estimates. Subgroup and meta-regression analyses were undertaken to explore heterogeneity. Publication bias was investigated via funnel plots and Egger's test.

RESULTS

Overall, 49 studies were determined to meet the inclusion criteria after rigorous screening. Patients with AD were more likely to have ADHD (ORs = 1.34, 95% CI 1.25-1.44, p < 0.01; HRs = 1.42, 95% CI 1.20-1.68, p < 0.01), while patients with ADHD also had an increased risk of developing AD (ORs = 1.45, 95% CI 1.21-1.73, p < 0.01). Subgroup analyses indicated that the associations were particularly pronounced among studies that assessed patients with severe AD (ORs = 2.62, 95% CI 1.76-3.92, p < 0.01), suffered from multiple allergic conditions (ORs = 2.89, 95% CI 1.18-7.10, p < 0.01) and sleep disturbances (ORs = 2.43, 95% CI 2.14-2.76, p < 0.01) simultaneously.

CONCLUSION

This review substantiates the significant bidirectional association between AD and ADHD, indicating that they serve as mutually independent risk factors and may either exacerbate each other. These findings underscore the necessity for heightened awareness and early targeted interventions, especially in individuals with severe AD manifestations, sleep problems, and multiple allergic diseases.

Systematic review and meta-analysis on marginal bone loss of dental implants placed in augmented or pristine bone sites: Findings from clinical long-term studies

OBJECTIVES

Bone augmentation can be a risk factor for complications in dental implant therapy. Aim of this systematic review and meta-analysis was to assess the marginal bone loss (MBL) between dental implants placed in augmented or pristine bone sites.

STUDY SELECTION

Four electronic databases (PubMed, Embase, Scopus, and Web of Science) were searched for clinical studies with a follow-up period of at least five years. Additionally, a hand search was performed. Risk of bias was assessed using the Newcastle-Ottawa-Scale for non-randomized studies and Cochrane risk-of-bias-tool-2 for randomized controlled trials. Random-effect meta-analysis was performed for the mean MBL at implant level after 5 years of loading for dental implants placed in pristine and augmented bone sites. The study was registered in PROSPERO: CRD42024615716.

SOURCES

A total of 11 sources reporting on 10 studies were included. Four studies examined dental implants placed in pristine bone sites, four in augmented bone sites, and two in both conditions.

DATA

Random-effect meta-analysis for pristine bone sites estimated a mean MBL of 0.79 mm (95 % CI: 0.32-1.26) and for augmented bone sites a mean MBL of 1.90 mm (95 % CI: 1.73-2.07) after five years with a high heterogeneity of MBL reported in included studies.

CONCLUSIONS

Pre-implant augmentation appears to be one but not the only risk factor for MBL. Future studies on implant complications should describe in detail the patient (e.g., adherence, periodontitis history) and local factors (e.g., cleanability of superstructure, attached mucosa) in order to identify further risk factors in the long term.

CLINICAL SIGNIFICANCE

Dental implants in augmented bone sites show greater MBL after five years compared to pristine bone sites. Augmentation may increase early bone remodeling. Clinicians should consider augmentation-related remodeling dynamics and patient-specific risk factors when planning implant therapy to optimize long-term outcomes and reduce complications associated with peri‑implant bone loss.

Effect of blood flow restriction on muscle strength and stability following foot and ankle injury: A systematic review

BACKGROUND

Poor musculoskeletal recovery following foot and ankle injury can result in chronic instability and persistent muscle weakness. Preliminary evidence has shown that blood flow restriction (BFR) rehabilitation can increase muscle strength and stability, helping to restore physical function and prevent repeated injury.

AIM

To determine whether BFR is more effective than traditional rehabilitation in improving muscle strength, size, and stability after foot and ankle injury.

METHODS

A systematic review and meta-analysis were performed. Articles were retrieved from MEDLINE, EMBASE, and CENTRAL databases. Included studies compared the effectiveness of BFR rehabilitation to traditional foot and ankle rehabilitation exercises. Eligible patients were those with a history of foot or ankle injury. Muscle strength, size, and dynamic balance were assessed by comparing improvements in peak torque, cross-sectional area, and percent muscle activation. Methodological quality assessments were performed using the PEDro scale and Methodological Index for Non-Randomized Studies (MINORS).

RESULTS

Ten studies met the inclusion criteria. Five studies were of good to excellent quality according to the PEDro scale, and 5 studies were of moderate quality as per the MINORS criteria. Two studies compared the effect of BFR and non-BFR rehabilitation on muscle strength; the overall mean difference between the BRF and non-BFR groups was 0.09 [95%CI: (0.05, 0.12), P < 0.0001]. Two studies analyzed muscle activation following BFR and non-BFR rehabilitation; the overall mean difference between the BRF and non-BFR groups was 0.09 [95%CI: (0.05, 0.12), P < 0.0001]. Data on dynamic balance was synthesized from two studies; the mean difference between the BFR and control groups was 1.23 [95%CI: (-1.55, 4.01); P = 0.39].

CONCLUSION

BFR rehabilitation is more effective than non-BFR rehabilitation at improving muscle strength and activation following foot and ankle injury. Additional studies are needed to develop a standardized BFR training protocol.

AA amyloidosis in inflammatory joint diseases: A systematic review

BACKGROUND

AA amyloidosis (AAA) is a complication of chronic inflammation; the burden is expected to decrease with recent therapies. We conducted a systematic review of the incidence, prevalence, mortality and response to treatment of inflammatory joint disease (IJD)-related AAA.

METHODS

MEDLINE, EMBASE and Cochrane library databases were searched until October 2024. Selected studies were prospective and retrospective cohorts as well as case series (≥ 10 patients) of histologically proven AAA occurring in IJD.

RESULTS

From 1094 articles identified, we included 33. Substantial heterogeneity among studies was observed. Most studies (75.8 %) were published before 2010. No clear trend was identifiable in AAA incidence and mortality during the last decades. AAA prevalence rates in rheumatoid arthritis ranged from 16.7 % to 25.2 % before 2010 and decreased to 0.7 % after 2010, which suggests a potential positive role of biologic therapies. Similarly, AAA prevalence rates in ankylosing spondylitis ranged from 6.1 % to 8.5 % before 2010 and 1.1 % to 1.3 % after 2010. Immunomodulating therapies (especially biologics) seemed to improve values of AAA biomarkers, such as glomerular filtration rate and serum amyloid A level.

CONCLUSIONS

Our work highlights the need for more recent and comprehensive population-based epidemiological data to decipher the actual IJD-related AAA burden.

Association of weekend catch-up sleep with depression: A systematic review and meta-analysis

BACKGROUND

Weekend catch-up sleep (WCS) may alleviate weekday sleep deprivation, but its relationship with depression risk remains unclear. This systematic review and meta-analysis aims to explore the association between WCS and depression risk.

METHODS

A comprehensive search was conducted in PubMed, Cochrane Library, Embase, Web of Science, and Scopus for observational studies published up to June 1, 2024. Data extraction and bias assessment were independently performed by two reviewers. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated, with model selection based on the I2 statistic. Sensitivity analyses and publication bias tests were also conducted.

RESULTS

A total of ten cross-sectional studies (326,871 participants) were included. Meta-analysis showed that WCS was significantly associated with a reduced risk of depression (OR = 0.80, 95 % CI: 0.68-0.90). Subgroup analyses showed moderate amounts of WCS (0-2 h) may be protective, but WCS beyond 2 h had limited protective effects against depression. Qualitative analyses showed that the protective effect of WCS against depression was more pronounced in men and middle-aged adults, and was particularly applicable to those who were sleep-deprived on weekdays.

LIMITATIONS

The cross-sectional design of included studies limits causality inference, and the sample primarily represents populations from the United States and South Korea, potentially affecting generalizability.

CONCLUSIONS

Moderate WCS is associated with lower depression risk in those with weekday sleep deficits, while excessive WCS may have diminishing or adverse effects. Further research should examine optimal WCS duration and underlying mechanisms.

The Incidence and Risk Factors for Medical Adhesive-Related Skin Injury in Cancer Patients in China: A Systematic Review and Meta-Analysis

To explore the incidence and risk factors for medical adhesive-related skin injury (MARSI) in cancer patients in China, and to provide a basic framework for approaches designed to reduce the occurrence of MARSI and improve the management of its risk factors. PubMed, Web of Science, The Cochrane Library, EmBase, CNKI, VIP, Wanfang, and CBM were searched from database inception to October 2024. The Agency for Healthcare Research and Quality and the Newcastle-Ottawa Scale were used to assess the quality of the included studies, and a random-effects model with Stata 15.0 software was utilized for calculating the pooled incidence and risk factor for MARSI in cancer patients. A total of 18 studies were included, with 11,393 patients. Meta-analysis showed that the pooled incidence of MARSI in Chinese cancer patients was 24%. In subgroup analyses, dermatitis demonstrated the highest incidence rate (10%). MARSI history, allergy history, dressing type (3M), puncture site (upper arm), gender (female), BMI > 25 kg/m2, moist skin, and age (≥ 50 years) were risk factors for MARSI in cancer patients. The incidence of MARSI in Chinese cancer patients is high, and MARSI history, allergy history, dressing type (3M), puncture site, gender (female), BMI > 25 kg/m2, moist skin, and age (≥ 50 years) were risk factors for the occurrence of MARSI in Chinese cancer patients, suggesting that early identification and protection of high-risk patients, and timely targeted preventive measures are important to reduce the incidence of MARSI in cancer patients.

Patient reported outcomes in Usher Syndrome: a systematic review

INTRODUCTION

Usher Syndrome (USH) is a leading cause of deaf-blindness and significantly impacts quality of life. With no cure, it is essential to focus on addressing functional impairments and emotional well-being in 10 affected individuals.

METHODS

A systematic search was conducted on MEDLINE, Embase, PsychInfo, CINHAL, Web of Science, and Cochrane Library until 4 September 2024 to identify studies on patient-reported outcomes (PROs) in USH.

RESULTS

27 studies (1,009 participants, mean age 47.0, 52.4% female) focused on USH, with 74.1% having type 2, 31.4% having type 1, and 6.8% having type 3. 18 studies used quantitative methods, and 9 were qualitative. The Glasgow Benefit Inventory (GBI) was the most common PRO measure, followed by the Nijmegen Cochlear Implant Questionnaire, Usher Lifestyle Survey (ULS), and SF-12 (2 studies each). Weighted GBI scores indicated moderate benefits, but lower physical scores highlighted ongoing limitations. The ULS found that participants needed equipment for information access and mobility assistance. Notably, no studies addressed vision-related interventions, and only one used a vision-specific PRO measure. Qualitative findings emphasized psychological well-being and social support.

DISCUSSION

PRO data in USH is limited, underscoring the need for standardized measures and vision-related interventions. Ongoing challenges emphasize the need for multidisciplinary approaches to improve quality of life.

Second primary cancer risks in seminoma patients treated with current and previous radiotherapy protocols: a systematic literature review

BACKGROUND AND PURPOSE

Postoperative radiotherapy (RT) with para-aortal (PAO) +/- para-iliac (dog-leg) fields in seminoma patients is an effective treatment, associated with a lifetime risk of developing infra-diaphragmatic radiation-induced second primary cancers (SPC). We performed a systematic review to investigate dose to organs at risk (OAR), associated SPC risks, and landmark changes in RT-protocols, with a special interest in proton therapy.

METHODS

A systematic literature search (1990-2024) was conducted using PRISMA guidelines.

RESULTS

We identified eleven cohort studies reporting consistently excess SPC risks for pancreas, kidney, stomach, and (for dog-leg field) bladder, and colorectum after RT. Important RT-landmarks during the past 60 years were: abandoning mediastinal and inguinal RT, PAO only in stage I, prescription-dose reductions from 30-40 Gy to 20-26 Gy, largely abandoning elective PAO for stage I seminoma in favour of active surveillance, and introduction of proton therapy. RT remains an option in stage II (dog-leg with boosting) and high-risk stage I seminoma. Two studies estimated the dose-response-relationship for pancreas and stomach. Five planning studies showed consistent OAR dose reductions with proton versus photon therapy. Similar or higher OAR doses were observed with intensity-modulated versus conventional RT, due to larger low-dose baths.

CONCLUSIONS

Established SPC risks have changed clinical practice in seminoma patients, and remain relevant for current RT practice. Proton therapy has the potential to reduce dose in relevant OARs at risk for SPCs. Further research on dose-response relationships for SPCs with fractionated RT and protons is needed to improve SPC risk assessment.

Tools used to appraise the quality of studies included in systematic reviews and meta-analyses in human genetics: a systematic review

Quality assessment of primary studies is an essential component of systematic reviews (SRs). This methodological review systematically examines the choice, format and utilization of critical appraisal (CA) tools in SRs with or without meta-analyses in the field of human genetics. We searched MEDLINE, Embase, Web of Science, and PubMed up to January 2024. Two reviewers independently performed title, abstract, full-text screening and data extraction. This PROSPERO registered methodological review followed PRISMA guidelines. Meta-analysis and full-scale risk-of-bias assessment of SRs were not relevant. Among 149 randomly selected SRs, 136 mentioned CA tools (156 citations). Nineteen different generic tools constituted 71.2% of citations. NOS, QUADAS and the Cochrane risk-of-bias tool represented 36.5, 11.5, and 8.3% of tools, respectively. Ninety-three reviews stated following reporting guidelines, with 22 PRISMA checklists accessible. Detailed presentation of results was observed for 65.8% of generic and 37.8% of customized tools (p = 0.0013). Results for NOS were less often detailed than for other generic tools (p < 0.0001). Few SRs used CA results for study selection, data analysis, or discussion of findings. In conclusion, this first review of CA tools in human genetics SRs highlights a lack of transparency regarding utilization of CA tools and deficiencies in reporting of CA results.Registration: PROSPERO (CRD42023449349).

Multimorbidity and fluid biomarkers of Alzheimer's disease: a systematic review

PURPOSE

This systematic review aimed to summarize the evidence on the association between multimorbidity and fluid biomarkers of Alzheimer's disease (AD).

METHODS

We systematically searched PubMed, Web of Science, and Embase for studies investigating the association between multimorbidity-defined as the co-occurrence of multiple chronic conditions in the same individual-and levels of cerebrospinal fluid (CSF) or blood biomarkers of AD, focusing on the most established AD biomarkers (amyloid-beta, phosphorylated-tau, total-tau, neurofilament light chain, and glial fibrillary acidic protein). Studies were selected following PRISMA guidelines.

RESULTS

Out of 3,104 records, we identified 10 cross-sectional studies. Four studies assessed CSF biomarkers in dementia-free participants with mean age between 61.8 and 66.6 years, yielding mixed findings with no consistent association between multimorbidity and CSF biomarkers. Six studies focused on blood biomarkers in participants with mean age ranging from 66.5 to 76.4 years, five of which included individuals with dementia. Most of these studies reported an association between multimorbidity and elevated blood biomarker levels.

CONCLUSIONS

This review suggests a significant association between multimorbidity and AD blood biomarkers in older populations, while the results on CSF are mixed and inconsistent. Further research is needed, particularly longitudinal studies assessing both CSF and blood biomarkers within the same populations.

Cardiovascular disease burden in the homeless population

INTRODUCTION

The burden of cardiovascular disease (CVD) among the homeless population has been rising, driven by factors such as lack of healthcare access, rising mental health disorders and substance use. This study aims to systematically analyse the CVD burden among homeless adults and characterise its prevalence and risk factors. Additionally, our literature review revealed a significant lack of cardiac-focused interventions in this population, thus we build on existing models to propose new CVD-specific interventions.

METHODS

A comprehensive systematic review and meta-analysis were performed on data collected from PubMed and Scopus until 22 October 2024. All observational studies that assessed homeless populations and met inclusion criteria were analysed. The primary outcomes reported were mortality, morbidity and hospitalisation due to CVD. These measures were collectively analysed to evaluate the overall CVD burden.

RESULTS

Our search strategy identified 22 studies, of which 12 were suitable for meta-analysis. We analysed data from 226 205 adults spanning more than 1 000 000 person-years and sought to characterise CVD distribution by demographic subgroups. Our findings indicate that homeless adults experience greater morbidity and mortality due to CVD than non-homeless adults (pooled OR 2.77; 95% CI 1.93 to 3.93; p<0.001; I2 =96.2%). Subgroup analyses by age, sex and geographic region were performed, but no significant differences in CVD morbidity and mortality were found.

CONCLUSION

Homeless adults have approximately three times greater odds of CVD than the general population. We found that the risk of CVD remains elevated regardless of demographic subgroup. Our findings emphasise the urgent need for targeted interventions within this population and highlight its associated risk factors, providing a foundation for the development of targeted interventions and policies.

Type 1 Diabetes Mellitus and Vitamin D

Type 1 diabetes mellitus (T1DM) is a multifactorial disease in which environmental factors and genetic predisposition interact to induce an autoimmune response against pancreatic β-cells. Vitamin D promotes immune tolerance through immunomodulatory and anti-inflammatory functions. The aim of this study is to provide a narrative review about the association between vitamin D status in the pathogenesis of T1DM and the role of vitamin D supplementation in the prevention and treatment of T1DM. Although vitamin D deficiency is more prevalent in children/adolescents with new-onset T1DM than in healthy individuals, there does not appear to be an association between vitamin D status before diagnosis and the onset of T1DMD later in life. The results of vitamin D as adjuvant therapy have, at best, a positive short-term effect in newly diagnosed T1DM patients. Intervention studies have been conducted in the clinical phase of T1DM, but it would be desirable to do so in the early stages of the autoimmune process (pre-diabetes).

The role of FAPI PET/CT in patients with lymphoma: a systematic review

Introduction

Fluorodeoxyglucose (FDG) PET/CT is typically the reference imaging method for assessing and tracking lymphomas. However, fibroblast activation protein inhibitor (FAPI) PET is being explored as a potentially useful option, especially when Fluorodeoxyglucose (FDG) scans do not show clear results.

Methods

For this systematic review, two researchers searched PubMed/MEDLINE and Cochrane CENTRAL for studies on FAPI PET/CT in lymphoma patients.

Results

The literature search initially retrieved 249 articles. After removing duplicates and screening titles and abstracts, and full text, there was a final selection of 15 articles (3 original studies and 12 case reports), encompassing a total of 270 patients. The three original studies were judged to have a low risk of bias according to the QUADAS-2 criteria. The systematic review reveals that FAPI PET/CT exhibits lower diagnostic sensitivity than [18F]FDG PET/CT in lymphomas characterized by low FAP expression. Nevertheless, FAPI PET/CT retains potential as a complementary imaging modality.

Discussion

[18F]FDG PET/CT remains the gold standard in lymphoma imaging, but FAPI PET/CT can potentially provide supplementary information regarding the molecular characteristics of lymphomas. FAPI PET/CT may have prognostic and therapeutic implications. In particular, it could help identify lymphoma subgroups with distinct stromal environments, potentially serving as a prognostic biomarker. Further large-scale prospective studies are warranted to validate its role in lymphoma management.

Patterns of Use of Heated Tobacco Products: A Comprehensive Systematic Review

INTRODUCTION

Relative or absolute safety of heated tobacco products (HTPs) remains unknown, while independent literature suggests that these products do not favor tobacco control. We conducted a comprehensive systematic review and meta-analysis to evaluate HTP usage patterns and the effect of HTP use on conventional tobacco smoking (use transitions).

METHODS

We used Pubmed/MEDLINE, Embase, and the Cochrane Library to identify all articles published up to February 2022 on HTP use. For the present review, we included all representative cross-sectional studies dealing with HTP use, and all prospective cohort studies or cross-sectional studies on conventional tobacco smoking transitions due to HTP use. From 610 non-duplicate articles, 76 were eligible (71 cross-sectional and 5 prospective cohort studies).

RESULTS

Compared with young adults, HTP use was less frequent among middle-aged (15 studies; pooled odds ratio [OR] 0.59; 95% confidence interval [CI], 0.48-0.74) and older adults (12 studies; OR 0.17; 95% CI, 0.07-0.38). HTP use was more frequent among former (6 studies; OR 2.73; 95% CI, 1.03-7.25) and current smokers (12 studies; OR 14.53; 95% CI, 6.34-33.31). Overall, 68.3% of HTP users were dual users (n = 26). Eight studies (including 5 cohorts) showed that HTP users were more likely than non-users to start conventional cigarette smoking (2 studies; OR 6.31; 95% CI, 4.13-9.65), whereas current cigarette smokers using HTPs were less likely to quit (4 studies; OR 0.84; 95% CI, 0.80-0.89).

CONCLUSION

We found that HTPs are specifically popular among young generations. More than two out of three HTP users are dual users. Prospective studies consistently show that, in real life, HTPs are not effective smoking-cessation tools.

Prevalence and risk factors for cancer-related fatigue in women with malignant gynecological tumors: a meta-analysis and systematic review

BACKGROUND

Cancer-related fatigue (CRF) is one of the most prevalent symptoms, but its prevalence and associated risk factors remain inconsistent across studies.

OBJECTIVE

To identify the prevalence and risk factors for CRF in women with malignant gynecological tumors.

METHODS

A comprehensive search of databases, including Web of Science, Cochrane Library, PubMed, Embase, CNKI, VIP, Wan Fang, and CBM, was conducted for relevant studies published from the inception of the database until September 7, 2023. Two reviewers used EndnoteX9 software to independently review, extract data, cross-check, and use the Newcastle-Ottawa quality assessment scale and the Agency for Healthcare Research and Quality tool for risk of bias assessment to evaluate bias risk. Stata 17.0 software was used to perform a traditional meta-analysis.

RESULTS

The meta-analysis included 33 studies, of which 29 reported the prevalence of CRF. The combined prevalence of CRF was 89% (95% confidence interval [CI]: 80-95%), and the combined prevalence of chronic CRF was 25% (95%CI: 22-28%). The combined prevalence of CRF in patients with ovarian cancer, cervical cancer, endometrial, and gynecological malignancies (including but not limited to cervical, ovarian, vaginal and other mixed types of gynecological cancers) was 77%, 94%, 90%, and 93%, respectively. The variability in CRF measurement is due to the different scales used across studies. Its prevalence varies by country, and developing countries, especially China, have a high prevalence of CRF. The following risk factors were associated with CRF: age (odds ratio [OR] = 1.43, 95%CI = 1.12-1.83), psychological factors (OR = 1.40, 95%CI = 1.14-1.72), disease stage (OR = 1.65, 95%CI 1.14-2.40), and social support (OR = 0.77, 95%CI 0.67-0.87).

CONCLUSION

The prevalence of CRF is significant in women with gynecological cancers, especially in developing countries. Age, psychological factors, and disease stage are risk factors for CRF, while social support serves as a protective factor. Healthcare professionals can obtain a clearer picture of CRF in women with gynecological malignant tumors and identify risk factors to support subsequent interventions in these patients.

PROSPERO ID

CRD42023489433.

Lower Odor Identification in Subjective Cognitive Decline: A Meta-analysis

Introduction

Odor identification correlates with Alzheimer's disease (AD) biomarkers, and its decline may emerge before measurable cognitive deficits-as early as the subjective cognitive decline (SCD) stage. We aimed to compare odor identification between SCD and cognitively normal (CN) stages and investigate whether cognitive differences moderate olfactory deficits.

Methods

A systematic search of four databases identified studies assessing olfactory identification and cognitive screening in individuals aged 50+. A random-effects meta-analysis was performed on 11 studies (660 SCD, 574 CN).

Results

Individuals with SCD exhibited lower olfactory identification scores compared to CN participants (SMD = -0.67, 95%CI [-1.31, -0.03], p = .04). Meta-regression revealed a negative association (β = -1.79, p = .02) between cognitive and olfactory differences, indicating that greater cognitive decline was not consistently associated with greater olfactory deficits, lower odor identification scores in SCD occurred despite minimal cognitive differences across groups.

Discussion

Odor identification is lower in pre-MCI individuals reporting SCD. Olfactory decline may emerge independently prior to measurable cognitive decline, supporting the role of odor identification as a screen for AD.

Unlocking the Impact: A Systematic Review and Meta-Analysis of Biomechanical Insights into Rugby Head Impacts Using Wearable Sensor Technology

BACKGROUND

In the realm of sports medicine, understanding the biomechanics of head impacts, particularly in contact sports such as rugby, is of utmost interest for injury prevention and player safety.

OBJECTIVE

This systematic review and meta-analysis aims to consolidate existing knowledge on head impacts in rugby using wearable sensor technology, focusing on peak linear acceleration, peak rotational acceleration, and impact location.

METHODS

A systematic search of electronic databases [PubMed, Web of Science (WOS), Scopus, Embase, SPORTDiscus, PsycINFO, and CINAHL] was conducted in March 2024, including studies that assessed head impacts with wearable technology in rugby athletes. The search did not impose any restrictions on publication dates and included studies published in English and Spanish. A random-effects meta-analysis model was employed to combine comparable data from the included studies.

RESULTS

The literature search yielded 13 prospective cohort studies, collectively analyzing 895 participants and 44,036 head impacts. Most studies were conducted in Australasia and North America, with varying levels of play represented, from junior to semi/professional and from both rugby codes, rugby union (RU) and rugby league (RL). Wearable sensors, including instrumented mouthguards and skin patches, were utilized to measure head impact kinematics, with peak linear acceleration consistently reported across all studies. Results reveal significant heterogeneity in peak linear and rotational acceleration, highlighting the complexity of quantifying impact magnitudes in rugby. Impact location analysis indicated side impacts as most prevalent (44%), followed by frontal (29%) and back impacts (19%). Notably, concussive events yielded a pooled peak linear acceleration estimate of 63.01 g, with the RL cohort exhibiting higher acceleration than RU.

CONCLUSION

This study contributes to the growing body of literature on head impacts in rugby; identifying available evidence on the magnitude and location of head impacts measured by sensors, and emphasizing the importance of wearable sensor technology in advancing player safety and informing injury management practices. Despite the valuable insights provided, limitations, including methodological inconsistencies and study heterogeneity, underscore the need for cautious interpretation. Further research is warranted to standardize protocols and enhance the understanding of effective injury prevention strategies in rugby. PROSPERO registration number: CRD42023480779 (20 November 2023).

Risk of bias tools for medication adherence research: RoBIAS and RoBOAS

AIMS

An unbiased means of documenting medication-taking is important to ensure quality evidence about adherence research and to accurately identify individuals at risk of suboptimal adherence for the development of targeted and effective interventions. Guidance to assist researchers in the understanding of risk of bias when conducting or reviewing adherence research is currently not available. To address this gap, tools to identify and gauge the magnitude of important biases that may impact adherence research have been developed.

METHODS

The Risk of Bias tool for Interventional Adherence Studies (RoBIAS) and the Risk of Bias tool for Observational Adherence Studies (RoBOAS) were constructed from a literature review of key adherence guidelines/frameworks, drafted initially through author consensus. The draft bias tools were piloted and evaluated with expert adherence researchers through an online survey platform to assess the internal consistency and agreement in responses, including gather "free text" feedback to improve the tool's utility.

RESULTS

Of the 121 approached reviewers, only 20 out of the 30 reviewers who consented to participate completed the piloting of the tools. Both tools are structured around four domains relating to: (i) study design, (ii) randomization (RoBIAS tool) and confounding factors (RoBOAS tool), (iii) adherence outcome measurement, and (iv) data analysis. Each domain consists of items/statements, mapped to specific biases relevant to adherence research and study designs, including a domain-based ranking scale to determine the appropriate risk of bias judgement.

CONCLUSIONS

The tools are intended to have utility when systematically reviewing adherence research and to inform the design of future adherence studies.

Perianal Fistulizing Crohn's Disease-Associated Anorectal and Fistula Cancers: Systematic Review and Expert Consensus

BACKGROUND & AIMS

Perianal fistulizing Crohn's disease (PFCD)-associated anorectal and fistula cancers are rare but often devastating diagnoses. However, given the low incidence and consequent lack of data and clinical trials in the field, there is little to no guidance on screening and management of these cancers. To inform clinical practice, we developed consensus guidelines on PFCD-associated anorectal and fistula cancers by multidisciplinary experts from the international TOpClass consortium.

METHODS

We conducted a systematic review by standard methodology, using the Newcastle-Ottawa Scale quality assessment tool. We subsequently developed consensus statements using a Delphi consensus approach.

RESULTS

Of 561 articles identified, 110 were eligible, and 76 articles were included. The overall quality of evidence was low. The TOpClass consortium reached consensus on 6 structured statements addressing screening, risk assessment, and management of PFCD-associated anorectal and fistula cancers. Patients with long-standing (>10 years) PFCD should be considered at small but increased risk of developing perianal cancer, including squamous cell carcinoma of the anus and anorectal carcinoma. Risk factors for squamous cell carcinoma of the anus, notably human papilloma virus, should be considered. New, refractory, or progressive perianal symptoms should prompt evaluation for fistula cancer. There was no consensus on timing or frequency of screening in patients with asymptomatic perianal fistula. Multiple modalities may be required for diagnosis, including an examination under anesthesia with biopsy. Multidisciplinary team efforts were deemed central to the management of fistula cancers.

CONCLUSIONS

Inflammatory bowel disease clinicians should be aware of the risk of PFCD-associated anorectal and fistula cancers in all patients with PFCD. The TOpClass consortium consensus statements outlined herein offer guidance in managing this challenging scenario.

Oral probiotic supplementation to alleviate diarrhea induced by fluoropyrimidines or irinotecan-based chemotherapy: A systematic review and meta-analysis

BACKGROUND

Fluoropyrimidines and irinotecan cause diarrhea, which can be particularly severe in some cases. Probiotic supplementation is a potential option for managing chemotherapy-induced diarrhea. This study aims to evaluate the efficacy and safety of probiotics in managing diarrhea induced by fluoropyrimidine or irinotecan-based chemotherapy in cancer patients.

METHODS

A literature search was conducted in Cochrane Library, PubMed, ScienceDirect, SciFinder, and Scopus in August 2023. Observational and prospective studies of cancer patients receiving 5-fluorouracil, capecitabine, or irinotecan were included. RevMan (version 5.4.1) was used for statistical analysis. The study protocol was registered in PROSPERO.

RESULTS

Of the 9400 records, 24 and 14 studies were included in the systematic review and meta-analysis, respectively. Most studies provided a combination of probiotic strains to patients from the initiation to the completion of chemotherapy cycles. Probiotic supplementation significantly reduced all grade diarrhea (RR = 0.40; 95 % CI: 0.27, 0.60; P < 0.00001, I2: 0 %), nausea and vomiting (RR = 0.49; 95 % CI [0.37, 0.67]; P < 0.00001, I2: 0 %), bloating (RR = 0.27; 95 % CI [0.11, 0.69]; P = 0.006, I2: 0 %) and anorexia (RR = 0.62: 95 % CI [0.43, 0.90]; P = 0.01, I2: 39 %) compared to controls. Absolute risk reductions (ARR) ranged from 22.7 % to 28.5 %, with the number needed to treat (NNT) value of 3-5. Moreover, probiotics improved intestinal microbial balance and symptom scales of quality of life.

CONCLUSIONS

Probiotic supplementation is a promising option to manage chemoradiotherapy-induced diarrhea without serious side effects in cancer patients receiving fluoropyrimidines or irinotecan-based regimens. Given the clinically meaningful ARR and favorable NNT values, probiotics may have a role in clinical practice. However, larger trials are needed to standardize probiotic strain, dosage, duration, and target patient subgroups.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO database (CRD42023473324).

Incidence of pressure injuries in patients with spinal cord injury: A systematic review and meta-analysis

OBJECTIVE

To systematically evaluate the incidence of pressure injuries (PIs) in patients with spinal cord injury (SCI) and to provide a basis for preventing and treating PIs.

METHODS

A systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Electronic databases such as PubMed, Embase, Cochrane Library, Web of Science, China Knowledge Resource Integrated Database (CNKI), Wan-fang Database, Weipu Database (VIP), and the China Biomedical Database (CBM) were searched to collect cross-sectional and cohort studies related to PIs in SCI patients. All electronic literature sources were searched for relevant articles from inception to July 2024. Studies were independently assessed by two researchers and reviewed by a third. Data were extracted and presented in tabular form. The risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist and the Agency for Healthcare Quality and Research (AHRQ) Cross-Sectional Study Evaluation Criteria. All data were analysed using Stata 16.0. The I2 statistics and random effects models were used to determine heterogeneity, and results were expressed as incidence with 95 % confidence intervals (CI).

RESULTS

11,754 articles were screened, and 35 studies involving 150,391 patients were finally included. The combined incidence of PIs in SCI patients was 28.8 % (95%CI: 24.2 to 33.4). For different genders, the incidence of PIs in male SCI patients was 29.2 % (95 % CI: 20.4 to 38.1), while for female SCI patients, it was 25.2 % (95 % CI: 16.1 to 34.3). The PI incidence rate in patients with SCI was 33.9 % (95 % CI: 27.1 to 40.7) before 2005, 29.4 % (95 % CI: 19.1 to 39.7) from 2006 to 2015, and 27.1 % (95 % CI: 20.8 to 33.3) from 2016 to 2024. According to regional distribution data by country, the combined incidence of PIs in SCI patients was 34.3 % (95 % CI: 21.0 to 47.6) in European countries, 20.9 % (95 % CI: 12.8 to 28.9) in Asian countries, 43.3 % (95 % CI: 16.5 to 70.1) in African countries, 25.0 % (95 % CI: 15.9 to 34.0) in North American countries, and 65.3 % (95 % CI: 55.9-74.7) in South American countries. In 12 studies that reported the anatomical location of PIs in patients with SCI, 1113 patients developed 1836 PIs. The sacrococcygeal region had the highest number of these injuries, totalling 521 (28.8 %), followed by the sciatic tuberosity, with 233 (12.9 %), then, the heel, with 221 (12.3 %).

CONCLUSION

The study's results showed an overall incidence of PIs in patients with SCI of 28.8 %, significantly exceeding the average incidence rate in adults. We found that the incidence of PIs was higher in men than in women in patients with SCI. Therefore, clinical care staff needs to adopt effective preventive and therapeutic measures and strategies to reduce the occurrence of PIs. Additionally, the risk factors for PIs in patients with SCI can be further investigated to prevent and treat PIs effectively.

Prevalence of oral frailty in community-dwelling older adults: a systematic review and meta-analysis

Background

Older adults are vulnerable to oral frailty due to factors such as age, education level, physical condition, and limited access to medical resources. Given that oral frailty can lead to adverse outcomes and is often overlooked by policymakers and health professionals, it is important to understand the current state of oral frailty among community-dwelling older adults.

Design

Systematic review and meta-analysis.

Methods

Two researchers independently conducted searches in seven databases, extracted data, and assessed the quality of eligible studies. Data from cross-sectional studies or cohort studies with a clear definition of oral frailty. Stata 14.0 was utilized to evaluate the overall prevalence of oral frailty, while Cochrane's Q, I 2statistics were employed to assess statistical heterogeneity.

Results

A total of 15 studies were ultimately included in this analysis. The pooled prevalence of oral frailty among community-dwelling older adults was 32% (95% CI: 24%-40%, I 2 = 98.9%, P < 0.001). By country, the prevalence was 53% (95% CI: 42%-65%) in China and 22% (95% CI: 19%-39%) in Japan. The incidence of oral frailty was 29% (95% CI: 18%-39%) among those aged 74 and over and 26% (95% CI: 16%-36%) among those under 74. The prevalence of oral frailty was 46% (95% CI: 31%-60%) as assessed by the OFI-8 scale, 18% (95% CI: 14%-22%) using the OF-6 scale, and 37% (95% CI: 34%-39%) with the OFI-5 scale. The rates of oral frailty reported before 2021 and between 2022-2024 were 17% (95% CI: 13%-21%) and 42% (95% CI: 31%-53%), respectively. The rate of oral frailty was 39% (95% CI: 23%-54%) for sample sizes ≤ 500, and 25% (95% CI: 16%-33%) for sample sizes >500. Univariate meta-regression analysis revealed that country, measurement method, and publication year might be sources of heterogeneity. Funnel plot analysis and Egger's test showed no significant publication bias among the eligible studies.

Conclusion

Our study found that oral frailty affects more than one in three older adults living in the community. This highlights the importance for policymakers and health professionals to screen early and implement effective measures to prevent oral frailty among older adults residing in community settings.

Systematic review registration

https://www.crd.york.ac.uk/prospero/#searchadvanced, identifier: CRD42024527800.

Intracavitary electrocardiogram guidance for peripherally inserted central catheter placement: A systematic review and trial sequential meta-analysis

BACKGROUND

The intracavitary electrocardiogram (IC-ECG) localization technique has been widely used in peripherally inserted central catheter (PICC) placement. However, the accuracy of IC-ECG on PICC tip localization and complications remains controversial. The purpose of this work is to evaluate the clinical efficacy and safety of IC-ECG on PICC placement.

MATERIALS AND METHOD

We retrieved randomized control trials from PubMed, Web of Science, Cochrane Library, EMBASE, and CNKI databases published before October 30, 2024. Patients guided by IC-ECG technology or landmark, and then used radiography to confirm the tip position, regardless of age, race, nationality, and region. Interventions other than IC-ECG or landmark were excluded. We used the Cochrane Bias Risk Assessment tools version 2 to evaluate the quality of enrolled trials. The Grading of Recommendations Assessment, Development, and Evaluation Statements online tool was used to determine the certainty of the evidence. The primary outcome was the success rate on the first attempt.

RESULTS

Sixteen studies involving 6707 PICC patients are included. The results of the meta-analysis indicate that the IC-ECG group has a significantly higher success rate on first attempt of PICC placement (RR = 1.23, 95% CI [1.09-1.37], p < 0.00001). Total complications and phlebitis events decreased in the IC-ECG group compared with the landmark group. The mean procedure time, thrombogenesis, infection, and arrhythmia in the IC-ECG group are not statistically significant compared with the landmark group. Trial-sequential analysis (TSA) of the results indicate that sufficient events had been observed in the outcomes in success rate on first attempt, overall successful rate, total complications, phlebitis events, and infection events.

CONCLUSION

The IC-ECG guided method has a higher success rate on the first attempt and lower total complication for catheter tip localization in PICC placement. IC-ECG may be considered the preferred method for accurate catheter tip placement. (PROSPERO registration number, CRD42023456651).

Acute management of adults following chest wall injury: An assessment of institutional clinical practice guidelines across the UK and synthesis of care recommendations

OBJECTIVE

Chest wall injury causes significant morbidity and mortality. There is uncertainty regarding many aspects of clinical care for these patients, including optimal analgesia, acuity of monitoring and surgical fixation. Our aim in this work is to [1] objectively appraise the quality and extent of heterogeneity in UK major trauma centre (MTC) clinical practice guidelines regarding the management of chest wall injury; and [2] narratively summarise clinical and care process recommendations from these guidelines to provide a comparative description of recommendations between institutions.

METHODS

All major trauma centres in England and Wales were contacted for their institutional clinical practice guidelines relevant to chest wall injury. A literature search was executed seeking eligible supra-regional, national or international consensus documents or guidelines to serve as reference standards. Interrogation of the reference standard guidelines was performed to identify key clinical and care processes against which two blinded assessors judged the clinical validity of institutional clinical practice guidelines as part of the Appraisal of Guidelines for Research & Evaluation II Global Rating Scale (AGREE II-GRS) tool.

RESULTS

We received 17 institutional clinical practice guidelines and identified themes of care from seven reference standards identified during our literature search. Four institutional clinical practice guidelines were assessed as high-quality by pre-specified AGREE II-GRS criteria. Guidelines scored highly for the quality of their presentation of information (median (interquartile range [IQR]) AGREE II-GRS Item5 score 5 (4.5-5.5)); however, the quality of guideline development methodology and the guideline completeness in comprehensively addressing the needs of this population was generally poor (median (IQR) AGREE II-GRS Item1 methodology score 2.92 (2.33-5.25); AGREE II-GRS Item3 completeness score 2.63 (1.75-5.25) respectively).

CONCLUSIONS

This work highlights the paucity of high-quality local clinical practice guidelines to inform the management of adults with chest wall injury admitted to UK MTCs. Although some degree of variation between local guidelines is acceptable, we have identified substantial heterogeneity in the clinical care recommendations between institutions.

Gut microbiota of patients with post-stroke depression in Chinese population: a systematic review and meta-analysis

Background

Evidence of changes in the composition and function of the gut microbiota (GM) in post-stroke depression (PSD) patients is gradually accumulating. This study aimed to systematically evaluate the relationship between PSD and GM.

Methods

We searched in PubMed, Web of Science, Embase, Cochrane databases, Wangfang, VIP, CBM, and CNKI from the establishment of the database to April 17, 2024, and systematic review and meta-analysis were performed to investigate the differences of GM between patients with PSD spectrum and healthy controls (HC) or stroke spectrum.

Result

There were 14 studies consisting a total of 1,556 individuals included in the meta-analysis. The pooled results showed that PSD spectrum demonstrated significantly increased α diversity as indexed by Chao1 index, ACE indexes, Shannon index, and Simpson index as compared to HC. Additionally, stroke spectrum significantly increased α diversity as indexed by Simpson index compared to PSD. Furthermore, the pooled estimation of relative abundance showed that Bacteroidota, Fusobacteriota, and Pseudomonadota in PSD patients were significantly higher than those in the HC group, while the abundance of Bacillota was higher in the HC group. Moreover, significant differences in GM were observed between PSD patients and HC at the family and genus levels.

Conclusion

This study found that the α diversity of PSD patients was higher than that of HC. Moreover, there were also differences in the distribution of GM at the phylum, family, and genus levels, respectively. At the same time, the level of Lachnospira in PSD patients was lower than that in the stroke group.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024582708.

Efficacy of intravitreal faricimab therapy for polypoidal choroidal vasculopathy: A systematic review and meta-analysis

Polypoidal choroidal vasculopathy (PCV) is an aneurismal type of macular neovascularization that show similarities with age-related macular degeneration and diseases that are part of the pachychoroid disease spectrum. Exudative changes in PCV can be treated with intravitreal anti-vascular endothelial growth factor monotherapy; however, a combination therapy with photodynamic therapy may be required. In this systematic review and meta-analysis, we evaluated the efficacy of faricimab for PCV. We searched 12 literature databases for eligible studies. All study evaluation and data extraction were made by two authors in duplicate. Studies eligible for analysis were included for a qualitative and quantitative review. We identified seven studies with data from 150 eyes with PCV, five studies were of treatment-naïve eyes who were commenced in faricimab monotherapy, and two studies were of switch-over to faricimab from other anti-VEGF drugs. After faricimab loading dose in treatment-naïve eyes, the best-corrected visual acuity (BCVA) remained stable at -0.09 (95% CI: -0.20-0.03) logMAR, central retinal thickness (CRT) decreased -169 (95% CI: -311--27) μm, and 48.7 (95% CI: 32.5-65.0) % of eyes obtained polyp closure. In switch-over eyes, 57%-67% experienced fluid reduction and 21% were able to extend their treatment interval. In conclusion, faricimab monotherapy for PCV leads to acceptable clinical outcomes in terms of stable BCVA, reduction of CRT, and high incidence of polyp closure. Some cases may benefit from a switch to faricimab. However, long-term efficacy studies and controlled comparative studies are warranted.

Ultrathin bronchoscopy versus conventional bronchoscopy in the diagnosis of peripheral pulmonary lesions: a systematic review and meta-analysis

BACKGROUND

Ultrathin bronchoscopy (UTB) is commonly used to diagnose peripheral pulmonary lesions due to its small diameter. However, there is no consensus on its comparison with conventional bronchoscopy (CB) combined with various guiding modalities.

METHODS

A comprehensive literature search was performed to identify studies comparing UTB and CB, extracting data on diagnostic yield, operating time, complications, pathological diagnoses, and lesion size. Protocol registration: identifier CRD42024554649. PRISMA guidelines were followed.

RESULTS

This meta-analysis included 11 studies with 2,640 patients. UTB demonstrated a significantly higher diagnostic yield (70.5% vs. 57.6%, p = 0.005), particularly with rEBUS and fluoroscopy (p = 0.02). UTB had a higher complication rate, but the difference was not significant (p = 0.37). It also had a shorter operative time than CB-GS (p = 0.007). UTB showed a significant advantage in diagnosing malignant tumors, especially adenocarcinoma and metastatic cancer (p = 0.02, p = 0.03). Both techniques were comparable in diagnosing benign conditions, but UTB outperformed CB in all lesion size categories (p < 0.01).

CONCLUSIONS

UTB's smaller diameter likely provides a diagnostic advantage over CB and CB-GS by enabling deeper and more accurate access to peripheral lung regions.

A Scoping Review of Inclusive Best Practices in Geriatric Primary Care

The age of the United States is steadily increasing while the number of practicing and upcoming primary care physicians trained to provide geriatric care is limited. The US population is incredibly diverse, with minority ethnic groups anticipated to reach 50% of the US population over the next few decades. It is unclear how culture considerations are being integrated within primary care best practices, identifying a clear gap in our understanding and the literature. The current scoping review identified relevant publications regarding primary care best practices and the consideration of culture. Following Arksey and O'Malley's (2005) guidelines, two researchers completed two searches across databases for articles discussing best practices/culture considerations in primary care targeting geriatric populations. Seven articles were included for consideration in this review. Our findings indicate limited research has empirically investigated best practices or cultural considerations within geriatric primary care. Recommendations and future research are discussed.

Drug-drug interaction among elderly patients in Africa: a systematic review and meta-analysis

BACKGROUND

Elderly patients are at a heightened risk of drug-drug interactions due to their high prevalence of comorbidities, polypharmacy, and age-related physiological changes that alter drug metabolism and excretion. In Africa, these risks are compounded by unique healthcare challenges, including limited access to diagnostic tools, and high burdens of communicable diseases. The aim of this study is to estimate the prevalence of drug-drug interactions and its associated factors among elderly patients in Africa.

METHODS

Relevant research articles were identified from databases such as HINARI, Science Direct, Embase, PubMed/MEDLINE, Google Scholar, and Research Gate. Data were extracted via a Microsoft Excel spreadsheet and analyzed via STATA version 11.0. Egger regression tests and funnel plot analysis were used to check for publication bias, and the I2 statistic was used to evaluate statistical heterogeneity. Sensitivity and subgroup analyses were also conducted to identify potential causes of heterogeneity.

RESULTS

Fifteen articles were analyzed, and a total of 5651 potential drug-drug interactions (pDDIs) were identified in 1952 patients, resulting in an average of 2.89 pDDIs per patient. The overall prevalence of pDDIs among elderly patients was 52.53% (95% confidence interval (CI): 35.40, 69.66). However, the prevalence of pDDIs ranged widely from 2.8 to 90.1%. When the severity of the interactions was considered, the prevalence of pDDIs was 20.59%, 69.4%, 34.32% and 1.59% for major, moderate, minor, and contraindicated DDIs, respectively. Polypharmacy, long hospital stays, hypertension and diabetes mellitus were identified as factors associated with pDDIs among elderly patients in Africa.

CONCLUSION

DDIs are prevalent among elderly patients in Africa and are often associated with polypharmacy, prolonged hospitalizations, and the presence of chronic comorbidities, particularly hypertension and diabetes mellitus. Moderate-severity interactions were the most prevalent DDIs. The study suggests addressing this issue requires targeted interventions, including improved pharmacovigilance, enhanced prescribing practices, and integration of DDI risk assessment into routine clinical care. The study also suggests that the database itself could have modified the DDI prevalence rate. As a result, a single DDI identification database needs to be authorized; otherwise, clinical knowledge should be taken in to account when interpreting the information obtained.

Corticosteroids in posterior reversible encephalopathy syndrome: Friend or foe? A systematic review

BACKGROUND

Posterior reversible encephalopathy syndrome (PRES) is a complex neurological disorder characterized by symptoms such as headaches, seizures, confusion, and visual disturbances. The pathophysiology of PRES involves endothelial dysfunction, disrupted cerebral autoregulation, and resulting vasogenic edema. Hypertension and other factors that alter cerebral autoregulation are critical in its development. Corticosteroids, widely used for their anti-inflammatory and immunosuppressive properties, play a controversial role in PRES.

AIM

To elucidate the dual role of corticosteroids in the context of PRES by critically evaluating the existing literature. Specifically, it seeks to assess the results of PRES induced by corticosteroid therapy and the efficacy and safety of corticosteroids in the treatment of PRES. By synthesizing case reports and series, this review aims to provide a comprehensive understanding of the mechanisms, clinical presentations, and management strategies associated with corticosteroid-related PRES.

METHODS

The review was carried out according to the PRISMA guidelines. The databases searched included Science Direct, PubMed, and Hinari. The search strategy encompassed terms related to corticosteroids and PRES. Studies were included if they were peer-reviewed articles examining corticosteroids in PRES, excluding non-English publications, reviews, and editorials. Data on patient demographics, clinical characteristics, imaging findings, corticosteroid regimens, and outcomes were extracted. The risk of bias was evaluated using the Joanna Briggs Institute tool for case reports.

RESULTS

A total of 56 cases of PRES (66.1% women, 33.9% men) potentially induced by corticosteroids and 14 cases in which corticosteroids were used to treat PRES were identified. Cases of PRES reportedly caused by corticosteroids showed a mean age of approximately 25.2 years, with seizures, headaches, hypertension, and visual disturbances being common clinical sequelae. Magnetic resonance findings typically revealed vasogenic edema in the bilateral parieto-occipital lobes. High-dose or prolonged corticosteroid therapy was a significant risk factor. On the contrary, in the treatment cases, corticosteroids were associated with positive outcomes, including resolution of vasogenic edema and stabilization of symptoms, particularly in patients with underlying inflammatory or autoimmune diseases.

CONCLUSION

Corticosteroids have a dual role in PRES, capable of both inducing and treating the condition. The current body of literature suggests that corticosteroids may play a greater role as a precipitating agent of PRES rather than treating. Corticosteroids may induce PRES through hypertension and subsequent increased cerebral blood flow and loss of autoregulation. Corticosteroids may aid in the management of PRES: (1) Enhancing endothelial stability; (2) Anti-inflammatory properties; and (3) Improving blood-brain barrier integrity. Mechanisms which may reduce or mitigate vasogenic edema formation.

Association between metabolically healthy obesity and atrial fibrillation: A systematic review and meta-analysis of longitudinal studies

INTRODUCTION

Obesity is not a single diagnosis, and the association of 'metabolically unhealthy' obesity with cardiovascular disease is well-described. However, the relationship between metabolically healthy obesity (MHO) and atrial fibrillation (AF) is still debated.

OBJECTIVE

Our objective is to investigate the association between MHO and the risk of AF.

METHODS

A comprehensive search of databases, including PubMed, EMBASE, Web of Science, and the Cochrane Library regarding longitudinal studies of MHO and risk of AF was performed. Random effects were used to pool the effect estimates.

RESULTS

Nine cohort studies comprising 4,250,557 participants were included. The pooled results revealed that individuals with MHO were associated with a greater incidence of AF than those with a metabolically healthy normal weight (HR: 1.34, 95 % CI: 1.26 to 1.42) with moderate certainty according to the Grading of Recommendations Assessment, Development, and Evaluation assessment. Individuals with MHO were associated with a lower risk of AF compared with participants with metabolically unhealthy obesity (RR: 0.48, 95 % CI: 0.36 to 0.64). Individuals with MHO were not significantly associated with the risk of AF as compared to metabolically unhealthy normal weight (HR: 1.04, 95 % CI: 0.89 to 1.22).

CONCLUSION

MHO is associated with a greater incidence of AF, highlighting the importance of weight reduction in individuals without metabolic disorders in reducing the risk of AF.

REGISTRATION

PROSPERO - registration number CRD42023432195.

Association between prenatal environmental tobacco smoke exposure and preterm birth: A systematic review and meta-analysis

INTRODUCTION

The purpose of this systematic review and meta-analysis is to evaluate the global risk of preterm birth associated with passive smoking. Specifically, the study aims to examine whether passive smoking continues to impact preterm birth rates, with particular attention to the potential effects following the implementation of stricter smoking bans in recent years.

MATERIAL AND METHODS

This systematic review and meta-analysis followed PRISMA guidelines and was preregistered in PROSPERO. A comprehensive literature search was conducted in PubMed, Embase, CINAHL, and Web of Science up to February 17, 2024, using keywords related to passive smoking and preterm birth. Eligible observational studies were selected, and data were independently extracted and assessed for quality by two authors. Statistical analysis used odds ratios (ORs) and the I2 statistic for heterogeneity. Subgroup analyses and publication bias assessments were conducted. Review Manager and Stata were used for the analysis, with significance set at p < 0.05.

RESULTS

Meta-analysis showed a 21% increase in the odds of preterm birth in women exposed to environmental tobacco smoke (ETS) (OR, 1.21; 95% CI, 1.10-1.32) with significant heterogeneity (I2 = 76.2%). Stronger associations were found in cohort and cross-sectional studies, studies in Asia, larger sample sizes, and recent publications. Findings were robust across various analyses.

CONCLUSIONS

Prenatal environmental tobacco smoke exposure significantly increases preterm birth risk. Effective public health interventions, including stringent smoke-free policies, public education, and awareness campaigns, are needed to reduce environmental tobacco smoke exposure and improve maternal and infant health outcomes.

Ceramic-based 3D printed bone graft in bone tissue reconstruction: a systematic review and proportional meta-analysis of clinical studies

INTRODUCTION

This systematic review and proportional meta-analysis aims to evaluate the postoperative complication rate (CR%) of ceramic-based 3D-printed bone grafts based on the reported scientific articles conducted with human individuals.

METHODS

MEDLINE and SCOPUS were used as information sources. The synthesis of the study was carried out from studies with human individuals and the use of 3D-printed bone graft-ceramic as inclusion criteria. Cohen's kappa (κ) was calculated for interrater reliability. Qualitative analysis was performed based on the characteristics and outcomes of the individual study, and quantitative analysis was performed using proportional meta-analysis for CR%.

RESULTS

A total of 1352 records were identified through databases and resulted in 11 included studies (κ = 0.81-1.00) consisting of prospective clinical trials (64.63%), case series (16.67%), and case reports (18.18%). The overall postoperative complication rate was 14.3% (95% Cl: 0.19-53.6). The postoperative complication rate for studies conducted on the cranial defect, the maxillofacial-zygomatic defect, and the tibial-femoral defect was 2.7%, 11.1%, and 15.6%, respectively. This review also highlights common 3D printing techniques, materials, and grafs' characteristics, as well as their clinical applications.

CONCLUSIONS

Ceramic-based 3D-printed bone grafts show potential as alternatives for bone tissue reconstruction.

The association between serum soluble fms-like tyrosine kinase-1, placental growth factor, and soluble fms-like tyrosine kinase-1/placental growth factor ratio in singleton pregnancy and placental abruption: a systematic review and meta-analysis

OBJECTIVE

The study aimed to evaluate whether women with singleton pregnancies who experienced subsequent placental abruption had lower serum placental growth factor concentrations, higher serum soluble fms-like tyrosine kinase-1 concentrations, and a higher soluble fms-like tyrosine kinase-1/placental growth factor ratio compared to women with singleton pregnancies without placental abruption.

DATA SOURCES

PubMed/MEDLINE, Scopus, and the Web of Science and ClinicalTrials.gov databases had been searched electronically until March 2025, using combinations of relevant medical subject heading terms, keywords, and word variants considered suitable for the topic.

STUDY ELIGIBILITY CRITERIA

Prospective and retrospective comparative cohort studies and case-control studies were included. Case reports, editorials, letters to the editor, and conference abstracts were excluded from the systematic review.

STUDY APPRAISAL AND SYNTHESIS METHODS

The outcome of the study included differences in placental growth factor, soluble fms-like tyrosine kinase-1 concentrations, or the soluble fms-like tyrosine kinase-1/placental growth factor ratio between placental abruption cases and a group without placental abruption. The quality assessment of the included studies was performed using the Newcastle-Ottawa Scale. Continuous data were expressed as the mean difference with a 95% confidence interval when the units of measurement for the outcome variable were the same. When conducting the meta-analysis, a random effects model was consistently employed.

RESULTS

The main findings of this systematic review and meta-analysis are as follows: 1) maternal serum placental growth factor concentration did not differ between women with and without placental abruption; 2) maternal serum soluble fms-like tyrosine kinase-1 concentration was higher in women with placental abruption, especially when assessed in the second half of gestation; and 3) maternal serum soluble fms-like tyrosine kinase-1/placental growth factor ratio was higher in women with placental abruption, both in the first and second half of pregnancy, with the difference being no longer significant in women with the diagnosis or symptoms of preeclampsia.

CONCLUSION

The results presented in this systematic review may improve the risk stratification for placental abruption. Understanding the changes of the above markers in placental abruption may support clinical guideline development with regard to prediction models of the above complication.

Implant failure of facial prostheses: systematic review and meta-analysis

The aim of this systematic review was to evaluate craniofacial implant failure in the auricular, orbital, and nasal regions, including the impact of radiotherapy and evaluation of early (<1 year) and late (>1 year) implant failure. Five electronic databases were searched for articles reporting studies on implant failure in auricular, nasal, and/or orbital prostheses. The PRISMA guidelines were followed. Sixteen studies (3630 implants in 1127 patients) were included. The pooled implant failure rate was 3.5% in the auricular region, 18.7% in the orbital region, and 8.8% in the nasal region. Compared to the auricular region, implants inserted in the orbital (risk ratio (RR) 4.54) and nasal (RR 3.00) regions had a significantly higher risk of failure. Auricular (RR 2.17) and orbital (RR 2.07) implants had an increased risk of failure in irradiated bone. Regarding early failure (<1 year), 79.8% of nasal implants that failed were found to fail early, compared to 21.4% and 35.4% of failed auricular and orbital implants, respectively. This meta-analysis is novel in studying the timing of implant failure. Future studies should cover long observation periods and adequately report failure rates. There is a lack of high-quality studies and well-defined standardized outcome parameters. Results should be interpreted with caution due to low levels of evidence. DATA AVAILABILITY: This review has been registered with the Open Science Framework (doi:10.17605/OSF.IO/EBUC4). The study protocol and data files are publicly accessible.

Participation and Yield of Gastric Cancer Screening Programs: A Systematic Review and Meta-analysis

BACKGROUND & AIMS

Hundreds of gastric cancer (GC) screening programs have been launched worldwide over the past 3 decades. However, no comprehensive study evaluating the outcomes of these programs has been conducted.

METHODS

This meta-analysis aimed to evaluate the temporal and geographical patterns of three key indicators in GC screening programs: endoscopic uptake rate (EUR), GC detection rate (GCDR), and early GC detection rate (EGCDR). The search was conducted until September 20, 2023. Pooled random-effect estimates of the indicators were computed, with further subgroup analysis stratified by study period, country, screening setting, local GC age-standardized incidence, and pre-screening modality.

RESULTS

A total of 67 studies were included in the analysis. Of these, 42 reported an EUR of 46% (95% confidence interval [CI], 41%-52%), 47 reported a GCDR of 0.76% (95% CI, 0.55%-0.96%), and 27 reported an EGCDR of 59% (95% CI, 49%-70%). Developed countries demonstrated notably superior performance in EUR (51% vs 37%; P = .009) and EGCDR (78% vs 44%; P < .001) compared with developing countries. A gradual increase in the EUR was found, rising from 46% pre-2010 to 48% post-2010 (P = .739). In contrast, both GCDR and EGCDR exhibited a slight decline, with GCDR decreasing from 0.78% pre-2010 to 0.75% post-2010 (P = .905), and EGCDR from 65% pre-2010 to 56% post-2010 (P = .404). Multivariate meta-regression analysis revealed that a higher local GC incidence and studies conducted in Japan were independently associated with higher values of both EUR (P = .010 and P = .027, respectively) and EGCDR (P = .008 and P = .002).

CONCLUSIONS

The participation and yield of GC screening programs were comprehensively assessed using 3 indicators proposed in this study.

A Systematic Review and Meta-Analysis Association Between Periodontitis and Age-Related Macular Degeneration: Potential for Personalized Approach

Background/Objectives: Periodontitis is a chronic inflammatory disease that leads to systemic low-grade inflammation. Systemic low-grade inflammation has been found in patients with age-related macular degeneration (AMD). In this systematic review and meta-analysis, we evaluated the association between periodontitis and AMD. Methods: We searched 11 scientific literature databases on 16th December 2024 for studies of a diagnosis of periodontitis and prevalent or incident AMD. Eligible studies underwent a qualitative review and meta-analysis of the association. Study selection, data extraction, and risk of bias within studies were made in duplicate by two authors and conferred with a senior author. Results: Seven studies eligible for review included in total 149,217 individuals. Across the seven studies, different study designs, diagnoses and definitions of periodontitis, and diagnosis and definitions of AMD were employed. Our meta-analysis showed an association between periodontitis and AMD with an odds ratio of 1.42 (95% CI: 1.12 to 1.78; p = 0.003). Conclusions: Periodontitis is significantly associated with AMD. Unlike genetic predisposition and high age, which are important risk factors of AMD that cannot be modified, periodontitis is a risk factor that can be treated and potentially eliminated, thus allowing for a personalized approach for risk elimination in AMD. Attention should be given to the dental health of patients at risk of AMD.

Chronotype and synchrony effects in human cognitive performance: A systematic review

Chronotype is a proxy for various intra-individual rhythms (e.g. sleep-wake cycles) which fluctuate throughout the day. The extent to which chronotype modulates cognitive performance remains unclear. Here, we systematically reviewed studies to determine the influence of chronotype on its own, and/or in interaction with time of day (ToD; optimal/non-optimal), in cognitive function in healthy adults. Following PRISMA guidelines, data searches were conducted in PubMed and Web of Science databases (11 March 2024), yielding 65 studies (53 in adults aged 18-45 y; 11 comparing adults aged 18-32 and 50-95 y; one involving only morning type adults aged 60-76 y). Most of the reviewed studies (>80%) indicated no main effect of chronotype on cognitive function. There was evidence from 29 (45.31%) of 64 studies involving adults aged 18-45 y of a synchrony effect (i.e. superior performance at optimal ToD) in morning and/or evening types, mostly in attention, inhibition, and memory. In older adults, there was evidence of a synchrony effect from 10 (83.33%) of 12 studies, especially on tasks involving fluid abilities. Limited evidence suggested higher activation of inhibition-related brain regions at optimal ToD in both chronotypes, and synchrony effects being impacted by certain exogenous factors known to affect arousal and performance (e.g. task complexity, lighting conditions). Our findings highlight the need to carefully consider age along with endogenous and exogenous sources of intra-individual variations in arousal while determining synchrony effect in cognitive functions. Not acknowledging these synchrony effects may also result in exaggerated cognitive deficits especially in the elderly.

Cortisol in schizophrenia spectrum disorders: A comprehensive meta-analysis

Schizophrenia spectrum disorders (SSD) are characterized by alterations in cortisol levels across various parameters, including stress reactivity, hair cortisol, and baseline levels, which may be influenced by antipsychotic treatment. To provide a comprehensive overview of cortisol dysregulation in SSD, we conducted meta-analyses assessing (1) the effects of antipsychotic treatment in SSD patients, and additionally comparing cortisol in SSD patients versus healthy controls (HC) (2) following stress induction (metabolic, physiological, psychological stressors), (3) in hair and (4) baseline levels. Systematic literature searches in PubMed, Web of Science, and PsycINFO (November 2024) identified 121 studies (9049 SSD patients) for inclusion. Meta-analytic results revealed that antipsychotic treatment significantly reduced cortisol levels in SSD (k = 16, g = -0.480, 95 % CI [-0.818, -0.142], p = 0.005). Additionally, compared to HC, SSD was associated with reduced cortisol suppression following dexamethasone exposure (k = 9, g = 0.299, 95 % CI [0.091, 0.507], p = 0.005) and with elevated baseline cortisol levels in the morning (k = 71, g = 0.38, 95 % CI [0.210, 0.546], p < 0.001) and evening (k = 11, g = 0.368, 95 % CI [0.076, 0.661], p = 0.014). However, there were no significant group differences in afternoon baseline cortisol, hair cortisol or cortisol reactivity to stress (p > 0.05). These findings offer a detailed understanding of cortisol alterations in SSD and improve our understanding of HPA axis dysregulation in SSD.

Graft Options for the Reconstruction of Multi-ligament Knee Injury: A Systematic Review

Introduction

The literature lacks enough synthesis on which autograft option is suitable for a particular ligament reconstruction during multi-ligament reconstruction. This study aims to conduct a systematic review of existing literature to determine graft options available for the reconstruction of various ligaments in the context of multi-ligament knee injury.

Methods

A systematic review was conducted following the preferred research items for systematic reviews and meta-analyses (PRISMA) guidelines. It was registered in PROSPERO (CRD42024498917). Studies that met the predefined inclusion and exclusion criteria were included in this systematic review.

Results

Out of 8070 identified citations, 16 studies with a total of 640 patients(645 knees), including 420(65.6%) males and 220(34.4%) females, with a mean age of 35.1 years were included. Among 16 papers included in this review, combining autografts, allografts, or synthetic grafts was the preferred choice in seven studies. Autografts were chosen in five research studies, while allografts were preferred in four. For Anterior Cruciate Ligament (ACL) reconstruction: Eleven studies used only autografts, two used only allografts, and 1 study used both autografts and allografts. For Posterior Cruciate Ligament (PCL) reconstruction, nine studies used allografts, six used autografts, and 1 study used synthetic graft. For Posterior Lateral Corner (PLC) reconstruction, six studies used allografts, five used autografts, and 1 study used synthetic graft. For posterior medial corner (PMC) reconstruction, eight studies used autografts, five used allografts, and only one used synthetic grafts.

Conclusion

A combination of autografts, allografts, or synthetic grafts was the preferred graft option for multi-ligament knee reconstruction. Autografts are the most preferred option for ACL and PMC reconstruction, whereas allografts are the most preferred option for PCL and PLC reconstruction. The most preferred autograft was the Hamstring Tendon (HT) autograft. Similarly, the tendoachillies (TA) was the most used allograft. However, the strength of the evidence in this review is moderate to low.

Association Between Triglyceride Glucose Index and Risk of Carotid Plaques in Asia: A Systematic Review and Meta-Analysis

The triglyceride glucose (TyG) index is used to assess insulin resistance, which is associated with the occurrence and development of cardiovascular diseases, but the risk of carotid plaques is controversial in Asia. We searched PubMed, Embase, Scopus, and Cochrane Library for articles published up to October 15, 2023, to assess the association and dose-response association of the TyG index with the risk of carotid plaques in Asia. The random effects model was used to calculate the effect estimates and 95% confidence intervals (CIs). A total of 534 articles were retrieved, and eleven studies were selected, involving 145 218 Asian participants. When the TyG index was analyzed as a categorical variable, compared with the low TyG index, the high TyG index increased the risk of carotid plaques (OR=1.38, 95% CI: 1.20, 1.60, p<0.001). As continuous variables were analyzed, similar results were observed (OR=1.33, 95% CI: 1.22, 1.45, p<0.001). Meanwhile, dose-response analysis showed that the risk of carotid plaque increased by 1.03 times for every unit increase in the TyG index (RR=1.03, 95% CI: 1.02, 1.03, p<0.001). Our meta-analysis indicates an association between the TyG index and the risk of carotid plaques in Asia. Further studies are required to substantiate these findings.

The Impact of Sedative Choice in the Management of Aneurysmal Subarachnoid Hemorrhage: A Scoping Review

Aneurysmal subarachnoid hemorrhage (aSAH) is characterized by high mortality and morbidity. This scoping review assesses the current evidence regarding the use of sedatives and analgesics in the acute intensive care unit management of aSAH. We conducted a systematic search of Ovid MEDLINE, Ovid Embase, Ovid EmCare, APA PsycInfo, CINAHL, and the Cochrane Database of Systematic Reviews from inception to June 2023. Studies were included if they enrolled intensive care unit patients aged 18 or older with a significant proportion (> 20%) who had aSAH and evaluated the impact of one or more commonly used analgosedatives on physiological parameters in the management of aSAH. The methodological quality of the studies was assessed using the Methodological Index for Nonrandomized Studies score. Of 2,583 articles, 11 met the inclusion criteria. The median sample size was 47 (interquartile range 10-127), and the median Methodological Index for Nonrandomized Studies score was 9.5 (interquartile range 8-11). The studies' publication years ranged from 1980 to 2023. Dexmedetomidine and ketamine showed potential benefits in reducing the incidence of cortical spreading depolarization and delayed cerebral ischemia. Propofol and opioids appeared safe but lacked robust evidence for efficacy. Benzodiazepines were associated with increased delayed cerebral ischemia-related cerebral infarctions and cortical spreading depolarization events. The evidence available to guide the use of analgosedative medications in aSAH is critically inadequate. Dexmedetomidine and ketamine warrant further exploration in large-scale prospective studies because of their potential benefits. Improved study designs with consistent definitions and a focus on patient-centered outcomes are necessary to inform clinical practice.

The effect of pain on gait in older people: A systematic review and meta-analysis

Multi-site pain is common in people aged 60 years and over and is associated with a high risk of falls. To prevent and treat pain-related disabilities, it is crucial to identify the mechanisms underlying these associations. There is some evidence that pain leads to changes in walking, such as slower gait speed and shorter walking distance, which impair mobility and may increase the risk of falls. This review evaluated evidence on the relationship between pain and gait characteristics in older people. A comprehensive search on PubMed and Embase included observational studies and clinical trials assessing objective measures of walking, such as gait speed, cadence, stride length, and double-limb support time, in older people with and without pain. Of the 1218 studies screened, thirteen met the inclusion criteria from the primary search. An additional study was identified through the secondary search, resulting in fourteen studies included in this systematic review and meta-analysis. None of these studies investigated the relationship between fear of pain and gait characteristics in older people. Results showed that older people with pain had slower gait speed than those without pain, with a small effect size (Hedge's g = -0.30, 95% CI = -0.41 to -0.19, p < 0.0001). There were no statistically significant differences in cadence, stride length, and double-limb support time. These findings suggest that pain impacts walking speed in older people, highlighting the importance of addressing this association to manage mobility deficits and fall risk. PERSPECTIVE: This systematic review and meta-analysis show that pain is associated with reduced gait speed in older people. Recognising and addressing the impact of pain on walking may be important for preventing mobility-related disorders and falls in this population.

The experience and role of dissociation in psychosis following developmental trauma: A systematic review

Developmental trauma (DT), defined as abuse or neglect before age 18, is linked with elevated risk and poorer outcomes in psychosis. This systematic review aimed to elucidate the relationship between DT and dissociation in psychosis and discern the potential mediating role of dissociation in the link between DT and psychotic manifestations. Our study protocol was pre-registered with PROSPERO (CRD42022330026). We adopted broad criteria, including a variety of methodologies exploring dissociation post-DT in individuals exhibiting psychosis or psychotic features. Risk of bias was assessed for all included studies. Our review incorporated 40 studies, totalling 6941 participants. A significant moderate association was observed between DT and dissociation (r = 0.33 (95 %CI: 0.28-0.38)), underscored by dose-response effects. Sexual and emotional abuse demonstrated the most robust associations with dissociation. Individuals with psychosis and DT reported elevated dissociation relative to their non-traumatized counterparts. Dissociation mediated the link between DT and positive psychotic symptoms, notably hallucinations, across clinical and general populations. Five studies pinpointed dissociation's mediating role in tying DT to paranoia and delusional ideation. The review delves into clinical considerations, emphasizing screening for psychotic and dissociative symptoms in DT survivors, and outlining dissociation management strategies. Future research, employing longitudinal, qualitative, and experimental approaches, remains paramount.

Safety and efficacy of radiofrequency treatment for glossopharyngeal neuralgia: a systematic review and single-arm meta-analysis

To systematically evaluate the efficacy and recurrence rate of radiofrequency treatment for Glossopharyngeal Neuralgia, providing evidence-based support for clinical treatment. Systematic searches were conducted in databases including CNKI, Wanfang Data, VIP, PubMed, EMbase, and Cochrane Library from inception to September 30, 2024, for both Chinese and English literature on radiofrequency treatment of Glossopharyngeal neuralgia. Literature was strictly screened according to inclusion and exclusion criteria and data were processed and analyzed using RevMan 5.4 software for Meta-analysis. A total of 13 studies involving 437 patients were ultimately included. Meta-analysis results showed that Radiofrequency treatment resulted in significant improvements in pain scores at all postoperative time points (SMD = 3.38 at immediate postoperative, SMD = 4.18 at 1 month,SMD = 3.44 at 3 month,SMD = 2.94 at 6 month, SMD = 2.96 at 12 month) compared to baseline.The efficacy rate within one week after radiofrequency treatment was 84%. The efficacy rate within one year after radiofrequency treatment was 80%. The recurrence rate within one year after radiofrequency treatment was 13%. The incidence of complications within one year after radiofrequency treatment was 29%. Sensitivity analysis results indicated that the findings of this study are robust. Publication bias analysis showed that there is a low likelihood of publication bias in this study. Radiofrequency treatment for glossopharyngeal neuralgia has a good efficacy rate and a low recurrence rate, with radiofrequency thermocoagulation combined with Nerve destroying drugs showing the highest efficacy rate and the lowest recurrence rate, but there are certain complications.

A bespoke rapid evidence review process engaging stakeholders for supporting evolving and time-sensitive policy and clinical decision-making: reflection and lessons learned from the Wales COVID-19 Evidence Centre 2021-2023

BACKGROUND

The COVID-19 pandemic presented policymakers with time-sensitive decision problems and a rapidly increasing volume of research, not all of which was robust, or relevant to local contexts. A bespoke evidence review process supporting stakeholder engagement was developed as part of the Wales COVID-19 Evidence Centre (WCEC), which could flexibly react to the needs of decision-makers, to address urgent requests within days or months as required.

AIMS

To describe and appraise the WCEC review process and methods and identify key learning points.

METHODS

Three types of rapid review products were used, which could accommodate the breadth of decision problems and topics covered. Stakeholder (including public) engagement was integrated from the onset and supported throughout. The methods used were tailored depending on the needs of the decision-maker, type of research question, timeframe, and volume and type of evidence. We appraised the overall process and compared the methods used with the most recent and relevant best practice guidance.

RESULTS

The remote collaboration between research teams, establishing a clear pathway to impact upfront, and the strong stakeholder involvement embedded in the review process were considered particular strengths. Several key learning points were identified, which focused on: enhancing stakeholders' abilities to identify focused policy-relevant research questions; the collection and storage of review protocols at a central location; tightening quality assurance process regarding study selection, data extraction and quality assessment; adequate reporting of methodological shortcuts and understanding by stakeholders; piloting of an algorithm for assigning study design descriptors, and a single quality assessment tool covering multiple study designs; and incorporate, where appropriate an assessment of the confidence in the overall body of evidence using GRADE or similar framework.

CONCLUSIONS

The review process enabled a high volume of questions that were directly relevant to policy and clinical decision making to be addressed in a timely manner using a transparent and tailored approach.

The relationship between cardiorespiratory fitness and firefighter occupational performance: a systematic review and meta-analysis examining absolute versus relative VO2max

Unequivocally greater cardiorespiratory fitness (CRF) is beneficial for performing firefighting occupational tasks (OTs); however, the contribution of absolute vs. relative VO2max with OT performance warrants further study. This systematic review and meta-analysis compared the relationship between relative and absolute VO2max with the performance of firefighting OTs. Studies included career, volunteer, and firefighter recruits and examined the association of CRF measures with OT performance. Thirty-two studies were identified with 19 studies incorporating an occupational circuit of simulated firefighting OTs such as stair climbing, carrying equipment, victim rescue, forcible entry, and search tasks. The relative and absolute VO2max pooled correlations were r̅ =-0.64 (95%CI: [-0.69,-0.58]) and r̅ = -0.75 (95%CI: [-0.88, -0.62]), respectively. The findings support the importance of CRF, particularly absolute VO2max, for effective performance of firefighting OTs. Absolute VO2max likely has a stronger relationship with firefighters' functional work rate during operations, reflecting the absolute demands of firefighting tasks.