Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement

Approaches to teaching evidence-based medicine in residency: a systematic review

BACKGROUND

Studies of evidence-based medicine (EBM) curricula in graduate medical education are common, but little consensus exists on the best methods to teach EBM.

OBJECTIVE

The purpose of the current study was to evaluate EBM teaching approaches for graduate medical trainees and to update a 2014 systematic review.

METHODS

We conducted a systematic literature search of major health and education databases for articles published from January 2014 through October 2022. Articles were independently screened to ensure they described an experimental or quasi-experimental evaluation of EBM teaching for graduate medical trainees. Quality of included studies was appraised using the Medical Education Research Study Quality Instrument. Data were extracted and synthesized using Coomarasamy and Khan's hierarchy of EBM teaching and learning.

RESULTS

Over 1400 articles were screened; 35 met eligibility criteria and were included in our review. Interactive, classroom-based teaching approaches were most common (23/35, 66%). Only 2 (6%) studies used a clinically integrated teaching approach. Most studies reported positive short-term outcomes in EBM knowledge, skills, attitudes, or learner satisfaction. Few studies evaluated EBM behaviors, and none measured long-term application of EBM principles.

CONCLUSIONS

Reviewed studies had low to moderate study quality, often limited by small sample size and lack of validated measures. Although commonly encouraged as a teaching approach, few studies used clinically integrated EBM teaching. Instead of reporting individual, site-specific efforts, future studies should examine the broader culture of EBM in graduate medical education and prioritize sustained application of EBM into practice as a key outcome.

Determinants of stroke following percutaneous coronary intervention in patients with acute coronary syndrome: a systematic review and meta-analysis

BACKGROUND

Despite advances in the field, no systematic review has thoroughly documented the occurrence of stroke following Percutaneous Coronary Intervention (PCI) in patients with Acute Coronary Syndrome (ACS). This study aimed to investigate the factors contributing to stroke occurrence post-PCI in ACS patients.

METHODS

A systematic search of PubMed and EMBASE identified 2,369 articles. After full-text screening, 109 articles were included in the systematic review, with 55 articles selected for meta-analysis.

RESULTS

Data from 18,466,823 patients across 109 studies were analyzed. Among these, 202,999 patients (1.1%) experienced post-PCI stroke. The participants' ages ranged from 49.0 to 87.6 years (mean 64.3 ± 6.2 years). The incidence of early post-PCI stroke within 30 days was 1.1%, while the incidence of stroke occurring >30 days post-PCI was 1.8%, predominantly ischemic strokes. Predictors of stroke following PCI in ACS patients included traditional risk factors (i.e. female sex, older age, diabetes mellitus, hypertension, prior stroke or transient ischemic attack); comorbidities (i.e. chronic kidney disease, atrial fibrillation, anemia, high bleeding risk); and procedural factors (i.e. thrombus aspiration and Clopidogrel use).

CONCLUSIONS

This study highlights the relatively low prevalence of stroke following PCI, estimated at approximately 1% of the studied population. These findings emphasize the critical need for continued vigilance in identifying and managing risk factors associated with post-PCI stroke in ACS patients. Future research should prioritize refining risk prediction models, developing innovative preventive strategies, and optimizing post-PCI care pathways to effectively reduce the incidence of stroke in this population.

Nutritional optimization of fecal microbiota transplantation in humans: a scoping review

Diet constitutes a major source of nutrient flow to the gut microbes. As such, it can be used to help shape the gut microbiome. Fecal microbiota transplantation (FMT) is an increasingly promising therapy in disease states beyond recurrent Clostridioides difficile infection, but diet is largely overlooked for its potential to help optimize this therapy. Therefore, the aim of this scoping review is to present the literature landscape that captures pre- and post-FMT dietary intake in humans, identify research gaps, and provide recommendations for future research. A comprehensive search strategy was developed and searches were run in five databases. Studies were included if they discussed adults who underwent FMT for any recognized treatment indication and had dietary intake as a study objective, this search encompassed studies with interventions that included foods and dietary supplements. The initial screening identified a total of 7721 articles, of which 18 met the inclusion criteria for this review. Studies were heterogeneous, but taken together, they introduce a framework that defines important nutritional considerations for both donors and FMT recipients in the period around FMT dosing. This framework is summarized with this review and highlights the opportunities available to develop FMT-based precision nutrition strategies to optimize its clinical efficacy.

Effects of different movement velocities during resistance training on bone mineral density in older adults: A systematic review and meta-analysis

OBJECTIVE

To investigate the effects of different movement velocities during progressive resistance training (PRT) on bone mineral density (BMD) in older adults, with an emphasis on program design and training principles.

METHODS

Seven databases were comprehensively searched to identify studies investigating the effect of PRT at different movement velocities on BMD. The primary outcome was BMD at fracture-relevant sites measured by dual-energy X-ray absorptiometry (DXA). Meta-analysis of within-group changes was conducted using a random-effects model.

RESULTS

Of 1830 screened records, 9 studies met the inclusion criteria. No statistical comparison was possible regarding movement velocity. However, the findings suggest benefits of incorporating high-velocity movements. The analysis revealed that moderate-velocity programs frequently failed to prevent bone loss. In terms of program design, significant benefits of variation in PRT programs were observed. Moreover, the interventions demonstrated substantial interindividual variability in efficacy.

CONCLUSION

High-velocity PRT effectively enhanced BMD when overarching training principles were met. Nevertheless, further research is required to confirm the superior efficacy of high-velocity training. Moreover, individualization is essential since responses to programs vary, prompting questions about underlying differences. Considering that osteoporosis involves defective mechanotransduction, factors beyond established confounders may influence the intervention's efficacy.

Remineralizing potential of self-assembling peptides on dentinal lesions: A systematic review of the literature

OBJECTIVES

The aim of this study was to examine the efficacy of self-assembling peptides in promoting remineralization on demineralized dentin surfaces.

DATA, SOURCES AND STUDY SELECTION

A comprehensive electronic search was conducted using the MEDLINE via PubMed, EMBASE, Web of Science (WOS), and Scopus databases. The inclusion criteria focused on in vitro investigations using demineralized dentin surfaces from extracted permanent human teeth. These studies applied self-assembling peptides and evaluated tissue remineralization or mechanical properties. A total of 13 manuscripts met the inclusion criteria. The PRISMA guidelines were followed, and the methodological quality and risk of bias were evaluated according to the RoBDEMAT guidelines. Additionally, tables were created for data extraction, comprising outcomes related to dentin remineralization and mechanical properties assessment.

CONCLUSIONS

Self-assembling peptides, particularly P11-4, have demonstrated the potential to promote remineralization and enhance the mechanical properties of demineralized dentin surfaces. Self-assembling peptides appear to be a promising approach for achieving intrafibrillar remineralization.

CLINICAL SIGNIFICANCE

Dentin remineralization is one of the characteristics that biomaterials used in adhesive dentistry should aim for, as it can prolong the lifespan of restorations. Self-assembling peptides have shown potential to remineralize dentin surfaces.

Psychological readiness of return to sport after arthroscopic Bankart repair: A systematic review

Introduction

Surveys such as the Shoulder Instability-Return to Sport after Injury (SIRSI) scores can help identify athletes who are better prepared to return to sport (RTS) after arthroscopic Bankart repair (ABR). Therefore, the purpose of this systematic review was to clarify how psychologically ready athletes are to RTS after ABR, with the secondary purpose of evaluating the impact of psychological readiness on athletes' ability to RTSS after ABR.

Methods

The Ovid Medline, PubMed, and SportDiscus databases were searched from inception until January 2023 using keywords such as Bankart, anterior labral repair, shoulder stabilization, return to play, and return to sport. Original studies were included if both RTS outcomes after ABR and a psychological factor were reported, with potential psychological factors being psychological readiness to RTS and reasons of failing to RTS.

Results

Overall, 707 studies were screened and 16 met criteria for inclusion. The mean MINORS score of included studies was 13.3 ± 4.1. In patients who failed to RTS, most (74 %) patients failed due to recurrent shoulder instability, pain, or injury, while 26 % reported failing to RTS due to non-shoulder related causes such as apprehension and fear of reinjury. Eight studies evaluated post-operative SIRSI scores with a mean of 65.4 (95 % CI: 62.9-72.8) at an average of 5.4 years post-operatively.

Conclusion

Most athletes fail to RTS due to shoulder-related causes, with apprehension and fear of reinjury as common causes as shoulder-independent causes for failed RTS. The mean SIRSI score after ABR was 65.4, and athletes with higher post-operative SIRSI scores were more likely to RTS.

Level of evidence

IV.

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.

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.

Effect of Plant-Based Diets on Rheumatoid Arthritis: A Systematic Review

CONTEXT

Rheumatoid arthritis (RA) is an autoimmune disease that leads to chronic inflammation and joint damage. Various plant-based diets are thought to have effects on RA symptoms and disease activity.

OBJECTIVE

Relevant literature on the effect of different types of plant-based diets on RA was reviewed.

DATA SOURCES

A systematic search was conducted using the Web of Science, PubMed, Scopus, and Cochrane databases and following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA EXTRACTION

Articles on observational and interventional human studies carried out in the adult population and published in English between February 2013 and April 2023 were eligible for inclusion. Articles reporting on studies performed in populations under 18 years of age, with unclear methods and results, or for which the full text was unavailable were excluded. The risk of bias in the selected studies was assessed using the Joanna Briggs Institute checklists.

DATA ANALYSIS

Of 547 screened articles, 15 were included, comprising 4 cross-sectional, 2 cohort, and 9 randomized controlled trials. These studies examined the effects of various diets, including the Mediterranean, low-fat high-carbohydrate, anti-inflammatory, and vegan, on RA. Results indicate adherence to plant-based diets generally reduced disease severity and improved dietary intake, physical activity, body weight, and key clinical markers such as the Disease Activity Score-28, Visual Analog Scale score, Health Assessment Questionnaire Disability Index, erythrocyte sedimentation rate, and C-reactive protein level in patients with in RA.

CONCLUSIONS

Most of the studies suggested the Mediterranean diet may positively affect the severity of RA. However, the included studies show heterogeneity. Therefore, more randomized controlled studies are needed in this area to increase understanding of the effect of diet on RA and facilitate the implementation of strategies to prevent RA.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023420577.

Using a difficult-to-treat resistance index to gauge imbalance between countries' antibiotic resistance prevalence and access to antibiotics: a scoping review and concept proposal

BACKGROUND

Inferring the impact of antimicrobial resistance on patient outcomes is challenging, given the variability in antibiotic access across countries and over time. By denoting resistance to all highly safe and effective antibiotics, the difficult-to-treat resistance (DTR) definition offers a framework for such assessments globally.

OBJECTIVES

This study aims to conduct a scoping review to understand the international adoption, scalability, and prognostic utility of DTR and enable solutions to incorporate antibiotic access into the DTR framework.

METHODS

Data sources: Data sources included Agricola, Embase, Global Index Medicus, PubMed, Scopus, Web of Science: BIOSIS and Core Collection.

STUDY ELIGIBILITY CRITERIA

Study eligibility criteria included original research publications occurring after January 2018 using the term 'difficult-to-treat resistance' to describe antimicrobial-resistant bacterial isolates demonstrating resistance to all first-line antibiotics (i.e. all β-lactam and fluoroquinolone antibiotics).

ASSESSMENT OF RISK OF BIAS

Assessment of risk of bias included Joanna Briggs Institute critical appraisal tool.

METHODS OF DATA SYNTHESIS

We assessed the overall themes of the included studies and classified them into epidemiological, mortality, or antibiotic effectiveness/efficacy studies. Semiquantitative results among studies evaluating the prevalence of resistant bacterial isolates and mortality were reported. We propose a 'DTR index' (DTRi) that extends beyond gram-negative bacteria and complements DTR by estimating national proportions of bacterial isolates resistant to all first-line antibiotics available specifically in that country.

RESULTS

DTR was utilized in 57 studies spanning 94 countries. The DTR definition was predominantly applied unmodified and retained prognostic utility in 70% of studies. The variability in access to first-line antibiotics and emergence of newer agents across countries and over time influence practical treatment options that cannot be captured by 'fixed' DTR definitions underscoring the value of the proposed DTRi.

CONCLUSIONS

The DTRi could appraise the clinical impact of introducing new agents in a country, identify hot zones of resistance-access imbalance, and optimize resource allocation to improve antibiotic resistance outcomes, especially in under-resourced populations.

Enhancing the Design of Nutrient Clinical Trials for Disease Prevention-A Focus on Vitamin D: A Systematic Review

OBJECTIVES

This systematic review (SR) highlights principles for nutrient clinical trials and explore the diverse physiological functions of vitamin D beyond its traditional role in the musculoskeletal system related to clinical study designs.

BACKGROUND

Thousands of published research articles have investigated the benefits of vitamin D (a nutrient example taken in this SR) beyond the musculoskeletal system, including the immune, pulmonary, and cardiovascular systems; pregnancy; autoimmune disorders; and cancer. They illustrated vitamin D's molecular mechanisms, interactions, and genomic and nongenomic actions.

METHODS

This SR was designed to identify shortcomings in clinical study designs, statistical methods, and data interpretation that led to inconsistent findings in vitamin D-related publications. SR also highlights examples and insights into avoiding study design errors in future clinical studies, including randomized controlled clinical trials (RCTs). The SR adheres to the latest PRISMA statement, guidelines, and the PICOS process.

RESULTS

Inappropriate or flawed study designs were frequent in clinical trials. Major failures discussed here include too short clinical study duration, inadequate or infrequent doses, insufficient statistical power, failure to measure baseline and achieved levels, and recruiting vitamin D-sufficient participants. These design errors have led to misleading interpretations. Thus, conclusions from such studies should not be generalized or used in guidelines, recommendations, or policymaking.

CONCLUSION

Adequately powered epidemiological studies and RCTs with sufficient vitamin D and duration in individuals with vitamin D deficiency reported favorable clinical outcomes, enriching the literature, enabling to understand its physiology and mechanisms. Proper study designs with rigorous methodologies and cautious interpretation of outcomes are crucial in advancing the nutrient field. The principles discussed apply not only to vitamin D, but also other micro-nutrients and nutraceutical research. Adhering to them enhances the credibility and reliability of clinical trials, SRs, and meta-analysis outcomes. The study emphasizes the importance of focused, hypothesis-driven, well-designed, statistically powered RCTs to explore the diverse benefits of nutrients, conducted in index nutrient deficient participants, and avoidance of study design errors. Findings from such studies should be incorporated into clinical practice, policymaking, and public health guidelines, improving the health of the nation and reducing healthcare costs.

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.

What is chronic urinary tract infection? A systematic review

OBJECTIVE

To define 'chronic' urinary tract infection (UTI) by reviewing current published research that employs this term.

METHODS

We systematically searched Medline and Embase for studies covering all aspects of human UTI. For comparison, current urological and infectious disease guidelines were also reviewed.

RESULTS

The electronic search yielded a total of 2175 articles, of which 154 were eventually included for data extraction. Of these, six studies presented a definition of chronic UTI within the text. The definitions were highly incongruent among studies and often identical to the current definition of 'recurrent' UTI.

CONCLUSION

Chronic UTI is an undefined term, which has nevertheless been increasingly used in the past 15 years. Chronic UTI does not represent a distinct clinical or microbiological condition that justifies its use as medical diagnosis.

Estimating Age-Related Change in Infants' Linguistic and Cognitive Development Using (Meta-)Meta-Analysis

Developmental psychology focuses on how psychological constructs change with age. In cognitive development research, however, the specifics of this emergence is often underspecified. Researchers often provisionally assume linear growth by including chronological age as a predictor in regression models. In this work, we aim to evaluate this assumption by examining the functional form of age trajectories across 25 phenomena in early linguistic and cognitive development by combining the results of multiple meta-analyses in Metalab, an open database. Surprisingly, for most meta-analyses, the effect size for the phenomenon did not change meaningfully across age. We investigated four possible hypotheses explaining this pattern: (1) age-related selection bias against younger infants; (2) methodological adaptation for older infants; (3) change in only a subset of conditions; and (4) positive growth only after infancy. None of these explained the lack of age-related growth in most datasets. Our work challenges the assumption of linear growth in early cognitive development and suggests the importance of uniform measurement across children of different ages.

The Natural History of Acanthamoeba Keratitis: A Systematic Literature Review

INTRODUCTION

Acanthamoeba keratitis (AK) was first identified in 1972 and the first patient cured with propamidine was reported in 1985. Treatment outcomes, before the advent of the first effective anti-amoebic treatment, were known to be poor and often required therapeutic keratoplasty (TK) but have not been evaluated in detail. Analysis of these outcomes has value for several reasons: it gives an historical perspective, describes the natural history of AK when the disease was minimally modified by the early treatments and provides a benchmark against which current treatments can be compared and how these have changed the therapeutic results.

METHODS

We conducted a systematic literature review for the period 1970-1995 using PRISMA guidelines. The population of interest comprised patients with AK treated without products having established anti-amoebic activity against both trophozoites and cysts (biguanides or diamidines). The outcomes of interest were medical cure, TK and enucleation. Proportions and 95% confidence intervals were estimated.

RESULTS

Fifty-six case reports were eligible. Risk factors for AK were reported in 44/56 patients: contact lens wear in 30/44 (68.2%) and trauma in 14/44 (31.8%). The mean time from presentation to diagnosis was 7.3 weeks (standard deviation 9.3 weeks); 13/56 (23.2%) were diagnosed within 4 weeks. Topical treatments given to patients included corticosteroids (85.2%), antibiotics (85.2%), antivirals (72.2%) and antifungals (51.8%). Final visual acuity was ≥ 20/40 in 17/33 (51.5%) patients with no missing data. Medical cures were reported in 11/56 patients (19.6%), TK in 38/56 (67.9%), other surgery in 4/56 (7.1%) and enucleation in 3/56 (5.4%).

CONCLUSION

This study suggests that, before the availability of propamidine as the first effective treatment for AK, the clinical outcome of these patients was poor with only a few patients cured without surgery. These findings should be interpreted with caution because they rely on case reports and series that are subject to inherent bias.

Effects of Supplementation With Different Specificities of Dietary Fiber on Health-Related Indicators in Adults With Overweight or Obesity: A Systematic Review and Meta-analysis of Randomized Controlled Trials

CONTEXT

Dietary fiber (DF) exhibits variations in its chemical and physical complexity, as well as in its utilization by the gut microbiota. However, the impact of these differences on the health status of adults with overweight or obesity remains unclear.

OBJECTIVE

This meta-analysis aimed to explore the varying effects of supplementing with different specificities of DF on the health of adults with overweight or obesity, providing guidance on selecting DF supplementation to improve health status.

DATA SOURCES

The literature search encompassed 4 electronic databases-PubMed, Cochrane Library, Web of Science, and EMBASE-and was conducted between January 1, 2012, and November 10, 2023. Randomized controlled trials comparing DF with placebo treatment, without energy restriction, were included.

DATA EXTRACTION

Two independent reviewers extracted data using a standardized form, resolving discrepancies through discussion. The data included study characteristics, participant demographics, DF specifications, and outcome measures.

DATA ANALYSIS

Random-effects models and the generic inverse variance method were used to analyze data, assuming varying outcomes based on DF specificity. Meta-regression assessed the impact of population, duration, and dosage. Publication bias was evaluated using funnel plots and Egger's and Begg's tests. The analysis included 34 trials (n = 1804) examining DF supplementation at 1.5 to 40 g/day for 3 to 16 weeks. DF supplementation significantly reduced glycated hemoglobin (HbA1c) by 0.13%, fasting insulin by 0.82 μIU/mL, and homeostatic model assessment of insulin resistance (HOMA-IR) by 0.33 in adults with overweight or obesity. Subgroup analyses based on DF specificity revealed differences in effects on HbA1c, fasting insulin, and systolic blood pressure. The low-specificity subgroup showed significant heterogeneity in body weight, body mass index, HbA1c, fasting insulin, and HOMA-IR, with a decrease in fasting insulin by 1.09 μIU/mL. The low-to-intermediate-specificity subgroup had reductions in HbA1c by 0.8%, fasting insulin by 2.08 μIU/mL, and HOMA-IR by 0.61. The intermediate-specificity subgroup experienced a 2.85-kg decrease in body weight and a 9.03-mg/dL increase in LDL cholesterol. The mixed subgroup showed an increase in systolic blood pressure by 3.85 mmHg.

CONCLUSION

Supplementing with different specificities of DF may have distinct effects on health-related indicators in adults with overweight or obesity. Considering individuals' gut microbiota composition and specific health goals is recommended when selecting DF supplementation for adults with overweight or obesity.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023432920.

Reconstruction of Tongue Malignancy Defects: A Systematic Review and Treatment Algorithm

INTRODUCTION

The tongue is the most common site of oral malignancies, with surgical resection the mainstay of treatment. Tongue cancer resections have significant functional impacts. Ideal reconstruction would restore speech intelligibility, facilitate swallowing of liquids and solids without significant dysphagia, and have minimal morbidity. We aimed to review and synthesize published outcomes of tongue reconstructive methods into a useful clinical treatment algorithm.

METHODS

A systematic electronic search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Medline (OVID), Embase (OVID), PubMed, and the Cochrane Central Register of Controlled Trials (CENTRAL) were reviewed for all studies published prior to October 12th, 2024. Conference abstracts, case reports, case series, and review papers were excluded. Quantitative data were extracted and tabulated.

RESULTS

After screening 1268 abstracts and 321 full-text articles, 113 papers were included. Multiple free and locoregional flap reconstructive methods, skin grafting techniques, and tissue substitutes were identified. The anterolateral thigh (ALT) free flap and radial forearm free flap (RFFF) were the most common reconstructive methods.

CONCLUSIONS

A treatment algorithm is proposed to facilitate structured surgical planning and intra-operative reconstructive decision-making for tongue malignancy defects. PROSPERO Registration: CRD420223818875.

Diaphragmatic Rapid Shallow Breathing Index for predicting successful weaning from mechanical ventilation: A systematic review and meta-analysis

BACKGROUND

The Diaphragmatic Rapid Shallow Breathing Index (D-RSBI) has been proposed as a promising tool for predicting successful weaning from mechanical ventilation. By focussing on diaphragmatic activity, the D-RSBI aims to overcome the limitations of the classic rapid shallow breathing index, providing a more specific assessment of the patient's ability to sustain independent breathing following extubation.

METHODS

Two investigators conducted independent systematic searches in the PubMed, Embase, Cochrane Database, Scopus, Medline, Science Direct, and Epistemonikos databases, covering publications from inception to 30 November 2024. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. A meta-analysis was performed using the random-effect model, calculating sensitivity, specificity, diagnostic odds ratio, and the area under the summary receiver operating characteristic curve for the D-RSBI. The systematic review protocol was registered in the Centre for Reviews and Dissemination database 42024582489 of the Prospective International Registry of Systematic Reviews. Subgroup analyses, bivariate meta-regressions, and sensitivity analyses were conducted. Publication bias was evaluated using a funnel plot, along with Begg's and Egger's tests. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology.

RESULTS

Fourteen studies were included in the meta-analysis, comprising a total of 1104 patients. The D-RSBI score was significantly lower in the successful weaning group than in the failure group, with a mean difference of -1.09 (95% confidence interval: -1.36 to -0.82; p < 0.05). The pooled sensitivity was 0.88, specificity was 0.82, and the area under the curve was 0.93. The diagnostic odds ratio was 45.2 (95% confidence interval: 23.5 to 87.2; p < 0.05). The studies included were of moderate to high quality, and the certainty of the evidence was rated as moderate.

CONCLUSIONS

The D-RSBI appears to be a promising predictor for forecasting the success of weaning from mechanical ventilation, offering adequate sensitivity and specificity. However, further clinical trials are needed to confirm and validate these findings and thus to establish the score's potential for enhancing the clinical management of weaning in critically ill patients.

Effects of probiotic supplementation on growth performance and feed intake of dairy calves: A meta-analysis

The objective of this systematic review and meta-analysis was to evaluate the effect of probiotic supplementation on ADG, feed intake, and feed efficiency (FE) of dairy calves. A secondary objective was to assess outcomes stratified by probiotic type. Our study included quasirandomized and randomized controlled trials written in English, Spanish, or Portuguese that assessed the effects of probiotic supplementation on the growth of dairy calves. No restrictions were placed on the publication year. A total of 5,480 records were initially identified after conducting searches in Biosis, CAB Abstracts, Medline, Scopus, and the Dissertations and Theses Database. After applying inclusion criteria, 55 studies (56 trials) were included in the analysis. Multilevel random-effects models were fitted for a single dataset combining all trials regardless of probiotic type and for 4 datasets stratified by 4 probiotic types (Bacillus, Lactobacillus, Saccharomyces, and multiple genera probiotics). Meta-analyses showed that probiotic supplementation did not result in significant difference in FE compared with the control group (no treatment or placebo). Probiotic supplementation improved total DMI, starter intake, and ADG and tended to decrease milk intake. A meta-regression analysis indicated a significant association between starter intake and probiotic type and the duration of probiotic supplementation. Analyses by probiotic type revealed no significant effects on DMI or FE for Lactobacillus spp., Saccharomyces spp., or multiple genera probiotics, whereas Bacillus spp. showed no effect on DMI but a tendency to improve FE. Supplementation with Lactobacillus spp. and multiple genera probiotics tended to increase starter intake. Supplementation with Bacillus spp. and Lactobacillus spp. increased the ADG of calves, whereas Saccharomyces spp. and multiple genera probiotic supplementation did not yield significant differences. Substantial and significant heterogeneity was observed for most outcomes; thus, results must be interpreted carefully. Probiotics may be beneficial for enhancing DMI, starter intake, and ADG in dairy calves; however, current evidence remains limited due to high heterogeneity. Results of analyses by probiotic type should be interpreted carefully due to the limited number of studies per category. To develop appropriate recommendations, additional research is required to address the sources of heterogeneity in existing studies.

Airborne pathogen monitoring and dispersion modelling on passenger ships: A review

The COVID-19 pandemic demonstrated a profound inability of pre-pandemic passenger ship policies implemented by both ship operators and governmental authorities to detect and address newly emerging diseases. The essentiality of maritime transport puts into focus the risk of approach to address known and new emerging airborne infectious diseases that, due to increasing capacity, are likely to occur on passenger ships. In order to enhance the passenger experience, prepare shipping for pandemics like COVID-19, and improve the resilience and safety of the industry, this review critically synthesises existing literature on (1) monitoring ventilation conditions and aerosol dispersion, linking them to airborne transmission risk using airborne aerosols and ventilation performance as input parameters for computational fluid dynamics (CFD) simulations, and (2) modelling airborne disease transmission risk in controlled passenger ship environments. This review analysed 39 studies on aerosol monitoring, thermal comfort, and infection risk modelling on passenger ships (2000-2023). Additionally, 55 papers on CFD modelling of airborne pathogen dispersion were reviewed: 22 included validation, with most focused on built environments and only four specifically addressing ship environments. Two major challenges relate to the complexity and poorly characterised ventilation boundary conditions on passenger ships, and the other is the lack of suitable validation data. For this reason, ship experimental studies are required for CFD model validation. Only a handful of studies were found that have measured aerosol concentrations on board passenger ships. To the best of our knowledge, there have been no studies conducted on aerosol mass or airborne transmission sampling on board passenger ships or other types of vessels. The results of this review have the potential to create synergistic connections between experimental and modelling studies to inform, characterise and improve the development of numerical models that can accurately estimate infection risk on ships for prevention, mitigation and management of outbreaks.

Prediction Models for Postoperative Delirium of Cardiovascular Surgery (PODOCVS): Protocol for a Systematic Review

BACKGROUND

Postoperative delirium of cardiovascular surgery (PODOCVS) is an acute brain dysfunction characterized by inattention, impaired consciousness, and cognitive disorders, and the severity and presence of these symptoms fluctuate over time. PODOCVS occurs during the early postoperative period and is associated with adverse outcomes, including prolonged mechanical ventilation, premature mortality, and so on. Advances in its early diagnosis and treatment have mitigated some of the initial adverse effects of PODOCVS, but models for predicting risk in patients who have already developed PODOCVS remain inadequate for effective secondary prevention. Developing multivariable prediction models for stratifying PODOCVS risk would enable early, personalized interventions.

OBJECTIVE

This study aims to systematically review and critically evaluate the development, performance, and applicability of existing prediction models for PODOCVS.

METHODS

An extensive systematic search will be performed across multiple databases, including Embase, PubMed, the Web of Science, and so on, to identify studies related to multivariate predictive models for PODOCVS. A manual search of the included studies' reference lists will also be conducted to identify any additional relevant publications. This systematic review will include studies that meet the following criteria: (1) studies with subject populations comprising adult cardiovascular surgery patients aged ≥18 years, (2) studies involving the development and internal or external validation of predictive models for PODOCVS via multivariate analysis, and (3) studies with outcome measures focused on postoperative delirium. Two researchers (ZXL and WYK) will independently extract the data and assess the included studies' model quality using the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) checklist and the Predictive Model Bias Risk Assessment Tool (PROBAST). Since this study will not involve patient data, ethics approval is not required. Our findings will be published in a peer-reviewed scientific journal and the dataset will be made freely available.

RESULTS

Literature searches were conducted from the inception of the database to May 20, 2024 (updated up to January 31, 2025), and data extraction and analysis are expected to be complete by the end of May 2025. We currently have a preliminary plan to publish the complete study results by August 2025, subject to any unforeseen delays or changes in the research timeline.

CONCLUSIONS

We present a protocol for the systematic review of prediction models for postoperative delirium in cardiac surgery patients. Aiming to identify, summarize, and critically appraise existing risk models globally, this review seeks to provide an up-to-date reference for stakeholders involved in patients with cardiac surgery care, policy making, and research. In addition, we aim to investigate whether machine learning models for PODOCVS offer more accurate predictions than traditional statistical models.

TRIAL REGISTRATION

PROSPERO CRD42024578957; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024578957.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/75368.

Prevalence and types of errors in the electronic health record: protocol for a mixed systematic review

INTRODUCTION

In countries with access to the electronic health record (EHR), both patients and healthcare professionals have reported finding errors in the EHR, so-called EHRrors. These can range from simple typos to more serious cases of missing or incorrect health information. Despite their potential detrimental effect, the evidence on EHRrors has not been systematically analysed. It is unknown how common EHRrors are or how they impact patients and healthcare professionals.

METHODS AND ANALYSIS

A mixed systematic review will be carried out to address the research gap. We will search PubMed, Web of Science and CINAHL for studies published since 2000, which report original research data on patient-identified and healthcare professional-identified EHRrors. We will analyse (1) the prevalence of EHRrors, (2) the types of EHRrors and (3) their impact on care. Quantitative and qualitative findings will be synthesised following the Joanna Briggs Institute Framework for Mixed Systematic Reviews. Identified studies will be critically appraised for meta-biases and risk of bias in individual studies. The confidence in the emerging evidence will be further assessed through the Grading of Recommendations Assessment, Development and Evaluation approach. Findings will be contextualised and interpreted involving an international team of patient representatives and practising healthcare professionals.

ETHICS AND DISSEMINATION

The study will not involve collection or analysis of individual patient data; thus, ethical approval is not required. Results will be published in a peer-reviewed publication and further disseminated through scientific events and educational materials.

PROSPERO REGISTRATION NUMBER

CRD42024622849.

The effects of aerobic exercise in patients with cancer-related fatigue: A systematic review and meta-analysis

BACKGROUND

Cancer-related fatigue (CRF) is characterized by an unusual and persistent sensation of tiredness that can occur during or after treatment, potentially impacting both physical and mental capability, and which does not ameliorate with rest. Aerobic exercise (AE) has been identified as a potent modality to mitigate the severity of CRF in such patients.

OBJECTIVE

This study aims to investigate the efficacy of AE in alleviating CRF among patients.

METHODS

A comprehensive literature search was implemented on PubMed, Web of Science, EBSCO, Cochrane, and Embase until June 2024. Studies were selected based on the following PICOS criteria: Participants (P): cancer patients undergoing treatment or in recovery; Intervention (I): aerobic exercise, including activities such as walking, running, yoga, or tai chi; AE interventions conducted during both treatment and recovery were included. Comparison (C): usual care, no-treatment/wait-list, or attention/activity placebo controls; Outcome (O): cancer-related fatigue (CRF) measured by validated scales; Study design (S): randomized controlled trials (RCTs). The meta-analysis was performed using Review Manager 5.3.

RESULTS

The results indicate that AE exerts a significant impact on CRF, but the heterogeneity is high (SMD = -0.76, 95% CI: -1.30 to -0.22, P < 0.05, I² = 94%). Subgroup analysis revealed that AE interventions lasting at least 12 weeks (SMD = -1.12, 95% CI = -2.02 ~ -0.22, P < 0.05, I² = 96%), 3 times or less per week (SMD = -1.00, 95% CI = -1.83 ~ -0.16, P < 0.05, I2 = 96%), with each session exceeding 60 minutes (SMD = -1.48, 95% CI = -2.32 ~ -0.64, P < 0.01, I2 = 96%), compared to the control group, significantly improve CRF in patients.

CONCLUSION

The research findings confirm the effectiveness of AE in alleviating CRF. Subgroup analysis further elucidated that AE interventions lasting at least 12 weeks, 3 times or less per week, with 60 minutes or more per session, significantly alleviated CRF among patients. However, given the limited number of included studies, caution is warranted in interpreting these subgroup analysis outcomes. The protocol for this review was duly registered on PROSPERO under the registration number CRD42024559098.

Comparing percutaneous treatment and cholecystectomy outcomes in acute cholecystitis patients: a systematic review and meta-analysis

BACKGROUND

Acute cholecystitis (AC) is a common and serious condition characterized by gallbladder inflammation, most often caused by cystic duct obstruction due to gallstones. Although laparoscopic cholecystectomy (CC) is the preferred surgical treatment, percutaneous cholecystostomy (PC) is frequently considered for high-risk surgical patients. The optimal management strategy for these patients remains a topic of debate. These systematic review and meta-analysis aim to provide an updated evaluation of studies comparing the clinical outcomes of AC patients treated with PC versus those undergoing CC, as well as the outcomes of CC alone versus PC followed by CC.

METHODS

A literature search was carried out across Web of Science, Medline, Embase, and PubMed up to April 2024. Observational studies comparing patients undergoing PC versus CC, as well as CC versus PC followed by CC, and reporting mortality, morbidity, and readmission were included. Data extraction and quality assessment were independently performed by two reviewers, with bias risk evaluated using the Newcastle-Ottawa Quality Scale. The pooled odds ratio (OR) was obtained through meta-analyses by using STATA software (Version 18).

RESULTS

A total of 27 studies were included, with 16 comparing PC versus CC and 11 assessing PC followed by CC versus CC alone. Meta-analyses revealed that CC was associated with significantly lower mortality (OR = 0.26; 95% CI = 0.14-0.48) and readmission rates (OR = 0.37; 95% CI = 0.18-0.75) compared to PC. The benefits of laparoscopic cholecystectomy over percutaneous cholecystostomy were particularly evident for mortality (OR = 0.17; 95% CI = 0.09-0.33), while a non-significant trend towards reduced readmission rates was also observed (OR = 0.28; 95% CI = 0.07-1.13). However, PC was identified as a viable alternative in high-risk surgical patients. Studies examining PC followed by CC versus CC alone showed diverse results, with some indicating reduced surgical complications and improved outcomes, while others reported no significant benefits.

CONCLUSION

This work highlights that CC is associated with better outcomes, including lower mortality and readmission rates, compared to both PC alone and PC followed by CC. The combined approach did not show a significant advantage over immediate CC. Further research with larger studies and standardized protocols is needed to refine treatment strategies for high-risk AC patients.

Dose-dependent effect of coconut oil supplementation on obesity indices: a systematic review and dose-response meta-analysis of clinical trials

BACKGROUND

Coconut oil has been suggested as a potential dietary intervention for weight management. However, the evidence regarding the effects of coconut oil supplementation on anthropometric measures (body weight, body mass index (BMI) and waist circumference (WC)) remains inconclusive.

OBJECTIVE

we aimed to assess the overall effect of coconut oil supplementation on these anthropometric parameters and explore potential sources of heterogeneity.

METHODS

We comprehensively searched electronic databases using appropriate keywords. We included 15 studies with the following criteria: (1) clinical trials in adults, with parallel or cross-over design, (2) evaluated the effect of coconut oil on body weight, BMI or WC, (3) compared the effect of a specific dose of coconut oil against a coconut oil-free diet or other types of oils, (4) considered the change in anthropometric parameters as the primary or one of the secondary outcomes, (5) provided mean and standard deviation (SD) of change in anthropometric parameters across study arms, (6) reported the number of participants in each study arm.

RESULTS

The trials included 620 participants and assessed the effects of coconut oil supplementation on body weight, BMI and WC. Our meta-analysis revealed statistically significant effects of coconut oil supplementation on weight and BMI, with mean differences of 0.04 kg (95% CI: 0.01 to 0.08 kg) and 0.01 kg/m2 (95% CI: 0.00 to 0.02). However, the effects were not clinically meaningful. There was no significant effect of coconut oil on WC. Subgroup analyses suggested that the duration of the intervention may influence the effect of coconut oil on body weight. In the sensitivity analysis, we found that the result of one study influenced the associations between coconut oil supplementation and weight or BMI.

CONCLUSIONS

Overall, our findings suggest no clinically significant effects of coconut oil supplementation on weight loss. Further research is needed to clarify the issue.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD420251031291.

Adolescents, menstruation, and physical activity: insights from a global scoping review

BACKGROUND

Adolescent girls tend to be less physically active than boys, a trend that coincides with puberty. Menstruation may act as a barrier to physical activity, which in turn may influence menstrual symptoms. The purpose of this scoping review was to synthesise the global literature on the association between menstruation and physical activity among adolescents.

METHODS

A systematic search was conducted across five databases, identifying studies on menstruation and physical activity in adolescents (aged 10-18 years) without date restrictions. Studies not in English, including only athlete populations and focusing solely on premenstrual syndrome were excluded. Titles and abstracts, followed by full texts were screened by two independent reviewers.

RESULTS

Eighty-six studies were included, spanning 33 countries. Thematic synthesis of data from the selected studies suggests a bidirectional relationship in that menstruation may act as a barrier to physical activity due to symptoms, societal stigma and menstrual product access, while physical activity may alleviate symptoms for some. The review highlights variability in study methodologies, with most relying on self-report data.

CONCLUSION

This review provides insights into the varied experiences of adolescent girls' physical activity and menstruation, influenced by cultural, social, and resource-related factors. It makes important and timely recommendations for the direction of future research, which should employ longitudinal and mixed methods approaches to better understand the association between menstruation and physical activity in this population and address gaps regarding the mechanisms and magnitude of this relationship.

Botulinum toxin in fracture management: a scoping review

PURPOSE

Using botulinum toxin (BoNT) as an adjunct in fracture management is a novel approach with the potential to improve clinical outcomes, particularly in atypical fractures and patients with concurrent neuromuscular disorders. This scoping review explores the literature on BoNT's effectiveness in facilitating fracture healing and immobilisation across various fracture types.

METHODS

The PubMed, Embase, and Cochrane databases were searched with defined operators. Two investigators conducted independent searches, which were combined. Animal studies, case reports, case series, cohort reviews and randomised control trials were included.

RESULTS

Fifty studies were identified for screening, from which 15 studies were included in the review. The findings highlight mixed outcomes in BoNT's role in enhancing bone healing and reducing muscle-induced displacement. While BoNT injections demonstrated potential benefits in specific cases, such as atypical fractures, periprosthetic fractures and fractures in patients with motor dysfunctions, results from animal studies were inconsistent, showing varied effects on callous formation and bone mineral density.

CONCLUSION

Clinical applications of BoNT in fracture management indicate its utility as an immobilisation agent to promote fracture healing and reduce complications. However, this review highlights that further research is necessary to bridge the gap between experimental and clinical studies and to clarify BoNT's effectiveness in different use cases.

Neuropsychological assessment in cognitively healthy nonagenarians and centenarians: an updated systematic review and meta-analysis

The assessment of cognitive impairment in individuals aged 90 years and older is based on normative data estimated in the younger elderly. A first systematic review had provided the reference values in the oldest population for a few neuropsychological tests. Robust estimations on additional cohorts are needed. We designed a systematic review update (PROSPERO: CRD42022347327) encompassing the literature published from 2015 to June 2024, to include studies reporting raw neuropsychological test scores from at least ten individuals aged >90 without dementia. All types of cohort studies were eligible. The data set from the previously published systematic review and the studies retrieved in the update process were pooled. Random effect meta-analysis was applied to estimate the updated mean and cut-off values. The systematic workflow provided 11 articles eligible for data abstraction. Based on the pooled data we estimated the updated reference scores for MMSE, BNT-SF, Semantic Fluency, TMT-A, TMT-B, Digit span forward and Digit span backward. Moreover, we estimated for the first time the reference values for the Word List Immediate and Word List Delayed tasks. The systematic review provided an updated set of norms for the neuropsychological test that are frequently used to assess the cognitive profile in individuals aged >90 years. The heterogeneity of the assessments limited the quantitative synthesis. Further studies on large cohorts are needed to stratify the normative values by age, gender and education. The identification of country- and population-specific values would help clinicians and researchers to characterise the cognitive profile in the oldest old individuals.

PROTOCOL: Understanding Intergenerational Programmes to Improve the Psychosocial Health and Well-Being of Older Adults in Residential Aged Care: A Rapid Realist Review Protocol

This is the protocol for a Campbell systematic review. The objectives are as follows. The aim of this study is to briefly outline the objectives of the proposed review. While Campbell systematic reviews might be motivated by many reasons, their overarching aim should be to gather, summarise and integrate empirical research so as to help people understand the evidence.

Mechanisms Underlying Range of Motion Improvements Following Acute and Chronic Static Stretching: A Systematic Review, Meta-analysis and Multivariate Meta-regression

BACKGROUND

Static stretching (SS) is routinely used in sports and clinical settings to increase joint range of motion (ROM). However, the mechanisms underlying improvements in ROM remain unclear.

OBJECTIVE

We aimed to determine the effects of a single session (acute) and multiple sessions (chronic) of SS on stretch tolerance, passive stiffness and fascicle length, and whether such effects are moderated by specific training parameters and participant characteristics. A secondary aim was to explore the mechanisms associated with improved ROM.

METHODS

Seven databases (CINAHL Complete, Cochrane CENTRAL, Embase, Emcare, MEDLINE, Scopus and SPORTDiscus) were systematically searched up to 6 June, 2024. Randomised and non-randomised controlled trials investigating the effects of acute (single session) or chronic (two or more sessions) SS on muscle-tendon unit structure (fascicle length), mechanical properties (stiffness) or stretch tolerance (maximum tolerable passive resistive torque) compared to non-stretching passive controls (adults aged ≥ 18 years) were included. The effects of SS were examined using a multi-level meta-analysis, with associations between changes in maximum tolerable passive resistive torque, stiffness and fascicle length with improvements in ROM examined using multivariate meta-regression.

RESULTS

Data from 65 studies representing 1542 adults (71% male; mean ± standard deviation age = 26.1 ± 11 years) were included. We found a small decrease in overall stiffness following both acute (Hedges' g = 0.42, 95% confidence interval [CI] 0.21, 0.63, p < 0.001) and chronic SS (Hedges' g = 0.37, 95% confidence interval 0.18, 0.56, p < 0.001), and a moderate increase in maximum tolerable passive resistive torque following chronic SS (Hedges' g = 0.74, 95% CI 0.38, 1.10, p < 0.001). Neither acute nor chronic SS had a significant effect on fascicle length. For acute SS, greater reductions in overall stiffness were found with moderate (p < 0.002) and high SS intensities (p = 0.02) compared with low-intensity SS, and in individuals with normal flexibility compared with those with poor flexibility at baseline (p < 0.001). Conversely, the effects of chronic SS on overall stiffness and maximum tolerable passive resistive torque were not moderated by stretching intensity, intervention length, baseline flexibility or sex (p > 0.05). Last, improved ROM following chronic SS was significantly associated with both decreased overall stiffness (g = 0.59, 95% CI 0.08, 1.10, p = 0.03) and increased maximum tolerable passive resistive torque (g = 0.74, 95% CI 0.41, 1.09, p < 0.001).

CONCLUSIONS

While both acute and chronic SS reduced overall stiffness, stretch tolerance only increased following chronic SS. Neither acute nor chronic SS altered fascicle length. The effect of acute SS on reduced overall stiffness was greater when stretching at a moderate or higher intensity and in those with normal flexibility. Increased ROM was significantly associated with decreased overall stiffness and increased stretch tolerance following chronic SS. Understanding the mechanisms underlying SS will assist coaches and clinicians in deciding whether and when to prescribe SS to their athletes and patients.

CLINICAL TRIAL REGISTRATION

PROSPERO CRD42023420168.

Use of artificial intelligence to support quality of life of people with dementia: A scoping review

BACKGROUND

Dementia has an impact on the quality of life (QoL) of people with dementia. Tailored services are crucial for improving their QoL. Advances in artificial intelligence (AI) offer opportunities for personalised care, potentially delaying institutionalisation and enhancing QoL. However, AI's specific role in approaches to support QoL for people with dementia remains unclear. This scoping review aims to synthesise the scientific evidence and grey literature on how AI can support the QoL of people with dementia.

METHOD

Following Joanna Briggs Institute guidelines, we searched PubMed, Scopus, ACM Digital Library, and Google Scholar in January 2024. Studies on AI, QoL (using Lawton's four-domain QoL definition), and people with dementia across various care settings were included. Two reviewers conducted a two-stage screening, and a narrative synthesis identified common themes arising from the individual studies to address the research question.

RESULTS

The search yielded 5.467 studies, after screening, thirty studies were included. Three AI categories were identified: monitoring systems, social robots, and AI approaches for performing activities of daily living. Most studies were feasibility studies, with little active involvement of people with dementia during the research process. Most AI-based approaches were monitoring systems targeting Lawton's behavioural competence (capacity for independent functioning) domain.

CONCLUSION

This review highlights that AI applications for enhancing QoL in people with dementia are still in early development, with research largely limited to small-scale feasibility studies rather than demonstrating clinical effectiveness. While AI holds promise, further exploration and rigorous real-world validation are needed before AI can meaningfully impact the daily lives of people with dementia.

Efficacy and safety of non-vitamin K antagonist oral anticoagulants versus warfarin in atrial fibrillation and kidney failure under hemodialysis: A meta-analysis of controlled randomized trials

Background

Atrial fibrillation (AF)-related strokes are associated with disability and mortality. Stroke prevention with non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKAs) is the cornerstone of holistic management of AF. However, the safety and efficacy of NOACs in patients with AF on hemodialysis remain uncertain. This meta-analysis aimed to evaluate currently available data to determine the potential utility of NOACs in AF patients with kidney failure receiving hemodialysis.

Methods

We searched the literature for randomized clinical trials comparing NOACs to VKA therapy in this population.

Results

About the Principal Efficacy Outcome, NOACs Did Not Decrease the Risk Compared to Warfarin (Relative Risk [RR] 0.79, 95% CI 0.45-1.37) while a Significant Heterogeneity Was Noted (p = 0.03). In the Valkyrie Study, Rivaroxaban Had better Cardiovascular Outcome than Warfarin (RR 0.57, 95% CI 0.43-0.75). For the Principal Safety Outcome, the Risk Was Similar between NOACs and Warfarin (RR 0.81, 95% CI 0.52-1.27) without Significant Heterogeneity (p = 0.11). The Pooled Event Rate of 3 Trials Disclosed a High Risk of all-Cause Mortality (39.9% for NOACs, 34.6% for Warfarin) and Cardiovascular Mortality (10.1% for NOACs, 8.5% for Warfarin) for AF Patients with Kidney Failure Receiving Hemodialysis Even on Oral Anticoagulants.

Conclusion

Our results suggest that NOACs (rivaroxaban or apixaban) are as safe and effective as VKAs in patients with AF and kidney failure with hemodialysis. Even on oral anticoagulants, these patients remain at high risk of cardiovascular events and all-cause mortality. Integrated care and holistic management are important for this high-risk population.

Factors influencing the adoption of Internet of Medical Things for remote patient monitoring: A systematic literature review

The Internet of Medical Things (IoMT) is a network of interconnected medical devices and applications aiming to facilitate real-time data sharing and personalised patient care. IoMT devices collect vast amounts of data, which are then analysed using advanced computational methods. Real-time patient monitoring is crucial, particularly for people with chronic diseases and older adults. Moreover, traditional in-person monitoring by healthcare providers can be resource-intensive and time-consuming. By leveraging IoMT technology for remote patient monitoring (RPM), healthcare providers can improve service quality, reduce costs and enhance patient care. To evaluate the current state of knowledge and address research gaps in IoMT adoption for RPM, we conducted a thorough systematic literature review (SLR). This SLR aims to provide a comprehensive overview of existing research, identify knowledge gaps, and analyse the factors that influence IoMT adoption. It follows the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) protocol. PRISMA guidelines allow us to systematically evaluate and synthesise the current state of relevant literature. After analysing the theoretical models used in previous studies on IoMT adoption for RPM, UTAUT2 was identified as the most effective framework for technology adoption in this area. Additionally, this SLR has identified the key factors influencing the adoption of IoMT technology, including privacy, trust, security, and perceived risk, and suggested their inclusion in future studies by analysing and integrating the findings of other studies. As much of the current research focuses solely on patient viewpoints, our SLR points to the necessity of giving equal weight to the opinions of both patients and healthcare professionals. To create IoMT systems that are more effective and inclusive, these deficiencies must be filled. This study will benefit researchers, healthcare professionals, policymakers and technology developers by offering insights to inform decision-making, guide future research and aid the development of effective IoMT solutions for RPM.

Effectiveness of Chatbot interventions for reducing caregiver burden: Protocol for a systematic review and meta-analysis

This protocol outlines a systematic review and meta-analysis examining the effectiveness of fully automated, AI-driven chatbot interventions in reducing subjective burden among informal caregivers. We will search 8 electronic databases (PubMed, Web of Science, Embase, CINAHL, MEDLINE, Cochrane Library, PsycINFO, Scopus) and grey literature sources from January 2010 to December 2024 for randomized controlled trials (RCTs) meeting predefined eligibility criteria. The primary outcome is caregiver burden, assessed using validated scales such as the Zarit Burden Interview. Secondary outcomes encompass caregiver mental health, quality of life, self-efficacy and care recipient status. Two reviewers will independently perform study selection, data extraction, risk of bias evaluation using Cochrane RoB 2 tool, and appraise certainty of evidence utilizing the GRADE approach. We will conduct random-effects meta-analyses, subgroup analyses, and meta-regression to compute pooled effect estimates and explore heterogeneity. If quantitative synthesis is precluded, narrative synthesis will be undertaken following SWiM guideline. Caregiver partners will provide input on interpretation and dissemination of findings.•Protocol adheres to PRISMA-P reporting standards and will be prospectively registered in PROSPERO•Graphviz code for replicating the systematic review methodology diagram is provided•Review will yield critical evidence to guide development and implementation of chatbots into caregiver support services.

Association Between the c.34C > T (rs17602729) Polymorphism of the AMPD1 Gene and the Status of Endurance and Power Athletes: A Systematic Review and Meta-Analysis

BACKGROUND

Previous research has shown that variants in the AMPD1 gene, which encodes the adenosine monophosphate deaminase 1 (AMPD1) protein, may affect energy supply of the muscle and fatigue resistance during high-intensity exercise. A single nucleotide substitution in this gene, specifically a cytosine-to-thymine substitution (c.34C > T; rs17602729), results in a nonsense mutation that causes a deficiency in the AMPD1 protein. Deficiency of the AMPD1 protein due to this polymorphism can influence exercise performance, ultimately affecting the likelihood of reaching the status of elite endurance or power athlete.

OBJECTIVE

This systematic review and meta-analysis aimed to investigate the distribution of CC, CT, and TT genotypes of the AMPD1 c.34C > T polymorphism (rs17602729) in endurance and power athletes to assess potential associations between this polymorphism and elite athlete status.

METHODS

Studies investigating genotype distribution in the AMPD1 c.34C > T (rs17602729) polymorphism in endurance and/or power athletes were searched for in four electronic databases (PubMed, Web of Science, Scopus, Science Direct). The studies were selected and the genotypic and allelic frequencies of the AMPD1 c.34C > T (rs17602729) polymorphism were extracted if data for endurance and/or power athletes were compared with controls (non-athletes). Meta-analyses were computed using fixed or random effects models to calculate odds ratios (OR) with confidence interval (95% CI). Heterogeneity of the meta-analyses was reported using I2 statistics.

RESULTS

After examining 1229 studies on the distribution of the AMPD1 c.34C > T (rs17602729) polymorphism in endurance and/or power athletes, 20 studies were considered eligible to be included in our meta-analysis. The studies were conducted in 11 different countries, including 5717 participants. There was a higher frequency of the CC genotype (OR 1.72; 95% CI 1.40-2.12; p < 0.00001) in endurance athletes compared with non-athletic controls with a lower frequency of CT (OR 0.61; 95% CI 0.49-0.75; p < 0.00001) and TT genotypes in endurance athletes versus non-athletic controls (OR 0.43; 95% CI 0.19-0.97; p = 0.04). A higher frequency of the CC genotype was also observed in power athletes compared with controls (OR 2.17; 95% CI 1.69-2.78; p < 0.00001) with a lower frequency of the CT (OR 0.51; 95% CI 0.39-0.65; p < 0.00001) and TT genotypes (OR 0.25; 95% CI 0.09-0.68; p = 0.007) in power athletes compared with controls. Overall, the genotype distribution of the AMPD1 c.34C > T polymorphism (rs17602729) was similar in endurance and power athletes (OR between 0.76 and 1.39; p = 0.47-0.72).

CONCLUSION

Our findings indicate that the CC genotype was overrepresented in endurance and power athletes compared with controls, suggesting that possessing two copies of the C allele of the AMPD1 c.34C > T (rs17602729) polymorphism may be associated with a 1.72-2.17 times greater likelihood of achieving elite or sub-elite athlete status in disciplines reliant on aerobic and anaerobic metabolic pathways. No statistically significant differences were found in the AMPD1 genotype distribution between endurance and power athletes.

Moving Towards a Medicine of Dance: A Scoping Review of Characteristics of Dance Interventions Targeting Older Adults and a Theoretical Framework

BackgroundDance combines cultural and aesthetic elements with behaviors important for brain health, including physical activity, social engagement, and cognitive challenge. Therefore, dance could positively impact public health given the rapidly aging population, increasing incidence of Alzheimer's disease and related dementias, and lack of uptake of exercise in many older adults. Despite a high volume of literature, existing literature does not support evidence-based guidelines for dance to support healthy aging.ObjectiveTo conduct a scoping review of the dance intervention literature in older adults and provide information to facilitate a more consistent approach among scientists in designing dance interventions for older adults that stimulate physical and neurocognitive health adaptations.MethodsStudy characteristics (sample size, population, study design, outcomes, intervention details) were ascertained from 112 separate studies of dance reported in 127 papers that reported outcomes important for brain health (cardiorespiratory fitness, balance and mobility, cognition, mood, and quality of life).ResultsHigh heterogeneity across studies was evident. Class frequency ranged from < 1 to 5 classes per week, class length from 30-120 minutes, and intervention duration from 2 weeks to 18 months. Studies often did not randomize participants, had small (< 30) sample sizes, and used varied comparator conditions. Over 50 tests of cognition, 40 dance forms, and 30 tests of mobility were identified.ConclusionsBased on these results, important future directions are establishing common data elements, developing intervention mapping and mechanistic modeling, and testing dosing parameters to strengthen and focus trial design of future studies and generate evidence-based guidelines for dance.

A decade on: Reflecting on the limitations of the first meta-analysis of the Implicit Relational Assessment Procedure's (IRAP) criterion validity in the clinical domain

Hussey (in press) recently conducted a detailed critical reanalysis of Vahey, Nicholson and Barnes-Holmes' (2015) meta-analysis. Its stated purpose was to (a) examine the extent to which Vahey et al.'s (2015) meta-analysis contains errors; and (b) to test how computationally reproducible it is by current standards of best practice. Hussey identified a small number of minor numerical errors, but crucially was unable to exactly replicate the original meta-effect of r‾ = .45. Six different variations of the meta-analysis reported by Vahey et al. were used and obtained meta-effects that deviated from the original by Δr‾ = .01-.02. Hussey also reported corresponding 95% credibility intervals that were all of zero width. These discrepancies prompted the present authors to conduct a detailed audit of the original meta-analysis. This revealed one minor transposing error in addition to three identified by Hussey. Once corrected this resulted in a marginally increased Hunter and Schmidt meta-analytic effect of r‾ = .46 without a credibility interval, and a Hedges-Vevea meta-effect of r‾ = .47 with 95% confidence interval (.40, .54). This correction was too small to have any bearing on Vahey et al.'s supplementary analyses regarding publication bias or statistical power. Vahey et al. contained a much lower proportion of transposing errors than is typical of meta-analyses even still (cf. Kadlec, Sainani, & Nimphius, 2023; Lakens et al., 2016; Lakens et al., 2017). Nonetheless, Hussey highlighted important ambiguities about the theoretical and practical meaning of the meta-effect reported by Vahey et al. We clarify our position on these matters in summary, and in so doing explain why we believe that the wider IRAP literature would undoubtedly benefit from increased adoption of contemporary open science standards.

Prevalence of oculomotor, binocular vision anomalies and refractive error among children with cerebral palsy in WHO South-East Asia: A protocol of systematic review and meta-analysis

Introduction

Children with cerebral palsy (CP) may experience a variety of visual abnormalities, which might hamper their daily activities. Most physical therapy for the CP population focuses on visual aspects, which postpone rehabilitation outcomes. Considering the significance of vision to the CP community, we aimed to conduct a systematic review of the prevalence of ocular abnormalities such as oculomotor abnormalities, refractive errors, and binocular vision anomalies in children with Cerebral palsy in the absence of eye injury in WHO South-East Asia region.

Methods & analysis

This systematic review and meta-analysis protocol are reported as per the PRISMA- P and MOOSE guidelines. A complete search strategy will be framed using MeSH terms and the opinion of the subject expert. A detailed search on PubMed, the Cochrane Library, Scopus, Web of Science and CINHAL will be carried out to retract the data on the prevalence of visual problems in the CP population (age< 18 years), published in English between January 2010 and 2024. Covidence software will be used to manage data, screen records and extract the information. The Newcastle-Ottawa Scale will be used to evaluate the listed studies quality and risk of bias. RevMan V.5 will be used to analyse the data.

A Comprehensive Systematic Review and Meta-analysis of the Role of Prostate-specific Membrane Antigen Positron Emission Tomography for Prostate Cancer Diagnosis and Primary Staging before Definitive Treatment

BACKGROUND AND OBJECTIVE

Positron emission tomography (PET) with prostate-specific membrane antigen (PSMA) in the diagnosis and primary staging of patients with prostate cancer (PCa) has an established role, but recent summative evidence on its actual diagnostic and staging value is still missing. We aimed to collect and analyze published studies reporting the accuracy of PSMA PET for the diagnosis of clinically significant prostate cancer (csPCa) and detection of distant metastases at primary staging before definitive treatment.

METHODS

We performed a systematic review of the literature, by searching the PubMed/MEDLINE, Cochrane library's CENTRAL, EMBASE, and Scopus databases, from inception to April 2024. Two coprimary outcomes were assessed: first, to evaluate the sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of PSMA PET in detecting intraprostatic csPCa on a per-patient level, and second, to assess the positivity rates of metastatic disease in the primary staging, prior to definitive therapy. As a secondary outcome, the diagnostic accuracy of PET PSMA for the detection of lymph nodal invasion (LNI) was tested in a per-patient-level analysis of studies where pelvic lymph node dissection (PLND) was available as the reference standard. Positivity and detection rates were pooled using random-effect models. Preplanned subgroup analyses tested the diagnostic accuracy of PET PSMA across different study cohorts. Variation in PPV and NPV over csPCa and LNI prevalence was evaluated.

KEY FINDINGS AND LIMITATIONS

In total, 12 and 99 studies, with a total of 1533 and 18 649 participants, respectively, were included in the quantitative synthesis for intraprostatic diagnosis and staging. For intraprostatic disease, the sensitivity, specificity, PPV, and NPV of PSMA PET for csPCa were 82% (95% confidence interval [CI] 73-90%), 67% (95% CI 46-85%), 77% (95% CI 63-88%), and 73% (95% CI 56-87%), respectively. At a bivariate analysis, the diagnostic accuracy of PSMA PET estimated through a summary receiver operating characteristic curve-derived area under the curve was 84%, increasing up to 88% when combined with magnetic resonance imaging (MRI). On staging level, PSMA PET results were positive outside the prostate in 23% of the patients, with substantial variation in positivity rates between high-risk (31%) and intermediate-risk (12%) subcohorts. When using PLND as the reference standard (51 studies, 7713 patients), the sensitivity, specificity, PPV, and NPV of PSMA PET were, respectively, 54%, 94%, 77%, and 86%. With higher csPCa and LNI prevalence, a similar increase in PPV and a decrease in NPV were observed.

CONCLUSIONS AND CLINICAL IMPLICATIONS

The current updated systematic review and meta-analysis provides updated evidence on the diagnostic and staging accuracy of PSMA PET in PCa. We reported good accuracy of PSMA PET to discriminate csPCa, particularly when added to MRI, but NPV alone is insufficient to omit a biopsy. Regarding staging, PSMA PET cannot be used alone to determine the need for lymph node dissection (LND) and should be combined with additional clinical information within predictive tools. As such, further research should develop and validate models that incorporate PSMA PET to reliably inform biopsy or LND.

Outcomes of femoral shaft fractures in Sub-Saharan Africa: A systematic review

PURPOSE

Femoral shaft fractures are significant injuries and if not managed appropriately can result in high complication rates and long-term disability. These complex injuries occur at a higher rate across low and middle income countries and sub-Saharan Africa is thought to have a higher incidence than other regions across the world. This study aims to summarise the most up to date evidence surrounding the treatment and associated outcomes of adult femoral shaft fractures in sub-Saharan Africa - giving a clear understanding of current practices and highlighting potential areas for further research.

METHODS

PubMed, Google Scholar, Africa Journals Online, Cochrane, Clinicaltrial.gov were searched using Boolean search strategies. Data collected included demographics, fracture classification, interventions, union rates, time to union, patient-reported outcomes / functional outcome scores, and secondary outcomes (orthopaedic and medical complications, malunion / non-union, length of admission).

RESULTS

Twenty-three studies reporting 2,180 patients were included-73% (1592/2180) of patients were male, with a mean age of 35 years. Overall, 59% of patients were treated with intramedullary nailing (IMN), 23% with skeletal traction, and 14% with open reduction internal fixation (ORIF). There was a heterogeneity in practice in different regions, with the highest reported rates of IMN in Tanzania (99%), and lowest in Malawi (29.4%). Union rates were highest in IMN (82.4-100%) versus traction (48 - 100%) and ORIF (83.3-87%). Intramedullary nailing demonstrated a super complication profile, with better functional outcomes, shorter hospital stays and time to mobilisation.

CONCLUSION

Intramedullary nailing demonstrated superior clinical and functional outcomes compared to other modalities for the treatment of femur shaft fractures across sub-Saharan Africa. However, there is significant sparsity of research and variable management approaches across the region. Focused research to determine the burden of injury, current healthcare resources and cost-effective and appropriate interventions to improve outcomes are now a public health priority.

Association of sleep duration with hypertension in young and middle-aged adults: A systematic review and meta-analysis

Background

Hypertension is a primary risk factor for cardiovascular and cerebrovascular diseases. A number of studies have suggested that sleep duration play an important role in the development of hypertension. Hypertension in young and middle-aged individuals is characterized by low awareness and treatment rates, increasing the risk of adverse events. To further elucidate the relationship between sleep duration and hypertension risk in young and middle-aged individuals, we conducted a meta-analysis.

Methods

This study searched PubMed, Embase, and the Cochrane Library from January 2003 to November 5, 2023. Data analysis was performed using STATA 17. Using Q test and I2-statistic, heterogeneity test for the included studies was conducted. Potential small-sample effects were evaluated based on the symmetry of funnel plots, and publication bias in included studies was evaluated using Egger's test.

Results

Data analysis of sleep duration was conducted for 16 studies, which revealed that both long sleep duration (OR, 1.10; 95 % CI, 1.05-1.15) and short sleep duration (RR: 1.10, 95 % CI: 1.05 to 1.15) were associated with hypertension in young and middle-aged individuals, particularly in Asian populations.

Conclusions

This meta-analysis revealed an association between sleep duration (short [<7 h] and long [≥9 h]) and the development of hypertension in young and middle-aged adults, particularly in Asian populations. Sleep is a behavior that can be modified. Clinicians and health professionals should be encouraged to intensify efforts to promote healthy sleep for all and reduce the occurrence of high blood pressure in young and middle-aged individuals.

Abatacept and the risk of malignancy: a meta-analysis across disease indications

OBJECTIVES

To estimate the association between abatacept use and the incidence of malignancy excluding non-melanomatous skin cancers (NMSCs).

METHODS

Systematic database searches were performed, to April 2024, to identify phase II/III/IV randomized clinical trials (RCTs), long-term extension (LTE) and observational cohort studies of abatacept in people with rheumatoid arthritis and psoriatic arthritis. Network and pairwise meta-analyses were performed to estimate incidence rate ratios (IRRs) for malignancy excluding NMSC, comparing abatacept with placebo and tumour necrosis factor inhibitors (TNFi) in RCT/LTE studies. Pairwise meta-analyses evaluated the same outcome in observational studies, comparing abatacept with conventional synthetic DMARDs (csDMARDs) and biologic/targeted synthetic disease modifying antirheumatic drugs (b/tsDMARDs).

RESULTS

In 18 eligible RCTs and 10 LTE studies, there were 15 535 person-years of exposure to abatacept, 1495 to placebo and 733 to TNFi. In network meta-analyses of combined RCT/LTE data, the incidence of all malignancies excluding NMSCs was not significantly different between abatacept and placebo (IRR 0.58; 95% CI 0.32-1.09) or TNFi (IRR 0.72; 95% 0.27-1.87). In observational data, the incidence of malignancy was higher with abatacept, relative to other b/tsDMARDs (IRR 1.21; 95% CI 1.15-1.28), but not significantly different compared with csDMARDs (IRR 0.97; 95% CI 0.90-1.06).

CONCLUSIONS

Abatacept was associated with a higher incidence of malignancy compared with other b/tsDMARDs in observational studies, but not when compared with placebo or TNFi in RCT/LTE data. Further pharmacovigilance data is essential to help elucidate whether abatacept modifies cancer risk.

PROSPERO REGISTRATION NUMBER

CRD42023382314.

The Ethics of Human Embryo Editing via CRISPR-Cas9 Technology: A Systematic Review of Ethical Arguments, Reasons, and Concerns

The possibility of editing the genomes of human embryos has generated significant discussion and interest as a matter of science and ethics. While it holds significant promise to prevent or treat disease, research on and potential clinical applications of human embryo editing also raise ethical, regulatory, and safety concerns. This systematic review included 223 publications to identify the ethical arguments, reasons, and concerns that have been offered for and against the editing of human embryos using CRISPR-Cas9 technology. We identified six major themes: risk/harm; potential benefit; oversight; informed consent; justice, equity, and other social considerations; and eugenics. We explore these themes and provide an overview and analysis of the critical points in the current literature.

Mollusc and crustacean consumption in the first 1000 days: a scoping review

Mollusc and crustacean consumption in the first 1000 d may improve maternal and child health by providing essential nutrients. However, in some contexts, molluscs and crustaceans have been associated with allergies and environmental contamination, potentially leading to adverse health and development outcomes. It is unclear whether the health benefits of consuming molluscs and crustaceans, collectively classified as shellfish in nutrition, are outweighed by the potential risks to pregnant women and children. We conducted a scoping review (PROSPERO: CRD42022320454) in PubMed, Scopus and EBSCO Global Health of articles published between January 2000 and March 2022 that assessed shellfish consumption during pregnancy, lactation or childhood (0-2 years) in relation to maternal health, child health or child development. A total of forty-six articles were included in this review. Overall, shellfish consumption was associated with higher biomarkers of environmental contaminants, with mercury being the most studied and having the strongest evidence base. The limited research on nutritional biomarker status shows an association between shellfish consumption and iodine status. Preterm birth was not associated with shellfish consumption, but newborn anthropometry showed mixed results, with several studies reporting lower birth weight with higher shellfish consumption. The few studies that examined child development and maternal health outcomes reported no significant associations. This review revealed trade-off health risks and benefits with inclusion of molluscs and crustaceans in the dietary patterns of mothers and young children. More research is needed to understand how these aquatic animal-source foods may be safely consumed and leveraged for improving human nutrition.

Measuring suicidal behavior in the era of rapid-acting antidepressants: A systematic review of ketamine studies

Assessment measures for suicidal behavior range from depression scales to longer suicide-specific instruments. In this review, we systematically summarize and discuss the currently used instruments for assessing suicidal behavior in the context of ketamine and its enantiomers. We searched Medline/PubMed, Embase, and PsycINFO databases for ketamine (and its enantiomers) human studies exploring this drug's antisuicidal effects on major depressive disorder patients, published from February 2000 to June 2023. Forty-six studies were included, identifying 16 assessment tools, mostly explicit and clinician-rated measures. Prominent tools included the Montgomery-Åsberg Depression Rating Scale (MADRS), Hamilton Depression Rating Scale (HAM-D), and both the clinician and patient-rated Beck Scales for Suicide Ideation (SSI and BSS). With the exception of the Suicide Ideation and Behavior Assessment Tool (SIBAT), to the best of our knowledge, no other instrument that assesses suicidality seems to be specifically developed for measuring treatment response in rapid-acting antidepressants trials. Most scales have been validated in conventional antidepressant or psychotherapy contexts, though, for MADRS, as well as for SSI, BDI, and HAM-D, efforts have been made towards investigating their psychometric properties in the field of rapid-acting antidepressants. The heterogeneity of suicidal behavior assessment in ketamine studies may hinder adequate comparisons between them. Although there does not seem to be a universally preferable instrument for measuring suicidal behavior to date, the MADRS potentially emerges as an adequately recommended choice.

Vasoplegia in Cardiac Surgery: A Systematic Review and Meta-analysis of Current Definitions and Their Influence on Clinical Outcomes

OBJECTIVES

To identify differences in the reported vasoplegia incidence, intensive care unit (ICU) length of stay (LOS), and 30-day mortality rates as influenced by different vasoplegia definitions used in cardiac surgery studies.

DESIGN

A systematic review was performed covering the period 1977 to 2023 using PubMed/MEDLINE, Embase, Web of Science, Cochrane Library, and Emcare and a meta-analysis (PROSPERO: CRD42021258328) was performed.

SETTING AND PARTICIPANTS

One hundred studies defining vasoplegia in cardiac surgery patients were systematically reviewed. Sixty studies with 20 or more patients, irrespective of design, reporting vasoplegia incidence, ICU LOS, or 30-day mortality were included for meta-analysis.

INTERVENTIONS

Cardiac surgery on cardiopulmonary bypass.

MEASUREMENTS AND MAIN RESULTS

Studies were categorized depending on the used mean arterial pressure (MAP) thresholds. Random intercept logistic regression models were used for meta-analysis of incidence and mortality. Random effect meta-analysis was used for ICU LOS. One hundred studies were reviewed systematically. MAP and cardiac index thresholds varied considerably (<50-80 mmHg and 2.0-3.5 L·min-1m-2, respectively). Vasopressor dosages also differed between definitions. The reported incidence (60 studies; mean incidence, 19.9%; 95% confidence interval [CI], 16.1-24.4) varied largely between studies (2.5%-66.3%; I2 = 97%; p < 0.0001). Meta-regression models, including the MAP-threshold, did not explain this heterogeneity. Similarly, the effect of vasoplegia on ICU LOS, and 30-day mortality was very heterogeneous among studies (I2 = 99% and I2 = 73%, respectively).

CONCLUSIONS

The large variability in vasoplegia definitions is associated with significant heterogeneity regarding incidence and clinical outcomes, which cannot be explained by factors included in our models. Such variations in definitions leads to inconsistent patient diagnosis and renders published vasoplegia research incomparable.

Normothermic Machine Perfusion vs. Static Cold Storage in Liver Transplantation: A Systematic Review and Meta-Analysis

BACKGROUND

Normothermic machine perfusion (NMP) represents an alternative to prolong liver preservation and reduce organ discard rates. We performed an updated systematic review and meta-analysis to compare NMP with static cold storage (SCS) in liver transplantation.

METHODS

MEDLINE, Embase, and Cochrane were searched for randomized controlled trials (RCTs) or observational studies. Risk ratios (RR) and mean differences were calculated. p < 0.05 was considered significant. A random-effects model was applied for all outcomes.

PROSPERO ID

CRD42023486184.

RESULTS

We included 1295 patients from 5 RCTs and 6 observational studies from 2016 to 2023. 592 (45.7%) underwent NMP. A subgroup RCT analysis favored NMP for non-anastomotic strictures (RR 0.4; 95% CI 0.2, 0.9), postreperfusion syndrome (RR 0.4; 95% CI 0.27, 0.56), and early allograft dysfunction (RR 0.6; 95% CI 0.4, 0.9). NMP favored higher organ utilization rates (RR 1.1; 95% CI 1.02, 1.18). No significant differences between NMP and SCS were observed in graft survival or patient survival at 12 months, primary non-function, serious adverse events, overall biliary complications, AST, or bilirubin levels peak within the first 7 days, ICU or hospital length of stay.

CONCLUSION

Our findings suggest that NMP is associated with lower non-anastomotic biliary stricture rates, postreperfusion syndrome, early allograft dysfunction, and higher organ utilization in the RCT subgroup analysis, without increasing adverse events.

Anterior distal femoral hemiepiphysiodesis for knee flexion contracture in paediatric patients with neuromuscular disorders: A systematic review and meta- analysis

BACKGROUND

This meta-analysis assesses the effectiveness of ADFH in the operative management of knee flexion contracture in children with neuromuscular disorders.

METHODS

The study included 218 patients and assessed 340 knees. Patients had a median age of 11 years (age range 4-17 years) at initial evaluation. The mean follow up time was 25 months.

RESULTS

Gait deviation index improved by 8.49 points following ADFH (95 % CI 4.82-12.15, p < 0.01). Minimum flexion angle saw an overall improvement of 20.61 degrees (95 % CI 15.8 - 26.04, p < 0.001). Knee flexion contracture had an overall improvement of 11.74 degrees across (95 % CI 10.14-13.33, p < 0.001). Popliteal angle improved by 15.59 degrees overall following ADFH (95 % CI 7.57-23.60), p < 0.01).

CONCLUSION

Orthopaedic operations are known to improve knee kinematics and clinical examination findings in neuromuscular disorder patients. ADFH is effective in improving passive and dynamic sagittal knee function.

Comparative global epidemiology and species distribution of Sarcocystis spp. in new and old world camelids: A systematic review and meta-analysis

This study aimed to investigate the global prevalence, species diversity, and geographical distribution of Sarcocystis spp. in Old World Camelids (OWCs) and New World Camelids (NWCs). A comprehensive literature search was conducted across multiple databases, covering studies up to December 22, 2024. The analysis included 36 studies (28 on OWCs and 8 on NWCs), comprising data from 5942 camelids (4850 OWCs and 1092 NWCs) across 13 countries in three continents. A random-effects model was used to estimate pooled prevalence rates, and heterogeneity was assessed using the I² statistic. The overall prevalence of Sarcocystis spp. in camelids was 57.7 % (95 % CI: 49.4-65.6 %). NWCs exhibited a significantly higher pooled prevalence (77.6 %, 95 % CI: 55-90.8 %) compared to OWCs (55.1 %, 95 % CI: 46.4-63.6 %). The highest regional pooled prevalence was observed in South America (82.3 %), particularly in the WHO AMR region (82.3 %), with Peru reporting the highest pooled prevalence at 99.3 %. The oesophagus was the most frequently infected tissue. Four valid Sarcocystis species were identified in camelids: S. cameli and S. ippeni in OWCs, and S. aucheniae and S. masoni in NWCs. Many positive samples were classified only as Sarcocystis spp. Although none of these species poses a zoonotic risk, some like S. cameli and S. aucheniae are particularly significant due to their economic and veterinary impact on camelids. Their ability to form macroscopic cysts can negatively affect meat quality, leading to considerable economic losses in the camel industry. Targeted surveillance and control measures are recommended, particularly in high-prevalence regions.