Measuring inconsistency in meta-analyses

Electroacupuncture for the treatment of ischemic stroke: A preclinical meta-analysis and systematic review

Stroke remains a leading cause of death and disability worldwide, and electroacupuncture has a long history of use in stroke treatment. This meta-analysis and systematic review aimed to evaluate the efficacy of electroacupuncture and explore its potential mechanisms in animal models of ischemic stroke. The PubMed, EMBASE, Web of Science, CENTRAL, and CINAHL databases were comprehensively searched up to May 1, 2024. This review included articles on preclinical investigations of the efficacy and mechanisms of electroacupuncture in treating ischemic stroke. Data from 70 eligible studies were analyzed in Stata 18.0, using a random-effects model to calculate the standardized mean difference (Hedge's g). The risk of bias was assessed using RevMan 5.4 software, and the quality of evidence was rated according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Subgroup analyses were conducted to test the consistency of the results and sensitivity analyses were used to assess their robustness. The quality assessment revealed that most studies adequately handled incomplete data and selective reporting. However, several methodological limitations were identified: only 4 studies demonstrated a low risk of allocation concealment, 26 achieved a low risk of outcome assessment bias, and 9 had a high risk of randomization bias. Additionally, there was an unclear risk regarding participant blinding and other methodological aspects. The GRADE assessment rated 12 outcomes as moderate quality and 6 as low quality. The mechanisms of electroacupuncture treatment for ischemic stroke can be categorized as five primary pathways: (1) Electroacupuncture significantly reduced infarct volume and apoptotic cell death ( P < 0.01) in ischemic stroke models; (2) electroacupuncture significantly decreased the levels of pro-inflammatory factors ( P < 0.01) while increasing the levels of anti-inflammatory factors ( P = 0.02); (3) electroacupuncture reduced the levels of oxidative stress indicators ( P < 0.01) and enhanced the expression of antioxidant enzymes ( P < 0.01); (4) electroacupuncture significantly promoted nerve regeneration ( P < 0.01); and (5) electroacupuncture influenced blood flow remodeling ( P < 0.01) and angiogenesis ( P < 0.01). Subgroup analyses indicated that electroacupuncture was most effective in the transient middle cerebral artery occlusion model ( P < 0.01) and in post-middle cerebral artery occlusion intervention ( P < 0.01). Dispersive waves were found to outperform continuous waves with respect to neuroprotection and anti-inflammatory effects ( P < 0.01), while scalp acupoints demonstrated greater efficacy than body acupoints ( P < 0.01). The heterogeneity among the included studies was minimal, and sensitivity analyses indicated stable results. Their methodological quality was generally satisfactory. In conclusion, electroacupuncture is effective in treating cerebral ischemia by modulating cell apoptosis, oxidative stress, inflammation, stroke-induced nerve regeneration, blood flow remodeling, and angiogenesis. The efficacy of electroacupuncture may be influenced by factors such as the middle cerebral artery occlusion model, the timing of intervention onset, waveform, and acupoint selection. Despite the moderate to low quality of evidence, these findings suggest that electroacupuncture has clinical potential for improving outcomes in ischemic stroke.

Associations of anxiety and depression with prognosis in chronic obstructive pulmonary disease: A systematic review and meta-analysis

The associations between anxiety, depression, and the prognosis of COPD remain uncertain. The present study aims to investigate the associations of anxiety and depression with 30-day readmission rates and acute exacerbations of COPD (AECOPD). Four databases were searched to identify relevant studies published before 13 March 2024. Studies that report on the impact of anxiety and depression on the prognosis of AECOPD were included. The pooled effect size and its 95% confidence interval (CI) were calculated using a random effects model. The primary outcomes were 30-day readmission and AECOPD within the first year after discharge in COPD patients. Of the 5,955 studies screened, 14 studies were included in the analysis. Patients with anxiety had a higher risk of AECOPD within the first year after discharge compared to those without anxiety (HR: 2.10, 95% CI: 1.28-3.45, p = 0.003). Patients with depression also had a higher risk of AECOPD within the first year after discharge (HR: 1.36, 95% CI: 1.10-1.69, p = 0.004). Similar results were observed in the associations of anxiety and depression with 30-day readmission. Our results suggested that anxiety and depression were associated with an increased risk of 30-day readmission and AECOPD in patients with COPD.

Association of mild chronic obstructive pulmonary disease with all-cause mortality: A systematic review and meta-analysis

BACKGROUND

It is unclear whether patients with Global Initiative for Chronic Obstructive Lung Disease stage 1 (mild) chronic obstructive pulmonary disease (COPD) have worse respiratory outcomes than individuals with normal spirometry.

METHODS

For this systematic review and meta-analysis, we conducted a search of PubMed, Embase, and Web of Science for all literature published up to 1 March 2023. Studies comparing mortality between mild COPD and normal spirometry were included. A random-effects model was used to estimate the combined effect size and its 95% confidence interval (CI). The primary outcome was all-cause mortality. Respiratory disease-related mortality were examined as secondary outcomes.

RESULTS

Of 5242 titles identified, 12 publications were included. Patients with mild COPD had a higher risk of all-cause mortality than individuals with normal spirometry (pre-bronchodilator: hazard ratio [HR] = 1.21, 95% CI: 1.11-1.32, I2 = 47.1%; post-bronchodilator: HR = 1.19, 95% CI: 1.02-1.39, I2 = 0.0%). Funnel plots showed a symmetrical distribution of studies and did not suggest publication bias. In jackknife sensitivity analyses, the increased risk of all-cause mortality remained consistent for mild COPD. When the meta-analysis was repeated and one study was omitted each time, the HR and corresponding 95% CI were >1. Patients with mild COPD also had a higher risk of respiratory disease-related mortality (HR = 1.71, 95% CI: 1.03-2.82, I2 = 0.0%).

CONCLUSIONS

Our results suggest that mild COPD is associated with increased all-cause mortality and respiratory disease-related mortality compared with normal spirometry. Further research is required to determine whether early intervention and treatment are beneficial in mild COPD.

High altitudes and partial pressure of arterial oxygen in patients with chronic obstructive pulmonary disease - A systematic review and meta-analysis

IMPORTANCE

Prior study in healthy subjects has shown a reduction of partial pressure of arterial oxygen (PaO2) by -1.60 kPa/kilometre of altitude gain. However, the association of altitude-related change in PaO2 and altitude-related adverse health effects (ARAHE) in patients with chronic obstructive pulmonary disease (COPD) remain unknown.

OBJECTIVE

To provide an effect size estimate for the decline in PaO2 with each kilometre of altitude gain and to identify ARAHE in relation to altitude in patients with COPD. www.crd.york.ac.uk/prospero: CRD42020217938.

DATA SOURCES

A systematic search of PubMed and Embase was performed from inception to May 30, 2023.

STUDY SELECTION

Peer-reviewed and prospective studies in patients with COPD staying at altitudes >1500 m providing arterial blood gases within the first 3 days at the target altitude.

DATA EXTRACTION AND SYNTHESIS

Aggregate data (AD) on study characteristics were extracted, and individual patient data (IPD) were requested. Estimates were pooled using random-effects meta-analysis.

MAIN OUTCOME AND MEASURES

Relative risk estimates and 95 % confidence intervals for the association between PaO2 and altitude in patients with COPD.

RESULTS

Thirteen studies were included in the AD analysis, of which 6 studies (222 patients, 45.2 % female) provided IPD, thus were included in the quantitative analysis. The estimated effect size of PaO2 was -0.84 kPa [95 %CI, -0.92 to -0.76] per 1000 m of altitude gain (I2=65.0 %, P < 0.001). In multivariable regression analysis, COPD severity, baseline PaO2, age and time spent at altitude were predictors for PaO2 at altitude. Overall, 37.8 % of COPD patients experienced an ARAHE, whereas older age, female sex, COPD severity, baseline PaO2, and target altitude were predictors for the occurrence of ARAHE (area under ROC curve: 0.9275, P < 0.001).

CONCLUSIONS AND RELEVANCE

This meta-analysis, providing altitude-related decrease in PaO2 and risk of ARAHE in patients with COPD ascending to altitudes >1500 m, revealed a lower altitude-related decrease in PaO2 in COPD patients compared with healthy. However, these findings might improve patient care and facilitate decisions about initiating preventive measures against hypoxaemia and ARAHE in patients with COPD planning an altitude sojourn or intercontinental flight, i.e. supplemental oxygen or acetazolamide.

Prevalence of attention deficit hyperactivity disorder in homeless children and adolescents: A systematic review and meta-analysis

INTRODUCTION

This systematic review and meta-analysis aimed to examine the prevalence of Attention deficit hyperactivity disorder (ADHD) in homeless children and adolescents, and the factors that may influence its prevalence.

METHODS

Relevant publications in Medline, Web of Science, Scopus and PsycINFO were systematically searched to identify studies on the prevalence of ADHD in homeless children and adolescents (≤19 years). The extracted data were pooled using a random-effects model.

RESULTS

Thirteen studies involving 2878 homeless children and adolescents were included (mean age: 12.0 years, sex F/M: 0.43). The prevalence rates of ADHD vary considerably across studies, ranging from 1.6% to 64.5%. The pooled prevalence of ADHD was 22.8% (95% CI 12.9-34.4%, I2 =98%). Meta-regression analyses indicated that age (slope = 0.046; p = .042) significantly increased ADHD prevalence. The prevalence of ADHD in studies with a mean age ≥ 12 years (43.1%, 95% CI 26.5-60.4%) was higher than those with a mean age < 12 years (13.1%, 95%CI 4.3-25.6).

CONCLUSION

Despite the high heterogeneity of the studies, we observed that ADHD could affect almost a quarter of homeless children and adolescents. Reintegrating them into care systems and ensuring access to public health interventions tailored for homeless families and youth is imperative for breaking the cycle of homelessness and improving long-term trajectories.

Effectiveness of health promotion interventions to increase faecal occult blood test uptake rates among older adults with an average-risk of colorectal cancer: A systematic review and meta-analysis

Objective

This review aims to examine the effectiveness of interventions in increasing faecal occult blood test (FOBT) uptake rates among older adults with an average-risk of colorectal cancer (CRC) and to identify essential components of such interventions based on current evidence.

Methods

Five databases were included in a systematic literature search for studies reporting randomized controlled trials (RCT) and interventions aimed at increasing FOBT uptake rates among average-risk individuals aged 50-75. Review Manager 5.4.1 was used for conducting meta-analyses and subgroup analyses.

Results

A meta-analysis of the 20 included studies demonstrated that health promotion interventions led to significant increases in FOBT uptake rates (odds ratio [OR] ​= ​1.55, 95% confidence interval (CI) ​= ​1.30-1.85; I 2 ​= ​95%). Provision of information, mailing of FOBT outreach, and reminders were identified as core components of promotion interventions to increase FOBT uptake rates. Among the different significant reminder strategies, a digital message (via text) plus telephone calls (automated and navigator-initiated) had a larger effect size than a telephone call alone. In addition, there was no significant evidence that financial incentives were associated with FOBT uptake. Most studies included a diverse mixture of components, but only a few studies utilized theoretical framework-based interventions.

Conclusions

Future studies with rigorous methodologies are warranted to examine the effectiveness and understand the mechanisms of theoretical framework-based multi-component educational programmes aimed at increasing FOBT uptake rates.

Systematic review registration

PROSPERO CRD42024520859.

Obstetric and perinatal outcomes in singleton pregnancies following medicated, stimulated and natural, frozen embryo transfer cycles: an updated systematic review and meta-analysis

Frozen embryo transfer (FET) has been associated with higher risks of hypertensive disorders of pregnancy (HDP), large for gestational age and high birth weight. This systematic review and meta-analysis evaluates obstetric and perinatal outcomes in medicated, stimulated and natural FET cycles. A literature search was performed using MEDLINE, EMBASE, CINAHL and the Cochrane Library database; 152,590 FET cycles were analysed from 31 included studies. Risk ratios (RR) and 95% confidence intervals (CI) were calculated using fixed and random effects models determined by the heterogeneity (I2). There was significantly higher risk of obstetric and perinatal complications, including HDP (RR 1.84, CI:1.48-2.29, I2 87%) and low birth weight (LBW) (RR 1.25, CI:1.12-1.39, I2 57%) following medicated compared to natural FET cycles. A higher risk of HDP (RR 1.50, CI:1.33-1.64, I2 32%) and macrosomia (RR 1.28, CI:1.17-1.40, I2 37%) was noted following medicated compared to stimulated cycles. Natural demonstrated lower risk of HDP (RR 0.77, CI:0.60-0.99, I2 32%), gestational diabetes (RR 0.78, CI:0.68-0.89, I2 43%), LBW (RR 0.78, CI:0.64-0.95, I2 48%) and small for gestational age (RR 0.83, CI:0.70-0.98, I2 12%) than stimulated cycles. These findings indicate that medicated FET cycles convey greater risks of obstetric and perinatal complications than natural or stimulated cycles.

Cardiopulmonary fitness in children/adolescents with chronic kidney disease and the impact of exercise training: a systematic review and meta-analysis of observational study and randomized controlled trials

BACKGROUND

This systematic review and meta-analysis aimed to evaluate differences in cardiopulmonary fitness between healthy controls and children/adolescents with chronic kidney disease (CKD) and the effects of exercise training.

METHODS

PubMed, Embase, Scopus and Web of Science were searched for published studies from reception to 14 June 2023, and updated search on 15 October 2023. The included observational studies reported on cardiorespiratory fitness, included maximal oxygen uptake (VO2max), peak oxygen consumption (VO2peak) and 6-minute walk distance (6MWD), in children/adolescents with CKD and age-matched healthy controls, as well as clinical intervention trials of exercise training on cardiorespiratory fitness in samples of children and/or adolescents up to 19.

RESULTS

Fifteen observational studies and five clinical trials were included, respectively. The studies found that the mean cardiopulmonary fitness was 1.82 standardized mean differences (SMDs) units (95% confidence interval (95% CI) 1.43-2.20) lower in children/adolescents with CKD than in healthy controls or reference values. Except for pre-dialysis CKD patients, peritoneal dialysis, haemodialysis and kidney transplant recipients had significantly lower cardiorespiratory fitness than healthy controls. The results of a meta-analysis based on a pre-post single-arm trial showed that compared to baseline, exercise training improved the 6MWD by approximately 58.17 m (95% CI 16.27-100.06), with very low evidence.

CONCLUSIONS

This systematic review and meta-analysis of observational studies and clinical trials that included children/adolescents with CKD found that cardiorespiratory fitness is severely reduced in this population and that exercise training may be an effective strategy for improvement. Given the low evidence certainty, additional high-quality trials are necessary.

Frailty risk prediction models in maintenance hemodialysis patients: a systematic review and meta-analysis of studies from China

OBJECTIVES

To systematically evaluate and meta-analyze the performance, validity, and influencing factors of frailty risk prediction models specifically developed for patients undergoing maintenance hemodialysis in China.

METHODS

China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database, SinoMed, PubMed, Web of Science, Cochrane Library, CINAHL and Embase were searched from inception to October 10, 2024. Two independent reviewers conducted literature screening, data extraction, and risk of bias assessment using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Meta-analysis was performed to pool the incidence rates and identify independent predictors.

RESULTS

Fourteen studies incorporating 16 distinct frailty risk prediction models were included. The predictive accuracy, measured by the area under the receiver operating characteristic curve (AUC), ranged from 0.819 to 0.998. Seven studies performed internal validation, one study executed external validation, and one study conducted both internal and external validation. All studies exhibited a high overall risk of bias. Pooled incidence of frailty among maintenance hemodialysis patients was 32.2% (95% CI: 26.9%-37.6%). Significant predictors of frailty included advanced age, hypoalbuminemia, poor nutritional status, female sex, comorbid conditions, and depression (p < 0.05).

CONCLUSIONS

The pooled incidence of frailty among maintenance hemodialysis patients was notably high at 32.2%, with advanced age, hypoalbuminemia, poor nutritional status, female sex, comorbid conditions, and depression emerging as significant predictors. Existing frailty prediction models for maintenance hemodialysis patients demonstrated robust predictive capacity but exhibited substantial methodological limitations, high bias and limited external validation. Future research should prioritize multicenter, large sample, validation studies to enhance applicability and reliability.

Systematic review and meta-analysis on the association of metabolic syndrome in women with overactive bladder

AIMS

A systematic review and meta-analysis were performed to determine the association of metabolic syndrome (METS) in women with and without overactive bladder (OAB).

METHODS

PRISMA guidelines were followed and the protocol was registered at PROSPERO (CRD42024606398). We searched PubMed, Embase, Cochrane Library, and LILACS databases to obtain relevant articles for studies reporting METS outcomes related to OAB published through October 2024. A meta-analysis was performed of available studies using random effect models. Results are reported as mean difference (MD), standardized MD (SMD), or odds ratio (OR) and their 95% confidence interval (CI). Heterogeneity was described with the I2 statistic. The quality of studies was assessed using the Newcastle-Ottawa Scale.

RESULTS

Of the 108 non-duplicated retrieved citations, after successive selection, four case-control studies with low or moderate risk of bias reported information about the association of METS in women assessed with the 8-item OAB Symptom Bother Scale. OAB patients displayed higher body mass index (BMI, MD: 3.27, 95% CI: 2.12, 4.43), waist circumference (MD: 7.96, 95% CI: 4.41, 11.52), fasting blood glucose (SMD: 1.26, 95% CI: 0.18, 2.34), triglycerides (SMD: 0.24, 95% CI: 0.01, 0.47), and LDL-cholesterol (SMD: 0.30, 95%CI: 0.06, 0.54) levels. In addition to low HDL-cholesterol levels (SMD: -0.40, 95% CI: -0.74, -0.06) compared to the control group. There were no significant differences in circulating total cholesterol levels and rates of hypertension, hysterectomy, postmenopausal status, and constipation in women with and without OAB.

CONCLUSION

Women with OAB display associations with age, BMI, waist circumference, and METS factors.

Clinical outcomes of atrial fibrillation screening: a meta-analysis of randomized controlled trials

BACKGROUND

Several randomized controlled trials (RCTs) have investigated the benefits of atrial fibrillation (AF) screening. However, since none have shown a significant reduction in stroke rates, the impact of screening on clinical outcomes remains uncertain.

MATERIALS AND METHODS

We conducted a systematic review and meta-analysis of RCTs reporting clinical outcomes of systematic AF screening in participants without known AF. Pooled risk ratios (RRs) were computed for all-cause stroke or systemic embolism, major bleeding, and all-cause mortality, comparing screening with no screening.

RESULTS

Seven RCTs encompassing 76 458 participants were identified. One trial utilized implantable loop recorders for rhythm monitoring, while the others employed non-invasive screening methods. Pooled results indicated that AF screening was associated with a significant reduction in all-cause stroke or systemic embolism (RR 0.932, 95% CI 0.873-0.996, I2 = 0%, p = 0.037), but had no effect on major bleeding (RR 0.996, 95% CI 0.935-1.060, I2 = 0%, p = 0.876) or all-cause mortality (RR 0.987, 95% CI 0.945-1.031, I2 = 0%, p = 0.550). We estimated a number needed to screen of 148 to prevent one stroke or systemic embolism over a 10-year period in a population of 75-year-olds. When only non-invasive screening methods were considered, the reduction in strokes was not statistically significant (RR 0.942, 95% CI 0.880-1.008, I2 = 0%, p = 0.083).

CONCLUSIONS

Systematic AF screening is associated with a modest yet statistically significant 7% relative reduction in stroke and systemic embolism, with no observed impact on major bleeding or all-cause mortality.

Comparative efficacy and safety of febuxostat and allopurinol in chronic kidney disease stage 3-5 patients with asymptomatic hyperuricemia: a network meta-analysis

OBJECTIVE

This study evaluates and compares the effectiveness and safety of febuxostat and allopurinol in chronic kidney disease (CKD) stages 3-5 patients with asymptomatic hyperuricemia using a network meta-analysis.

METHODS

A systematic review and network meta-analysis were conducted, adhering to PRISMA-NMA guidelines. Searches included PubMed, Embase, Cochrane Library, and Chinese databases up to June 2024. Randomized controlled trials (RCTs) and cohort studies were assessed for methodological rigor using GRADE.

RESULTS

A total of 12 RCTs and 4 cohort studies (n = 2,423 participants) were included. Febuxostat was associated with greater improvements in estimated glomerular filtration rate compared to allopurinol (MD, 4.99 mL/min/1.73 m2; 95%CI -0.65 to 10.78; certainty: low) and placebo (MD, 4.72 mL/min/1.73 m2; 95%CI 0.67 to 8.82; low). Serum uric acid reduction was also more pronounced with febuxostat (MD, -0.61 mg/dL; 95%CI -1.15 to -0.05; moderate). Safety outcomes, including major cardiovascular events and adverse events, showed no significant differences between febuxostat and allopurinol. Subgroup analyses revealed enhanced effectiveness of febuxostat at six months of treatment.

CONCLUSIONS

This analysis provides robust evidence that febuxostat might offers greater improvements in kidney function and uric acid levels compared to allopurinol or placebo in asymptomatic hyperuricemia with CKD stage 3-5 patients, without compromising safety. These findings can guide clinical decision-making and treatment optimization.

Global prevalence and psychological impact of bullying among children and adolescents: a meta-analysis

OBJECTIVE

Bullying is a significant public health concern with negative consequences. Therefore, we conducted this meta-analysis to estimate the pooled prevalence and psychological impact of bullying among children and adolescents.

METHODS

A comprehensive search of CINAHL, Embase, Ovid MEDLINE, PubMed, Scopus, and Web of Science was conducted until April 2024. Data were analyzed using the Generalized Linear Mixed Model adopted random-effect model in R software. We assessed heterogeneity using I2 test and Cochran's Q-statistic and study quality using Joanna Briggs Institute (JBI) critical appraisal tools. Moreover, meta-regression and subgroup analyses identified factors contributing to prevalence of bullying.

RESULTS

A total of 116 studies involving 603,231 participants were identified. The pooled prevalence of bullying victims was 25 % (95%CI: 22 %-28 %), followed by 16 % (13 %-20 %) for bullying perpetrators, and 16 % (11 %-21 %) for bully-victims (individuals who experience both roles). We found that bullying has psychological impacts for all groups, including emotional distress, loneliness, anxiety, depression, self-harming behavior, suicidal ideation, and suicidal attempts.

LIMITATIONS

The results showed high heterogeneity; however, meta-regression and sub-group analyses were performed to identify potential moderating factors.

CONCLUSIONS

This study highlights that one-quarter of children and adolescents are bullying victims, while perpetrators and bully-victims share a prevalence of one-sixth. Addressing bullying requires collaboration among schools, parents, and healthcare professionals. Educational programs focused on prevention and targeted interventions for all groups are essential to mitigate the long-term mental health consequences of bullying. A comprehensive approach is crucial, considering the interconnected roles of victims, perpetrators, and bully-victims in the bullying dynamic.

Bone mineral density deficits in individuals born preterm persist through young adulthood: A systematic review and meta-analysis of DXA studies

Individuals born preterm are at increased risk for bone deficits given that the majority of skeletal mineral accrual occurs during the final gestational trimester. It is unclear how preterm birth affects bone density with aging or if individuals born preterm have increased rates of osteoporosis. This systematic review and meta-analysis summarizes the current data on bone mineral content and density measured by dual-energy x-ray absorptiometry (DXA) at any time across the lifespan after preterm birth in generally healthy, appropriate size for gestational age individuals. Three databases, including PubMed, Scopus, and CINAHL, were searched using keywords related to preterm birth and skeletal mineralization. Total body, lumbar spine, and femoral neck were the most frequently reported DXA measurement sites. A total of 39 studies (145 comparisons) were included in the meta-analyses, with bone outcomes measured within days of birth through about 30 years of age, depending on the measurement site. Preterm birth was associated with reduced bone mineral content and density. The largest total body bone deficits were observed in preterm individuals who were less than one year of age, with greater variability observed during childhood and adolescence. Individuals born preterm in the oldest cohort (17-30 years) maintained deficits in bone mineral density as they approached the age of peak bone mass. Importantly, there were no DXA studies of preterm individuals beyond 30 years of age, so it remains unclear how preterm birth affects the skeleton with advanced aging.

Cognitive changes in schizophrenia before and after illness onset: A meta-analysis examining consistency in measurement tools as a moderator

Background

Cognitive impairment, a core feature of schizophrenia, is often evident before the onset of illness. The current study aimed to quantify IQ decline following the onset of illness by conducting a meta-analysis of longitudinal studies that evaluated cognitive functioning both before and after the first psychotic episode. Consistency in measurement tools - i.e. whether the same measurement tool was used at both assessments - was considered a potential moderating variable.

Method

Eleven studies were included in the meta-analysis - seven using the same measurement tool at both time-points and four using different tools. In addition, meta-regression explored whether the magnitude of IQ decline was associated with age at baseline.

Results

The meta-analysis effect size was -0.343 (95 % CI: -0.503 to -0.184), equivalent to a decrease of 5 IQ points. Use of the same (SMD -0.321, 95 % CI: -0.501 to -0.142) vs different (SMD -0.427, 95 % CI: -0.777 to -0.077) measurement tools was not a moderator of IQ change (p = 0.279). The meta-regression results were not significant (p = 0.544).

Conclusion

The current meta-analysis indicates a slight cognitive decline from the premorbid stage to post-onset. The use of different measurement tools yielded a slightly larger effect size and greater heterogeneity, suggesting that employing the same assessment tool could lead to more accurate results. Future longitudinal studies should focus on determining the timeline of cognitive decline.

Bidirectional relationship between gaming disorder, internalizing psychopathology, psychological distress, and well-being: A systematic review with meta-analysis of longitudinal studies

There is a lack of a synthesis of longitudinal studies that clarify the relationship between gaming disorder (GD) symptoms and mental health. To address this gap, we undertook a systematic review with meta-analysis of longitudinal studies. The study protocol was preregistered online on PROSPERO (CRD42023407665). We included studies analyzing the association between GD or problematic/pathological videogame use, and internalizing psychopathology (depression and anxiety), psychological distress (loneliness and stress), and well-being (life satisfaction, quality of life, and well-being). Research articles were searched in PsycInfo, PsycArticles, PubMed, and Web of Science up until December 29, 2022.30 articles were considered for meta-analysis (N = 28,782). Effect sizes (partial correlation) were pooled using random-effects models. Sensitivity analyses excluded studies rated as "poor" - using the National Institutes of Health quality assessment tool for observational cohort studies - and Chinese studies. The associations between GD and subsequent depression, emotional mixed symptoms (i.e., a combination of internalizing symptoms) and life satisfaction were statistically significant. GD was not associated with subsequent anxiety. On the other hand, depression, anxiety, emotional mixed symptoms, life satisfaction and loneliness were significantly associated with subsequent GD. Overall, sensitivity analyses supported the robustness of the main results. In conclusion, this study found reciprocal longitudinal associations between GD and depression, life satisfaction, and emotional mixed symptoms, an effect of anxiety on GD (but not the inverse), and of loneliness on GD. However, the causal nature and practical relevance remain uncertain because effect sizes were small - or medium, depending on effect size guidelines - and based on observational studies.

Comparative efficacy of non-pharmacological interventions on depression in people with multiple sclerosis: A systematic review and network meta-analysis

BACKGROUND

Depression, a common psychological problem in multiple sclerosis (MS) patients, can exacerbate the deterioration of the disease and have an impact on the quality of life of MS. Non-pharmacological therapies are effective alternatives to pharmacological treatments. It is not clear which non-pharmacological therapies are most effective in improving depression in MS at present.

AIMS

To compare the effectiveness of non-pharmacological interventions in enhancing depression in people with MS.

METHODS

A total of seven databases were searched from the establishment of the database to June 2024. After literature screening and data extraction, the Cochrane Bias Assessment Tool 2.0 version of randomized controlled trials (RCTs) was used to evaluate the quality of the literature. A network meta-analysis was performed to evaluate the relative efficacy of the non-pharmacological interventions on depression. Statistical analysis was performed using R (version 4.3.2) and STATA 17.0 software.

RESULTS

A total of 33 RCTs involving seven non-pharmacological interventions (cognitive behavioral therapy, mindfulness therapy, acceptance of commitment therapy, exercise therapy, relaxation therapy, education, and computer-assisted cognitive rehabilitation) were included. The results of the network meta-analysis showed that cognitive-behavioral therapy (SMD = -4.04, 95%CrI = -6.80 to -1.45), exercise therapy (SMD= = -3.62, 95 % CrI= = -6.55 to -0.85), and education (SMD = -2.94, 95 % CrI = -5.69 to -0.25) were effective in improving depression in multiple sclerosis patients relative to the control group.

CONCLUSION

This study confirms that non-pharmacological interventions can improve depression in MS patients. Healthcare professionals can choose non-pharmacological therapies according to the specific conditions of MS patients to improve the depression of them and thus enhance their quality of life in future.

The effect of social robot interventions on anxiety in children in clinical settings: a systematic review and meta-analysis

AIMS

Children in clinical settings are prone to anxiety due to developmental limitations, which hinders treatment progress. This systematic review and meta-analysis aimed to evaluate the efficacy of social robot interventions compared to routine care or alternative non-pharmacological strategies in reducing anxiety among children aged 4-12 years undergoing medical procedures in clinical settings, based on evidence from randomized controlled trials.

METHODS

The review protocol was prospectively registered in PROSPERO. Five electronic databases PubMed, Web of Science, Embase, Cochrane Library and PsycINFO were searched for randomized controlled trials (RCTs) examining the effects of SRs on children's anxiety. The search ends on 1 December 2024. A total of 10 RCTs meeting the inclusion criteria were identified, involving 877 children aged 4-12 years.

RESULTS

The meta-analysis reveals a significant reduction in anxiety levels among children who interacted with social robots in clinical settings. Subgroup analyses showed that 1) Both inpatient and outpatient children exhibited reduced anxiety levels. 2) School-age children experienced a decrease in anxiety following interventions with social robots. 3) The social robots were effective in alleviating children's anxiety using distraction techniques and psycho-educational interventions.

CONCLUSIONS

This meta-analysis is the first to summarize the effects of social robots on anxiety in children and finds an overall positive trend. It's more effective than traditional psychotherapy and has no adverse effects due to drug use. In the context of care shortages, social robots represent a significant tool for reducing anxiety among children in clinical settings and demonstrate promising potential.

Partial lateral patellar facetectomy is beneficial for patients with patellofemoral osteoarthritis: A systematic review and meta-analysis

Introduction

Surgical treatment for patellofemoral osteoarthritis (PFOA) consists of soft tissue, bony, and arthroplasty interventions. Partial lateral facetectomy (PLF) is a bone-reducing procedure, commonly done in conjunction with soft tissue and realignment procedures, that has grown in popularity after failure of conservative treatment due to its efficacy and minimally invasive nature. This systematic review and meta-analysis thus seeks to evaluate the efficacy of PLF in the absence of reviews on this topic.

Methods

A systematic review of three databases (PubMed, EMBASE, Scopus) was conducted, identifying studies that evaluated postoperative outcomes of PLF on patients who had PFOA. Pairwise meta-analysis was conducted between preoperative versus postoperative values of a subjective outcome measure (Knee Society Score (KSS)) and radiographic outcome measure (Congruence Angle (CA)). Subgroup analysis was performed on different concomitant procedures aside from PLF to determine their effect on clinical outcomes.

Results

Ten studies were included in this review, with 463 patients and 495 knees and a pooled mean follow-up of 63.2 months and age of 56.3 years. Six studies investigated PLF with lateral release, two with realignment procedures, one with lateral lengthening, and one with both lateral release and realignment. Five studies found significant improvement (p < 0.01) in KSS (34.45; 95%CI: 26.41 to 42.49, and four studies reported significant improvement (p < 0.01) in CA (-10.31; 95%CI: 13.80 to -6.81). Subgroup analysis showed a significant difference in KSS between PLF with lateral release, lateral lengthening, and realignment (p < 0.01) but not for CA (p = 0.65).

Conclusion

PLF is an effective treatment for PFOA using subjective and radiographic outcome measures. Current cohort studies have shown significant improvement in PFOA treatment, even in the context of long-term outcomes and severe PFOA, and provides valuable insight into the use of PLF as a viable minimally invasive surgical option to treat PFOA in addition to other procedures such as lateral retinacular release and realignment procedures.

Effects of exercise training on cognition in adults with depression: A systematic review and three-level meta-analysis

BACKGROUND

Cognitive impairment is a central feature of depression. Exercise training has enormous potential as a nonpharmacological intervention to improve cognition in depressed individuals.

OBJECTIVE

This review aimed to evaluate and update the effect of exercise training on overall cognition and its subdomains, as well as whether moderators influence the effect of exercise training on cognition in depressed adults.

DESIGN

Systematic review and three-level meta-analysis of randomized controlled trials.

METHODS

We systematically searched Embase, Ovid MEDLINE, Web of Science, PubMed, and Scopus from their inception to February 14, 2024, and updated the search results on December 5, 2024. Randomized controlled trials investigating how exercise training affected cognition in depressed adults were included. The meta-analysis was performed using a random-effects model in R. We used the Physiotherapy Evidence Database scale to evaluate the study's quality.

RESULTS

Twenty-two studies were included. Exercise training showed statistically significant improvements in overall cognition [g = 0.21; 95 % confidence interval (CI) = 0.12, 0.30] and cognitive subdomains of processing speed (g = 0.20; 95 % CI = 0.04, 0.36), attention (g = 0.21; 95 % CI = 0.06, 0.35), memory (g = 0.24; 95 % CI = 0.11, 0.38), and executive function (g = 0.21; 95 % CI = 0.09, 0.33) compared with comparison groups in depressed adults. The greater cognitive benefits were observed when participants exercised twice a week (g = 0.30; 95 % CI = 0.03, 0.56), at a low intensity (g = 0.26; 95 % CI = 0.08, 0.43), spent more than 60 min per session (g = 0.24; 95 % CI = 0.05, 0.44), 150 min or more per week (g = 0.27; 95 % CI = 0.09, 0.45), had a program duration more than 10 weeks (g = 0.25; 95 % CI = 0.12, 0.39), and engaged in mind-body exercise (g = 0.26; 95 % CI = 0.08, 0.43). The clinical setting, sample size, and comparison group for memory moderated the effects of exercise training on cognition.

CONCLUSIONS

Exercise training is an effective nonpharmacological intervention that enhances overall cognition and subdomains of processing speed, attention, memory, and executive function compared with comparison groups in depressed adults. This study only included English-language articles, which may have caused a language bias, and Egger's test revealed a possibility of publication bias.

REGISTRATION NUMBER

CRD42023457900 (PROSPERO).

TWEETABLE ABSTRACT

Exercise training is an effective nonpharmacological intervention for adults with depression to improve overall cognition and cognitive subdomains of processing speed, attention, memory, and executive function compared with comparison groups.

Effect of horticultural activities on reducing depressive symptoms in community-dwelling adults: A systematic review and meta-analysis

OBJECTIVE

To review and analyse randomised-controlled trials and controlled clinical trials on the effect of horticultural activities on alleviating depressive symptoms in community-dwelling adults.

ELIGIBILITY CRITERIA

We included randomised controlled trials and controlled clinical trials that reported depressive symptoms as an outcome. Only community-dwelling adults are included. Involved interventions were horticultural activities with direct interactions with real plants. Excluded interventions include complete virtual-reality-based interventions and passive involvement in a natural environment. The comparison group must not include any horticultural elements.

DATA SOURCES

On 12/9/2024, 14 databases were searched: Academic Search Ultimate, APA PsycInfo, British Nursing Index, CINAHL, CENTRAL, Educational Resources Information Center, Embase, Epistemonikos, Global Health, MEDLINE, Ovid Emcare, Ovid Nursing Database, Scopus, and Web of Science. Citation Search was performed.

RISK OF BIAS

The Risk of Bias-2 and the Risk-Of-Bias In Non-randomised Studies-of-Interventions tool were utilised.

RESULT SYNTHESIS

Data was synthesised using a random-effects meta-analyses model. Effect sizes were estimated as standardised mean differences.

RESULTS

The systematic review covered 30 studies and 2071 participants. The meta-analysis covered 25 studies and indicated that horticultural activities had an overall moderate effect on depressive symptoms (SMD - 0.67, 95 % CI -0.86 to -0.47, I2 54 %). Subgroup analyses revealed that horticultural therapy and therapeutic horticulture had no significant difference in effects (horticultural therapy: SMD -0.74, 95 % CI -1.35 to -0.14, I2 79 %; therapeutic horticulture: SMD - 0.62, 95 % CI -0.80 to -0.45, I2 27 %). The effect of horticultural activities in reducing depressive symptoms was moderate among younger adults (SMD - 0.59, 95 % CI -0.83 to -0.36, I2 43 %), and older adults (SMD - 0.73, 95 % CI -1.05 to -0.40, I2 61 %). The interventions conducted indoors and outdoors showed no significant difference (Indoor: SMD -0.55, 95 % Cl -0.87 to -0.23, I2 61 %; Outdoor: SMD - 0.62, 95 % Cl -0.83 to -0.42, I2 6 %). The effects of interventions once a week (SMD - 0.61, 95 % Cl -0.92 to -0.30, I2 68 %) were similar to those twice a week (SMD - 0.72, 95 % Cl -1.05 to -0.39, I2 37 %). The effective components of horticultural activities included plant care, horticultural artwork, harvesting, food consumption, sensory stimulation, and starting rituals.

DISCUSSION

Most studies have high risk of bias due to ethical requirements and the intervention nature. This review shows that depressive symptoms can be reduced through horticultural activities, such as plant care, horticultural artwork, harvesting, food consumption, sensory stimulation, and starting rituals. Implementing weekly horticultural activities can best achieve intervention results with less time investment.

Bidirectional relationship between diabetes and frailty in middle-aged and older adults: A systematic review and meta-analysis

BACKGROUND

Diabetes and frailty are prevalent and burdensome in middle-aged and older adults. However, current evidence on their association is inconsistent, and no quantitative meta-analysis exists. We conducted a systematic review and meta-analysis to examine whether diabetes increased the risk of frailty and vice versa.

METHODS

We systematically searched PubMed, Web of Science, Embase, and CINAHL databases from inception to 10 April 2025. Random-effects models were used to calculate pooled odds ratio (OR) and 95 % confidence interval (CI) for cross-sectional analysis and pooled relative risk (RR) for longitudinal analysis. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

RESULTS

From 8559 non-duplicated records, 31 articles were included. People with diabetes had increased risks of prevalent frailty (OR=2.21, 95 %CI: 1.60-3.06, I2=99.0 %, n = 15; GRADE=Low), prevalent pre-frailty (OR=2.23, 95 %CI: 2.19-2.28, I2=0.0 %, n = 2; GRADE=Very low), and incident frailty (RR=1.50, 95 %CI: 1.36-1.65, I2=0.0 %, n = 7; GRADE=Moderate). Those with pre-frailty (OR=1.95, 95 %CI: 1.61-2.36, I2=0.0 %; GRADE=Very low) but not with frailty (OR=2.28, 95 %CI:0.96-5.46, I2=92.3 %; GRADE=Very low) had increased odds of prevalent diabetes in two studies. In 15 studies, the pooled RRs for incident diabetes were 1.47 (95 %CI: 1.37-1.57, I2=91.0 %; GRADE=Moderate) in pre-frail participants and 1.96 (95 %CI: 1.73-2.23, I2=92.7 %; GRADE=Moderate) in frail participants.

CONCLUSION

Our findings support the bidirectional relationship between diabetes and frailty in middle-aged and older adults, with each condition contributing to the development of the other. This highlights the importance of early detection and integrated management strategies for diabetes and frailty.

Efficacy of cranial electrotherapy stimulation for treating primary and secondary depression in adults: A meta-analysis of randomized controlled trials

BACKGROUND

Antidepressants use is linked to poor response, treatment discontinuation, and treatment-resistant depression. However, evidence regarding efficacy of cranial electrotherapy stimulation (CES) in treating depression is limited. Therefore, we conducted the first meta-analysis to explore efficacy of CES in treating primary and secondary depression in adults.

METHODS

PubMed, Embase, CINAHL, Web of Science, EBSCOHost, and Cochrane Library were comprehensively searched. Dersimonian-Lard random-effects model in Comprehensive Meta-Analysis 4.0 was used, presenting Hedges' g with corresponding 95 % confidence interval (CI) for depressive symptoms and Quality of life (QoL) while odds ratio (OR) for safety and acceptability of CES. Heterogeneity was examined using Cochrane's Q and I2 statistics with moderator analysis determining sources of variation.

RESULTS

Sixteen randomized controlled trials involving 1148 adults were included. CES significantly reduced depressive symptoms with small effect (g = -0.33 [95%CI -0.46, -0.20]) compared to non-CES treatment; it was safe (OR = 0.84 [95%CI 0.32, 2.18]) and acceptable (OR = 0.72 [95%CI 0.41, 1.27]). CES revealed non-significant effect on improving QoL (g = 0.13 [95%CI -0.05, 0.31]). Substantial improvement of CES were observed for females (β = -0.010 [95%CI -0.019, -0.0003]), secondary depression (g = -0.42 [95%CI -0.58, -0.27]), current >100 μA (g = -0.38 [95%CI -0.58, -0.18]), frequency > 100 Hz (g = -0.50 [95%CI -0.81, -0.20]), length ≤ 30 min (g = -0.39 [95%CI -0.64, -0.14]), sessions/week ≤5times (g = -0.34 [95%CI -0.49, -0.19]), and duration ≤5 weeks (g = -0.45 [95%CI -0.63, -0.27]).

CONCLUSIONS

CES, a safe adjunctive therapy, demonstrates small effect in the treatment of depression. Future research should explore long-term effects of CES for treating adults with depression.

The cognitive and neural bases of creative thought: A cross-domain systematic review and meta-analysis of transcranial direct current stimulation studies

Creative thought enables humans to flexibly generate, evaluate and select novel and adaptive ideas across different contexts. Decades of research indicates that it involves two key aspects: retrieval of previously acquired knowledge and manipulation of that knowledge. However, the cognitive processes underpinning these aspects remain underspecified. The broader clinical-cognitive neuroscience literature suggests these functions rely on general-purpose cognitive mechanisms supporting semantic cognition, controlled episodic memory retrieval, and executive mechanisms. Transcranial direct current stimulation (tDCS) is a neuromodulation technique widely used in creativity and cognitive neuroscience research to examine causal brain-behaviour relationships. To identify converging evidence toward a unifying neurocognitive account of creative thought, we reviewed and meta-analysed 145 sham-controlled tDCS studies (involving 8399 healthy participants aged 18-40), drawn from electronic databases and previous reviews, across creativity and relevant cognitive neuroscience literatures. The results revealed that, only left lateral frontal anodal tDCS promotes creativity (p < .01). In parallel, anodal tDCS over the same region also promotes improvement in many other cognitive processes, including more efficient processing of semantic knowledge (p < .05), more accurate episodic memory retrieval (p < .05), better and more efficient manipulation of buffered knowledge (all p < .001), better self-initiated response generation (i.e., energization; p < .05), and more efficient response selection amongst competing options (i.e., task-setting; p < .01). By merging these previously separate literatures, tDCS studies - although heavily biased toward frontal montages - support the notion that creative thought arises from general-purpose cognitive mechanisms including controlled retrieval and temporary storage of semantic and episodic information, as well as executive mechanisms.

Effects of nurse-led interventions on enhancing patient-related outcomes in colorectal cancer management throughout the cancer care continuum: A systematic review and meta-analysis

BACKGROUND

Colorectal cancer ranks third in global incidence and second in cancer-related mortality worldwide. Despite persistent challenges across the care continuum, nurses play a pivotal role in optimizing patient outcomes through tailored interventions. However, robust evidence on the clinical efficacy and optimal delivery of nurse-led interventions remains limited.

OBJECTIVE

To describe the health problems of the participants and nurse-led interventions in accordance with the Omaha System and summarize evidence on the effects of these interventions throughout the continuum from colorectal cancer screening to survivorship.

METHODS

Eight databases, namely, Web of Science, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature, EMBASE, PubMed, Scopus, China National Knowledge Infrastructure and Wanfang Data, were searched from their inception to May 2024. Additionally, the reference lists of the included studies were examined. Content analysis was applied to identify problems and interventions based on the Omaha System. Meta-analysis and descriptive analysis were adopted. Subgroup analyses were conducted on the basis of the study design, treatment history and mode of intervention delivery.

RESULTS

Twenty-eight studies identified problems and types of nurse-led interventions. There were 13 problems in the psychosocial, physiological and health-related behaviors domains. The nurse-led interventions included teaching, guidance and counseling; case management; and treatments and procedures. Nurse-led interventions improved screening rates for colonoscopy and fecal occult blood testing (odds ratio [OR] = 2.51; 95 % confidence interval [CI]: 2.16 to 2.92; p < 0.001; OR = 6.14; 95 % CI: 1.93 to 19.47; p = 0.002), the adequacy of bowel preparation (OR = 1.69; 95 % CI: 1.40 to 2.03; p < 0.001), stoma self-efficacy (standardized mean difference [SMD] = 2.48; 95 % CI: 0.71 to 4.25; p = 0.006), and quality of life (SMD = 0.72; 95 % CI: 0.21 to 1.22; p = 0.005), and reduced the incidence of stoma complications (OR = 0.28; 95 % CI: 0.18 to 0.42; p < 0.001), anxiety (SMD = -1.19; 95 % CI: -1.40 to -0.99; p < 0.001), and depression (SMD = -1.00; 95 % CI: -1.20 to -0.79; p < 0.001). However, nurse-led interventions were ineffective in reducing distress and addressing unmet supportive care needs.

CONCLUSION

Nurse-led interventions can reduce stoma complications, anxiety and depression and increase the screening rate for colorectal cancer, the adequacy of bowel preparation, stoma self-efficiency and quality of life. Nevertheless, future rigorous research is needed to validate their effects and inform wider implementation.

REGISTRATION

PROSPERO (CRD42024505730) registered on February 18, 2024.

Effects of advance care planning for patients with advanced cancer: A meta-analysis of randomized controlled studies

BACKGROUND

Patients with advanced cancer often have to make difficult end-of-life decisions, which are closely associated with their access to anticipated care after loss of mental capacity. Advance care planning, an approach of discussing, documenting, and deciding on end-of-life preferences, helps with better decision-making. However, despite being recommended for oncology care, its efficacy for patients with advanced cancer remains unclear.

OBJECTIVE

To explore the effects of advance care planning in patients with advanced cancer.

DESIGN

Systematic review and meta-analysis.

METHODS

Twelve electronic databases, including Embase, Medline, the Cochrane Central Register of Controlled Trials, PsycINFO, Web of Science, CINAHL complete, CBM, CNKI, VIP, Wanfang, Google Scholar and Proguest Dissertations and Theses, were searched from inception to December 2024. The Cochrane Risk of Bias Tool 2.0 was used to evaluate the quality of the included studies. Meta-analysis was performed with R software, and outcomes not amenable to meta-analysis were narratively synthesized.

RESULTS

Fourteen studies were included. The results of the meta-analysis implied that advance care planning significantly improved the completion of advance directives (OR = 7.93, 95 % CI: 2.76-22.77, P = 0.0001) and palliative care utilization (OR = 1.39, 95 % CI: 1.08-1.78, P = 0.0009). Anxiety (SMD = -0.14, 95 % CI: -0.52-0.23, P = 0.45), depression (SMD = -0.10, 95 % CI: -0.55-0.34, P = 0.66), decisional conflicts (MD = -1.25, 95 % CI: -3.67-1.18, P = 0.31), patient satisfaction (SMD = 0.19, 95 % CI: -0.23-0.70, P = 0.47), and quality of life (SMD = 0.32, 95 % CI: -0.83-1.48, P = 0.58) were not improved. In the narrative synthesis, dignity was enhanced, but the effects of concordance between actual care received and preferences were inconsistent. In general, existing advance care planning is primarily delivered in a face-to-face format in hospitals and focuses on older patients.

CONCLUSIONS

Advance care planning may have desirable impacts on improving the completion of advance directives and palliative care utilization for patients with advanced cancer. It was not effective in improving anxiety, depression, decisional conflicts, patient satisfaction, and quality of life. The effects of dignity and care concordance need to be further validated. Young patient-specific, digital technology-based, and in-home advance care planning is encouraged, and the optimal timing of interventions also needs to be clarified.

Comparative efficacy of interventions for promoting physical activity in people with type 2 diabetes: A systematic review and network meta-analysis

BACKGROUND

Increasing physical activity is recommended as a cornerstone of self-management strategies for diabetes prevention and management. While evidence supporting the effectiveness of various interventions to enhance physical activity in individuals with type 2 diabetes is expanding, there remains a lack of consensus regarding the most effective intervention.

OBJECTIVE

To compare and rank the efficacy of different interventions in improving physical activity among individuals with type 2 diabetes.

DESIGN

Systematic review and network meta-analysis.

METHODS

PubMed, Cochrane Library, EMBASE, Web of Science, China Knowledge Resource Integrated Database, Wanfang Database, Weipu Database, and Chinese Biomedical Database were systematically searched for relevant studies published from the inception of databases until August 4, 2023. Randomized controlled trials evaluating any interventions aimed at improving physical activity (moderate-to-vigorous physical activity or steps per day measured objectively) in individuals with type 2 diabetes were included. The risk of bias was assessed according to the Revised Cochrane risk-of-bias tool for randomized trials (RoB2). A random-effects network meta-analysis model was employed to synthesize all available evidence. The registration number of this study is CRD42023432185.

RESULTS

33 studies involving 6304 participants were included in the quantitative synthesis. In total, the studies assessed 12 different interventions. Sixteen of the 33 studies (48.5 %) met the adapted Cochrane ROB2 for low risk of bias, while five studies were considered to be at high overall risk of bias. Compared to minimal intervention, multi-component interventions (MD 6.43 min/day, 95 % CI 1.85-11.01) had statistically significant effects on improving moderate-to-vigorous physical activity. Additionally, physical activity programme, counselling plus self-help materials, counselling plus Biofeedback, self-help materials plus biofeedback, physical activity programme plus biofeedback, and multi-component interventions had statistically significant effects on improving daily step counts, with MDs ranging from 1672 to 2504 steps per day in individuals with type 2 diabetes.

CONCLUSIONS

A combination of more than two intervention components appears required to increase physical activity. Counselling, physical activity programme, and biofeedback may be effective ingredients of such combinations, especially to increase the daily step count, among individuals with type 2 diabetes. However, the findings should be interpreted cautiously due to the limited number of studies, small sample sizes, and inconsistencies between outcome measures and comparison types. Further research is needed to strengthen the evidence base for clinical decision-making and to identify the most effective intervention combinations.

The prevalence of common mental disorders, stress, and sleep disturbance among international migrant workers: A meta-analysis with subgroup analysis

International migrant workers face an elevated risk of common mental disorders (CMDs), stress, and sleep disturbances due to various individual, psychosocial, and occupational factors. This meta-analysis systematically evaluated the prevalence of CMDs, stress, and sleep disturbance among international migrant workers. Two independent reviewers systematically searched the literature on five electronic databases from inception to June 2022. Random effects meta-analyses were performed to estimate the pooled prevalence of depressive symptoms, anxiety symptoms, stress, and sleep disturbance among international migrant workers. Additionally, subgroup analyses were conducted to examine potential modifiers for the prevalence rates. Of 8461 records, 57 studies (n = 29,481) were included in this meta-analysis. The pooled prevalence rates of depressive symptoms, anxiety symptoms, stress, and sleep disturbance were 20.3 %, 17.8 %, 17.3 %, and 25.3 %, respectively. Subgroup analyses revealed that the prevalence of CMDs and stress was statistically significantly modified by country of destination and type of work, stress by gender and country of origin, and anxiety by migration type. Potential publication bias was observed only in the meta-analysis of stress. Most of the studies included were of moderate to high methodological quality. However, given that the included studies were predominantly cross-sectional and used non-probability sampling, the results should be interpreted with caution. This meta-analysis highlights that CMDs, stress, and sleep disturbances are prevalent among international migrant workers, posing a significant public health concern for host countries. These findings underscore the urgent need for tailored mental health interventions for specific subgroups within this population.

The effectiveness of mindfulness-based interventions on menopausal symptoms: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Menopause, a crucial transitioning stage for women, can significantly impact mood and wellbeing. We aimed to systematically examine the effectiveness of Mindfulness-based interventions (MBIs) on health outcomes, including menopausal symptoms, quality of life (QOL), sleep quality, anxiety, depressive symptoms, stress, mindfulness levels, and female sexual function index.

METHODS

Eight databases were searched from inception to November 4, 2024 for randomized controlled trials. Two researchers independently selected, extracted, and appraised trials using the Cochrane Collaboration's 'risk of bias' tool. Meta-analysis, subgroup analysis, leave-one-out sensitivity analysis, and meta-regression were performed using Stata 18.0. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the quality of evidence.

RESULTS

A total of 19 studies (1670 participants) published between 2011 and 2024 were identified. Of these, 18 studies were included in the meta-analysis. Compared with control group, The pooled analysis demonstrated that MBIs had statistically significant effects on menopausal symptoms (SMD, -2.10; 95 % CI, -3.49 to -0.70), QOL (SMD, -0.88; 95 % CI, -1.67 to -0.09), sleep quality (SMD, -0.92; 95 % CI, -1.65 to -0.20), anxiety (SMD, -1.03; 95 % CI, -1.42 to -0.66), depressive symptoms (SMD, -0.91; 95 % CI, -1.30 to -0.53), stress (SMD, -0.85; 95 % CI, -1.55 to -0.15), and mindfulness levels (SMD, 1.19; 95 % CI, 0.35 to 2.02). The overall quality of evidence for all pooled estimates were graded as low and moderate due to methodological limitations and small sample size. The low attrition rate (6 %) and relatively high adherence rate (79 %) highlight the acceptability of MBIs.

CONCLUSIONS

This systematic review and meta-analysis support using of MBIs to improve health outcomes in menopausal women. Rigorous randomized controlled trials with extended follow-up are needed to elucidate the mechanisms linking MBIs to menopausal health and strengthen evidence for clinical application.

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 Total and Partial Meal Replacements on Factors Related to Glucose Metabolism: A Systematic Review and Meta-analysis of Randomized Controlled Trials

CONTEXT

Although some evidence shows the beneficial effects of meal replacements (MRs) on glucose metabolism as one of the main factors of diabetes, there are still no comprehensive findings in this field.

OBJECTIVE

We investigated the effects of total and partial MRs on fasting blood sugar (FBS), insulin, glycated hemoglobin (HbA1c), and homeostatic model assessment for insulin resistance (HOMA-IR) in this comprehensive study and meta-analysis.

DATA SOURCES

To find pertinent randomized controlled trials (RCTs) up to March 2024, databases including PubMed/Medline, Web of Science, Scopus, and Embase were searched.

DATA EXTRACTION

This study included all RCTs investigating the effects of MRs on factors related to glucose metabolism. The pooled weighted mean difference (WMD) and 95% CIs were computed using the random-effects model.

DATA ANALYSIS

The findings from 52 studies indicated significant reductions in FBS (WMD: -3.10 mg/dL; 95% CI: -4.99, -1.20; P < .001), insulin (WMD: -1.79 μU/mL; 95% CI: -3.51, -0.08; P = .40), HOMA-IR (WMD: -0.86; 95% CI: -1.68, -0.04; P = .040), and HbA1c (WMD: -0.24%; 95% CI: -0.35%, -0.13%; P < .001) levels following MR consumption compared with the control group. The findings obtained from the subgroup analysis showed that MRs cause a greater decrease in FBS, insulin, and HOMA-IR in the >50-years age group compared with those aged ≤50 years and also during interventions ≤24 weeks compared with >24 weeks.

CONCLUSION

In conclusion, it appears that MRs, along with other lifestyle factors, can lead to significant improvements in glucose metabolism.

Effects of Prebiotics and Probiotics on Symptoms of Depression and Anxiety in Clinically Diagnosed Samples: Systematic Review and Meta-analysis of Randomized Controlled Trials

CONTEXT

The use of prebiotics and probiotics as a treatment for psychiatric conditions has gained interest due to their potential to modulate the gut-brain axis. This review aims to assess the effectiveness of these interventions in reducing symptoms of depression and anxiety in psychiatric populations.

OBJECTIVE

The aim was to comprehensively review and appraise the effectiveness of prebiotic, probiotic, and synbiotic interventions in reducing clinical depression and anxiety symptoms.

DATA SOURCES

Systematic searches were conducted across Embase, Medline, PsycINFO, CINAHL, Cochrane Library, and Science Citation Index from database inception to May 22, 2023.

DATA EXTRACTION

Randomized controlled trials investigating prebiotic, probiotic, or synbiotic interventions for treating clinical depression or anxiety symptoms in clinical samples were included. Data were extracted on study characteristics, intervention details, and outcome measures. The Cochrane Collaboration Tool was used to assess the risk of bias.

DATA ANALYSIS

The standardized mean difference (SMD) was calculated using Hedge's g as the metric of effect size. A random-effects model was applied to estimate pooled effect sizes with 95% CIs. Subgroup analyses were performed based on study characteristics, methodological factors, and intervention types. Sensitivity analyses excluded studies with a high risk of bias.

RESULTS

Twenty-three RCTs involving 1401 patients met the inclusion criteria, with 20 trials providing sufficient data for meta-analysis. Of these, 18 trials investigated probiotics for depression, 9 trials assessed probiotics for anxiety, and 3 trials examined prebiotics for depression. Probiotics demonstrated a significant reduction in depression symptoms (SMD: -0.96; 95% CI: -1.31, -0.61) and a moderate reduction in anxiety symptoms (SMD: -0.59; 95% CI: -0.98, -0.19). Prebiotics did not show a significant effect on depression (SMD: -0.28; 95% CI: -0.61, 0.04). High heterogeneity was observed across studies, and subgroup analyses indicated that study duration and probiotic formulations contributed to the variation in effect sizes.

CONCLUSION

Probiotics showed substantial reductions in depression symptoms and moderate reductions in anxiety symptoms. Prebiotics showed a nonsignificant trend toward reducing depression. An adjunctive mental health treatment approach that diagnoses, monitors, and treats the gut microbiome alongside traditional pharmacological treatment holds promise for clinical practice.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023424136.

Continuous Glucose Monitoring and Hypoglycaemia Metrics With Once-Weekly Basal Insulin Fc Versus Insulin Degludec: A Systematic Review and Meta-Analysis

INTRODUCTION

Once-weekly basal insulin Fc (BIF) offers a promising alternative to daily basal insulin by reducing injection burden while maintaining glycaemic control. However, comprehensive comparisons with insulin degludec regarding continuous glucose monitoring (CGM) metrics and hypoglycaemia outcomes remain limited. This meta-analysis evaluates these critical parameters.

METHODS

We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) comparing once-weekly BIF with once-daily insulin degludec in type 1 and type 2 diabetes. Outcomes included CGM-derived glycaemic variability, time in range, time above/below range and hypoglycaemia event rates. Data were pooled using random-effects models, with heterogeneity assessed via I2 statistics.

RESULTS

Five RCTs (n = 2427) were included. BIF demonstrated comparable glycaemic variability (within-day CV: MD = 0.06, p = 0.90; between-day CV: MD = -0.26, p = 0.30) and Time in range (MD = 0.56, p = 0.27) versus degludec. However, BIF increased time spent in the mild hypoglycaemia range (54-69 mg/dL) (MD = 0.30, p = 0.0004) and clinically significant hypoglycaemia event rates (rate ratio = 1.20, p < 0.00001). Severe hypoglycaemia event rates were higher with BIF (rate ratio = 3.34, p < 0.0001). Nocturnal hypoglycaemia and time above range (> 250 mg/dL) did not differ significantly.

CONCLUSION

Once-weekly BIF provides similar overall glycaemic control to insulin degludec but with increased time in mild hypoglycaemia and higher event rates of clinically significant and severe hypoglycaemia. These findings highlight the need for individualised dosing and monitoring when transitioning to weekly insulin regimens.

Purine xanthine oxidase inhibitors are not conducive to the prognosis of chronic heart failure: a meta-analysis

BACKGROUND

According to previous studies, the efficacy of xanthine oxidase inhibitors (XOIs) in patients with chronic heart failure (CHF) is still controversial. Therefore, the purpose of this study was to investigate the efficacy of XOIs in patients with CHF.

METHODS

Up to July 2024, we searched PubMed, EMBASE, Medline, Web of Science, and Cochrane Library for studies on the efficacy of XOI in patients with CHF. The main results included all-cause mortality, cardiovascular (CV) mortality, and heart failure (HF) hospitalization rates. The results were evaluated by hazard ratio (HR) and 95% confidence interval (95% CI).

RESULTS

A total of eight studies were included in this meta-analysis, of which five were cohort studies and three were randomized controlled trials (RCTs). The total sample size was 301,345. The experimental group was exposed to allopurinol or hydroxypurinol. The all-cause mortality (HR = 1.26, 95% CI 1.05-1.51, p = 0.013) and CV mortality (HR = 1.58, 95% CI 1.17-2.14, p = 0.03) in the experimental group were higher than those in the control group. In terms of HF hospitalization, there was no difference between both groups (HR = 1.21, p = 0.292). Subgroup analysis showed that the CV hospitalization rate of the experimental group was higher than that of the control group, regardless of frequency and dose levels. The all-cause mortality in the low-dose group was higher than that in the control group (HR = 1.39, p = 0.033). The CV mortality of the low-dose group (HR = 1.55, p = 0.006) and the prevalent group (HR = 1.50, p = 0.042) was higher than that of the control group.

CONCLUSION

Purine XOI exposure may be unfavorable for the prognosis of CHF patients and is affected by the frequency and dose of use.

Efficacy and safety of tenecteplase administration in extended time window for acute ischemic stroke: An updated meta-analysis of randomized controlled trials

BACKGROUND

Data regarding the efficacy and safety of tenecteplase (TNK) in patients with acute ischemic stroke (AIS) who present outside the standard treatment window are limited. This study aims to evaluate the role of TNK at a dose of 0.25 mg/kg, in treating AIS patients in an extended time window.

METHODS

Searches were performed up to February 15, 2025 in PubMed, Embase, and Cochrane Library to include randomized-controlled trials (RCTs) comparing TNK (0.25 mg/kg) to no thrombolysis in AIS patients presenting after 4.5 hours of symptom onset or wake-up AIS. The primary efficacy outcomes included a 3-month excellent functional outcome (mRS ⩽1), and a good functional outcome (mRS ⩽2). Secondary safety outcomes assessed included symptomatic intracranial hemorrhage (sICH), any ICH, and 3-month all-cause death. A random-effects model was used to calculate summary estimates.

RESULTS

6 RCTs were included (n = 1,955 patients) in the meta-analysis. The pooled analysis demonstrated a significantly improved excellent functional outcome on 90 days (OR = 1.35, 95 % CI: 1.12 to 1.64) with TNK administration compared to control. No statistically significant association was observed for the two groups regarding good functional outcome (OR = 1.16, 95 % CI: 0.94 to 1.44), all-cause death (OR = 1.11, 95 % CI: 0.82 to 1.49), sICH (OR = 1.79, 95 % CI: 0.94 to 3.39), and any ICH (OR = 1.21, 95 % CI: 0.96 to 1.53).

CONCLUSION

TNK administration in an extended time window for AIS patients leads to favorable neurological outcomes with a good safety profile.

Effect of Plant Versus Animal Protein on Muscle Mass, Strength, Physical Performance, and Sarcopenia: A Systematic Review and Meta-analysis of Randomized Controlled Trials

CONTEXT

Dietary protein is recommended for sarcopenia-a debilitating condition of age-related loss of muscle mass and strength that affects 27% of older adults. The effects of protein on muscle health may depend on protein quality.

OBJECTIVE

The aim was to synthesize randomized controlled trial (RCT) data comparing plant with animal protein for muscle health.

DATA SOURCES

Forty-three eligible RCTs were sourced from Medline, Embase, Scopus, Web of Science, and CENTRAL databases.

DATA EXTRACTION

Four reviewers (R.J.R.-M., S.F.B., N.A.W., D.L.) extracted data from RCTs (study setting, population, intervention characteristics, outcomes, summary statistics) and conducted quality assessment using the Cochrane Risk of Bias 2.0.

DATA ANALYSIS

Standardized mean differences (SMDs) (95% CIs) were combined using a random-effects meta-analysis and forest plots were generated. I2 statistics were calculated to test for statistical heterogeneity.

CONCLUSION

Thirty RCTs (70%) were eligible for meta-analysis and all examined muscle mass outcomes. Compared with animal protein, plant protein resulted in lower muscle mass following the intervention (SMD = -0.20; 95% CI: -0.37, -0.03; P = .02), with stronger effects in younger (<60 years; SMD = -0.20; 95% CI: -0.37, -0.03; P = .02) than in older (≥60 years; SMD = -0.05; 95% CI: -0.32, 0.23; P = .74) adults. There was no pooled effect difference between soy and milk protein for muscle mass (SMD = -0.02; 95% CI: -0.20, 0.16; P = .80) (n = 17 RCTs), yet animal protein improved muscle mass compared with non-soy plant proteins (rice, chia, oat, and potato; SMD = -0.58; 95% CI: -1.06, -0.09; P = .02) (n = 5 RCTs) and plant-based diets (SMD = -0.51; 95% CI: -0.91, -0.11; P = .01) (n = 7 RCTs). No significant difference was found between plant or animal protein for muscle strength (n = 14 RCTs) or physical performance (n = 5 RCTs). No trials examined sarcopenia as an outcome. Animal protein may have a small beneficial effect over non-soy plant protein for muscle mass; however, research into a wider range of plant proteins and diets is needed.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42020188658.

Unravelling the associations between dissociation and emotion (dys)regulation: A multidimensional meta-analytic review

BACKGROUND

The relationship between dissociation features, maladaptive regulation strategies, and emotional dysregulation is a controversial issue. This meta-analytic review provides a comprehensive and multidimensional overview of the association between aspects of dissociation and emotional (dys)regulation.

METHODS

We conducted systematic research on the main databases (Psycinfo, PsycARTICLES, Pubmed, MEDLINE, Scopus), collecting the literature of the last 20 years. A total of 120 studies were included in the meta-analytic review. The analyses were based on the Pearson coefficient as a measure of the size of the effect, using the random effect model and performing moderation analysis.

RESULTS

Results showed significant relationships between emotion (dys)regulation and the different facets of dissociation. Overall, we observed stronger associations between deficits in emotion regulation/maladaptive regulating strategies, rather than alexithymia, and dissociation, supporting the prior involvement of emotional dimensions in dissociative experiences.

CONCLUSIONS

This work confirms the connection between emotion (dys)regulation and dissociation, revealing differential patterns according to the specific assessed dimensions and, thus, providing a systematization of the associations between specific aspects of the examined constructs.

Glymphatic pathway dysfunction in severe obstructive sleep apnea: A meta-analysis

BACKGROUND

Obstructive sleep apnea (OSA), a sleep disorder, is associated with cognitive decline and is potentially linked to glymphatic system dysfunction. This meta-analysis investigates glymphatic function in severe OSA (apnea-hypopnea index ≥30) using the Diffusion Tensor Imaging Analysis along the Perivascular Space (DTI-ALPS) index.

METHODS

This study followed PRISMA guidelines for systematic reviews and meta-analyses. A comprehensive search of PubMed, Web of Science, Scopus, and Embase was conducted from inception to January 20, 2024. Studies investigating the ALPS index in OSA using DTI were included. Analyses included a random-effects meta-analysis, sensitivity analysis, meta-regression, publication bias evaluation (funnel plot, Egger's test, and Begg's test), and risk of bias assessment.

RESULTS

Systematic review identified four studies (137 patients with severe OSA and 170 healthy controls (HCs)). Pooled analysis revealed a significant reduction in the DTI-ALPS index in severe OSA patients compared to HCs (standardized mean difference: -0.95, 95 % CI: -1.46 to -0.44, p < 0.001), indicating impaired glymphatic function. Heterogeneity was moderate to high (I2 = 76.07 %), but sensitivity analyses confirmed robustness. Meta-regression analyses identified the sources of heterogeneity as the apnea-hypopnea index (β = -0.039, p = 0.009) and the Epworth Sleepiness Scale (β = -0.150, p = 0.032), with no effects observed for age or male ratio. Qualitative (funnel plot) and quantitative publication bias assessments (Egger's and Begg's tests) showed no significant bias, and risk of bias evaluations using the Newcastle-Ottawa Scale indicated high methodological quality across studies.

CONCLUSIONS

These findings suggest that severe OSA disrupts glymphatic activity. The DTI-ALPS index emerges as a promising tool for assessing glymphatic dysfunction in OSA.

Targeting Ketone Body Metabolism Improves Cardiac Function and Hemodynamics in Patients With Heart Failure: A Systematic Review and Meta-Analysis

CONTEXT

The impacts of elevated ketone body levels on cardiac function and hemodynamics in patients with heart failure (HF) remain unclear.

OBJECTIVE

The effects of ketone intervention on these parameters in patients with HF were evaluated quantitatively in this meta-analysis.

DATA SOURCES

We searched the PubMed, Cochrane Library, and Embase databases for relevant studies published from inception to April 13, 2024. Ketone therapy included ketone ester and β-hydroxybutyrate intervention.

DATA EXTRACTION

Seven human studies were included for the quantitative analysis.

DATA ANALYSIS

Our results showed that ketone therapy significantly improved left ventricular ejection fraction (standardized mean difference, 0.52 [95% CI, 0.25-0.80]; I2 = 0%), cardiac output (0.84 [95% CI, 0.36-1.32]; I2 = 68%) and stroke volume (0.47 [95% CI, 0.10-0.84]; I2 = 39%), and significantly reduced systemic vascular resistance (-0.92 [95% CI, -1.52 to -0.33]; I2 = 74%) without influencing mean arterial pressure (-0.09 [95% CI: -0.40 to 0.22]; I2 = 0%) in patients with HF. Subgroup analysis revealed that the enhanced cardiac function and favorable hemodynamic effects of ketone therapy were also applicable to individuals without HF.

CONCLUSIONS

Ketone therapy may significantly improve cardiac systolic function and hemodynamics in patients with HF and in patients without HF, suggesting it may be a promising treatment for patients with HF and also a beneficial medical strategy for patients without HF or healthy individuals.

Trimodality therapy versus radical cystectomy for muscle-invasive bladder cancer: A systematic review and meta-analysis

BACKGROUND

Radical cystectomy (RC) is the guideline-recommended gold standard of curative treatment for muscle-invasive bladder cancer (MIBC). Trimodality therapy (TMT) has recently emerged as a viable alternative treatment, aiming to improve long term survival and bladder preservation rates.

METHODS

A systematic literature search was conducted on PubMed, Embase, Scopus and CENTRAL for randomized trials or covariate-matched studies comparing RC versus TMT for MIBC. A graphical reconstructive algorithm was used to obtain overall survival (OS) and cancer-specific survival (CSS) of individual patients, which was then pooled under random-effects individual patient data (IPD) meta-analysis using Cox-models to determine hazard ratios (HRs) and 95% CI.

RESULTS

Altogether, 11 studies, comprising mostly cT2-T4, node-negative, nonmetastatic MIBC, were analyzed. Across 9 studies (6780 patients), TMT was associated with lower OS versus RC (shared-frailty HR = 1.14, 95% CI, 1.08-1.21, P < 0.001). Estimated OS at 1, 5 and 10 years was 86%, 47% and 18% respectively for TMT, and 86%, 57% and 22% for RC. Across 8 studies (4,776 patients), TMT was associated with lower CSS versus RC (shared-frailty HR = 1.09, 95% CI, 1.01-1.18, P = 0.024). Estimated CSS at 1, 5 and 10 years was 92%, 62% and 29% respectively for TMT, and 94%, 72% and 29% respectively for RC.

CONCLUSIONS

In the absence of large trials, our meta-analysis of studies of the next-highest quality of evidence suggests that RC may still confer OS and CSS benefit over TMT in MIBC. RC should remain the standard of care for nonmetastatic MIBC while TMT remains a valid alternative for carefully selected and informed patients.

The prevalence of nomophobia: A systematic review and meta-analysis

Nomophobia (no mobile phone phobia) is a term used to describe discomfort or anxiety experienced when individuals are unable to use or access their mobile phones. Although not formally recognized in the DSM-5 or ICD-11, nomophobia has gained increasing research attention. The present study systematically reviewed and meta-analyzed the global prevalence of nomophobia, based on 43 studies (n = 36,656 participants) from 18 countries. Only studies using validated self-report instruments, primarily the Nomophobia Questionnaire (NMP-Q), were included. Subgroup analysis and meta-regression were conducted to determine the sources of heterogeneity. Results indicated that nomophobia is widespread, with 26 % of participants reporting mild symptoms, 51 % moderate symptoms, and 21 % severe symptoms. Importantly, these figures reflect self-reported levels of distress rather than clinical diagnoses. Higher prevalence was observed among university students and young adults. The wide variation across regions and instruments suggests nomophobia is influenced by cultural, behavioral, and technological contexts. Despite ongoing debates regarding whether nomophobia is an anxiety disorder, these findings highlight the critical need for precise definitions and continued exploration of its psychological correlates.

Pre-Existing and Gestational Diabetes and Risk of Maternal Venous Thromboembolism: A Systematic Review and Meta-Analysis of Observational Studies

BACKGROUND

Women who are pregnant are at increased risk of venous thromboembolism (VTE), which persists for up to 3 months following childbirth. Diabetes is known to increase the risk of serious cardiovascular outcomes.

OBJECTIVE

To comprehensively review literature on the extent to which pre-existing or gestational diabetes influences the risk of VTE in both pregnancy and postpartum.

SEARCH STRATEGY

We used Medline, Embase and Google Scholar to identify observational studies published up to 2 November 2023.

SELECTION CRITERIA

Studies which quantified the relationship between diabetes on antepartum and/or postpartum VTE, and which provide separate data for pre-existing and gestational diabetes.

DATA COLLECTION AND ANALYSIS

Results were pooled, where appropriate, using random-effects meta-analysis.

MAIN RESULTS

Twenty one studies from Europe, the United States and Asia were included. There was an increased risk of antepartum VTE in women with gestational diabetes (RR = 2.48, 95% CI 1.47 - 4.16, I2= 45%, 4 studies) but not pre-existing diabetes (RR = 1.71, 0.43 - 6.77, I2= 68%, 2 studies). For postpartum VTE, there was no clear association with either pre-existing (RR = 1.28, 0.73 - 2.24, I2= 73%, 6 studies) or gestational (RR = 1.39, 0.77 - 2.51, I2= 70%, 10 studies) diabetes.

CONCLUSIONS

Our results will provide some reassurance for pregnant women with pre-existing or gestational diabetes, owing to no clear evidence of an increased risk of maternal VTE. While some studies report a raised risk of VTE during antepartum specifically, results must be interpreted in light of high levels of heterogeneity.

Effects of patient safety education programs on nursing students' knowledge, attitude, and competency with patient safety: A systematic review, meta-analysis, and meta-regression

AIMS

Patient safety is a global concern, and nurses, as the largest group of healthcare professionals, play a critical role in ensuring patient safety. This study aimed to systematically review and analyze the effects of patient safety education programs on nursing students' knowledge, attitudes, and competencies by synthesizing existing research and identifying key factors contributing to program effectiveness.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Ovid-EMBASE, MEDLINE, CINAHL, and PubMed were selected for their comprehensive coverage of healthcare and nursing literature. Articles published between January 2000 and July 2024 were included, as the year 2000 marked the beginning of global efforts to prioritize patient safety in healthcare systems.

REVIEW METHODS

This systematic review and meta-analysis followed PRISMA guidelines. A comprehensive search of Ovid-EMBASE, MEDLINE, CINAHL, and PubMed (2000-2024) identified interventional studies on patient safety education for nursing students. Eligible studies underwent quality appraisal using the weight of evidence framework.

RESULTS

The meta-analysis showed significant improvements in nursing students' knowledge (Z = 5.315, p < .001), attitudes (Z = 2.727, p = .006), and competencies (Z = 4.870, p < .001). Effect sizes ranged from medium to very large (g = 0.684-2.461). Meta-regression analysis indicated that participants' grades (β = -3.29, p < .001) influenced attitudes, while both grades (β = -2.04, p = .007) and education methods (β = 0.85, p = .042) affected competency.

CONCLUSION

Patient safety education programs significantly enhance nursing students' knowledge, attitudes, and competencies. Structured, long-term education and interactive methods, such as simulation and virtual reality, enhance competency development. Integrating these approaches into nursing curricula can help bridge the gap between theory and practice, ultimately improving patient safety.

Effects of mindfulness- and acceptance-based interventions for individuals with schizophrenia spectrum disorders: A systematic meta-review

BACKGROUND

Mindfulness- and acceptance-based interventions (MBIs/ABIs) for persons with schizophrenia spectrum disorders (SSD) aim to cultivate purposeful attention, mind-body awareness, and targeted action-taking. This systematic meta-review assessed the current body of evidence regarding the effects of MBIs/ABIs for SSD symptoms.

METHODS

The study was registered with PROSPERO (CRD42024535284) on June 3, 2024. Seven databases were searched between April 18 and April 19, 2024. Meta-analyses investigating the effects of MBIs/ABIs for SSD symptoms were considered. Two authors (AM, AS) independently completed data extraction and analysis. Evidence grading and methodology assessments were conducted using the Ioannidis' criteria, AMSTAR-2, and AMSTAR-Plus Content guidelines.

FINDINGS

A total of 18 meta-analyses with up to 2572 participants were considered; 14 studies were eligible for analysis. Results were classified according to Ioannidis' criteria; the effect size of the highest ranked study with the largest number of primary studies is presented. Percentages indicate the number of studies reporting significant results. Significant evidence was found at end of treatment for overall symptomatology (MBIs: 100 %, n = 9, g = -0·7 (total range: -0·417 to -1·152), 95% CI: [-1·052, -0·347], I2 = 95·36; ABIs: 25 %, n = 29, g = -1·065 (total range: -0·1 to -1·065) [-1·371, -0·759], I2 = 85·1), positive (MBIs: 50 %, n = 6, g = -0·296 (total range: -0·155 to -0·416) [-0·528, -0·064], I2 = 34·69; ABIs: 33·33 %, n = 3, g = -0·602 (total range: -0·602 to 0·147) [-1·014, -0·191], I2 = 0), negative (MBIs: 100 %, n = 8, g = -0·94 (total range: -0·384 to -0.98) [-1·466, -0·413], I2 = 86·42; ABIs: 25 %, n = 2, g = -0·631 (total range: -0·028 to -0.631) [-1·108, -1·154], I2 = 0), affective symptoms (MBIs: 50 %, n = 9, g = -0·971 (total range: -0·275 to -0·971) [-1·413, -0·529], I2 = 91·32; ABIs: 33·33 %, n = 3, g = -0·854 (total range: -0·472 to -0·854) [-1·255, -0·453, I2 = 0), social functioning (MBIs: 100 %, n = 7, g = -1·368 (total range: -0·452 to -1·368) [-2·194, -0·542], I2 = 94·3; ABIs: g total range: -0·878 to 0·625), mindfulness (MBIs: 66·66 %, n = 5, g = -0·805 (total range: -0·488 to -1·429) [-1·16, -0·45], I2 = 0; ABIs: 66·66 %, n = 1, g = -0·959 (total range: -0·391 to -0·959) [-1·788, -0·129], I2 = NA), and acceptance (MBIs: g total range: -0·381 to 0·381; ABIs: 50 %, n = 4, g = -0·393 (total range: -0·393 to 0·398) [-0·673, -0·113], I2 = 0). Possible explanations for the differences in effect sizes for MBIs and ABIs are explored. Methodological assessments ranked 'low' or 'critically low' for all meta-analyses.

INTERPRETATION

Although subject to several limitations, significant small to large effect sizes were evident for overall symptomatology, mindfulness, and social functioning. Small to large effect sizes were found for positive, negative, and affective symptoms. Future research should incorporate additional risk of bias assessments, increased sample sizes, and consider cultural contexts (as the largest effect sizes were reported by studies with a majority of samples from Mainland China and Hong Kong) regarding the therapeutic benefits of MBIs/ABIs.

ROLE OF THE FUNDING SOURCE

There was no funding source for this study.

Effect of Treatment With Balanced Crystalloids Versus Normal Saline on the Mortality of Critically Ill Patients With and Without Traumatic Brain Injury: A Systematic Review and Meta-Analysis

BACKGROUND

Some studies suggest that balanced solutions may improve outcomes in critical care patients. However, in patients with traumatic brain injury (TBI) existing data indicate that normal saline may be preferred. We hypothesized that mortality in critically ill patients with and without TBI would differ with the use of balanced salt solutions versus normal saline.

METHODS

We conducted a systematic review and meta-analysis to investigate the impact of balanced crystalloids versus normal saline on 90-day mortality in adult critical care patients with and without TBI. Secondary outcomes included length of hospital stay, renal complications, need for vasopressors or mechanical ventilation, and mortality in critically ill patients with sepsis. We followed the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) statement and estimated the odds ratio (OR) and 95% confidence interval (CI) with a random-effects model.

RESULTS

We included 15 clinical trials involving 35,207 patients. The OR of mortality with balanced solutions versus saline in patients without TBI was 0.93 (95% CI, 0.87-0.98; P = .01; I 2 = 0%), while the OR for mortality in patients with TBI was 1.31 (95% CI, 1.03-1.65; P = .03; I 2 = 0%). We found no differences in secondary outcomes due to fluid choice although data were unavailable to calculate pooled estimates for some of the secondary outcomes for TBI patients. In patients with sepsis, the OR of mortality with balanced solutions was 0.92 (95% CI, 0.83-1.02; I 2 = 0%).

CONCLUSIONS

In comparison to normal saline, balanced solutions were associated with a reduction in mortality in critical care patients without TBI. However, balanced solutions were associated with an increase in mortality in patients with TBI. These findings suggest that the effect of fluid choice on intensive care unit (ICU) outcomes may depend partially on the type of critical illness and in particular in patients with TBI.

Radiomics-based machine learning in prediction of response to neoadjuvant chemotherapy in osteosarcoma: A systematic review and meta-analysis

BACKGROUND AND AIMS

Osteosarcoma (OS) is the most common primary bone malignancy, and neoadjuvant chemotherapy (NAC) improves survival rates. However, OS heterogeneity results in variable treatment responses, highlighting the need for reliable, non-invasive tools to predict NAC response. Radiomics-based machine learning (ML) offers potential for identifying imaging biomarkers to predict treatment outcomes. This systematic review and meta-analysis evaluated the accuracy and reliability of radiomics models for predicting NAC response in OS.

METHODS

A systematic search was conducted in PubMed, Embase, Scopus, and Web of Science up to November 2024. Studies using radiomics-based ML for NAC response prediction in OS were included. Pooled sensitivity, specificity, and AUC for training and validation cohorts were calculated using bivariate random-effects modeling, with clinical-combined models analyzed separately. Quality assessment was performed using the QUADAS-2 tool, radiomics quality score (RQS), and METRICS scores.

RESULTS

Sixteen studies were included, with 63 % using MRI and 37 % using CT. Twelve studies, comprising 1639 participants, were included in the meta-analysis. Pooled metrics for training cohorts showed an AUC of 0.93, sensitivity of 0.89, and specificity of 0.85. Validation cohorts achieved an AUC of 0.87, sensitivity of 0.81, and specificity of 0.82. Clinical-combined models outperformed radiomics-only models. The mean RQS score was 9.44 ± 3.41, and the mean METRICS score was 60.8 % ± 17.4 %.

CONCLUSION

Radiomics-based ML shows promise for predicting NAC response in OS, especially when combined with clinical indicators. However, limitations in external validation and methodological consistency must be addressed.

Systematic review and meta-analysis on the prevalence of extended-spectrum β-lactamases-producing Acinetobacter baumannii in Iran: Evaluation of TEM, PER, SHV, CTX-M, VEB and GES

Acinetobacter baumannii's resistance to antibiotics restricts treatment ways, and has enhanced its mortality rates approaching 35 %. Resistance to β-lactams in Acinetobacter baumannii, related to extended-spectrum β-lactamases (ESBLs), has become a worldwide concern. This study aimed to assess the prevalence of Extended-Spectrum Beta-Lactamase-Producing Acinetobacter baumannii in Iran. Important databases (PubMed, Scopus, Wily Online Library, ScienceDirect and Google Scholar) were searched for related literature published from January 2010 to April 2024. The inclusion criteria were predefined based on PRISMA guidelines. A random-effects model was used according to the heterogeneity test. Publication bias was specified using Egger's weighted regression and Begg's rank correlation methods. The statistical analyses were carried out relying on the Comprehensive Meta-Analysis Software (CMA). Among 2409 articles identified, 15 papers met the eligibility criteria. Among encoding genes of ESBLs, TEM, PER, SHV, CTX-M, VEB and GES were found with the prevalence of 25.0 % (95 % CI: 15.9-37.1 %), 16.1 % (95 % CI: 7.4-31.5 %), 14.3 % (95 % CI: 6.3-29.4 %), 11.1 % (95 % CI: 4.3-25.8 %), 9.9 % (95 % CI: 5.2-18.1 %) and 8.5 % (95 % CI: 1.4-37.2 %), respectively. A subgroup analysis based on province showed some differences in TEM prevalence. The evaluated pooled prevalence of TEM was highest in Ilam (53.4 %; 95 % CI: 42.0-64.5 %), however, it was based only on one study. It was 51.1 % (95 % CI: 33.7-68.3 %) in Tehran. The present studies demonstrate a high prevalence of ESBL in Acinetobacter Baumannii in Iran which poses a serious concern in critically ill patients. As well as these findings can assist our conception of the real prevalence of ESBL to work on new strategies for the control and prevention of infection.

Risk factors for depression, anxiety, and PTSS after loss: A systematic review and meta-analysis

BACKGROUND

Bereavement can lead to complicated grief reactions including clinically significant symptoms of depression, anxiety, and post-traumatic stress (PTSS) post-loss. Gaining insight into specific and shared risk factors for these complicated grief reactions can help identify individuals needing support.

METHODS

A comprehensive systematic review and meta-analysis of risk factors for post-loss depression, anxiety, and PTSS. PsycInfo, PubMed, Web of Science, and CINAHL were searched to identify risk factors for inclusion in the meta-analysis.

RESULTS

The systematic review included 144 studies. Most risk factors were of small magnitude. For depression, 21 risk factors were analyzed, with six analyses of adjusted risk factors reaching statistical significance. Pre-loss depression was the strongest risk factor (ESr = 0.25, 95 %CI [0.03,0.45]). Of nine analyzed risk factors for PTSS, four reached statistical significance, with the death of a close relative yielding the largest effect (ESr = 0.24, 95 %CI [0.01,0.44]). Only female gender significantly predicted anxiety (ESr = 0.21, 95 %CI [0.09,0.32]). Female gender, the death of a partner, and violent/unnatural losses were transdiagnostic risk factors.

CONCLUSIONS

An overview of risk factors for three complicated grief reactions, including their predictive strength, is presented. The results provide insights into transdiagnostic risk factors and can aid early identification of people at risk of complicated grief reactions.

The impact of feedback elements in serious games on nursing learning outcomes: A systematic review and meta-analysis

OBJECTIVE

This study evaluates the impact of different feedback elements in serious games (SGs) on nursing education outcomes.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

6546 English-language studies published between 2000 and 2023 were retrieved from seven electronic databases.

REVIEW METHODS

This systematic review and meta-analysis followed the PRISMA guidelines. The Cochrane Risk of Bias tool was used for quality assessment. Meta-analysis and subgroup analysis were conducted using RevMan 5.4, and the certainty of evidence for each outcome was assessed using the GRADE approach.

RESULTS

Eight studies were included in the meta-analysis. Findings showed that, compared to traditional learning methods, outcome feedback had a moderate effect size on knowledge (SMD = 0.51, 95 % CI [0.09, 0.92]), while comparative feedback had a small, non-significant effect size (SMD = 0.38, 95 % CI [-0.36, 1.12]). Immediate feedback had a large effect size on skills (SMD = 0.87, 95 % CI [0.61, 1.14]), and outcome feedback had a moderate effect size (SMD = 0.50, 95 % CI [0.21, 0.79]). Serious games with feedback had a large effect size on motivation (SMD = 1.31, 95 % CI [0.45, 2.17]). For confidence, outcome feedback had a moderately large effect size (SMD = 0.64, 95 % CI [-0.22, 1.51]), and comparative feedback had a small effect size (SMD = 0.24, 95 % CI [-0.44, 0.91]), but neither reached statistical significance. GRADE assessment showed high certainty for immediate feedback on skills, moderate certainty for outcome feedback on knowledge and skills, and very low certainty for comparative feedback on knowledge. Evidence certainty for motivation and confidence was low or very low.

CONCLUSION

Serious games incorporating feedback elements can enhance nursing students' motivation. Immediate feedback significantly improves nursing skills, while outcome feedback improves knowledge acquisition. However, further research is needed to validate these findings due to the limited number of studies and high heterogeneity.

Craniosynostosis among children with X-linked hypophosphatemia: A systematic review and meta-analysis

BACKGROUND

X-linked hypophosphatemia (XLH) is a rare genetic disorder caused by PHEX gene variants, leading to elevated FGF23 levels and impaired phosphate reabsorption, resulting in abnormal bone growth. Skull abnormalities, including craniosynostosis, are often reported in children with XLH, but the true prevalence of craniosynostosis among children with XLH is unknown.

METHODS

We performed a systematic review and meta-analysis to estimate craniosynostosis prevalence in children with XLH. We searched PubMed, Embase, and Web of Science for cohort studies or large case series published before June 2024. Eligible studies included at least ten children with XLH and reported craniosynostosis prevalence without selection based on skull abnormalities. Pooled prevalence was calculated using a random-effects model, with heterogeneity assessed.

RESULTS

Of 517 studies initially identified, ten studies with 461 patients met the criteria for inclusion. The pooled prevalence of craniosynostosis among children with XLH was 22 % (95 % confidence interval (CI) 9.0 % to 44 %) with significant heterogeneity across studies (I2 = 88.5 %, p < 0.01). This prevalence is far greater than the prevalence of craniosynostosis in the general pediatric population, which is estimated to be one in 2100-2500 births. We confirmed an expected female predominance among children with XLH (median 65.9 % female, interquartile range [IQR] 53.7 % to 68.4 %) but not among children with XLH and craniosynostosis (median 42 % female, range 21 % to 48 %).

CONCLUSION

Craniosynostosis is more common among children with XLH compared to the general pediatric population and may be disproportionately common among males. Increased vigilance for craniosynostosis is warranted for children with XLH.