PRISMA-S: an extension to the PRISMA Statement for Reporting Literature Searches in Systematic Reviews

Systematic review of the reporting of extrarenal manifestations in observational studies of Saudi patients with systemic lupus erythematosus

BACKGROUND

SLE is prevalent in Saudi Arabia, with numerous studies focusing on SLE in adult patients. However, there is a lack of comprehensive studies summarising the extrarenal manifestations of SLE in this population. This study aims to assess the variability in the prevalence rates of extrarenal manifestations of SLE across different cities in Saudi Arabia and to emphasise the need for a national registry to better understand the overall disease burden in the region.

METHODS

We conducted a systematic review of articles with no time restrictions, including studies from databases such as Medline, ScienceDirect, EBSCO and PubMed up to July 2024. The review process involved screening, data extraction and quality assessment in duplicate. Only observational or experimental studies focusing on extrarenal manifestations in adult patients with SLE in Saudi Arabia were included. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist for systematic reviews to ensure a rigorous and comprehensive evaluation.

RESULTS

A total of 35 studies were included, primarily retrospective cohort studies. Riyadh showed the highest number of publications over time. Musculoskeletal involvement in SLE ranged from 2% to 100%, with most studies reporting 46%-85%. Mucocutaneous manifestations, including discoid rash (5%-100%), malar rash (up to 79%) and photosensitivity (6.12%-29.3%), varied widely. Raynaud's phenomenon was noted at 4.5%-15.2%. Constitutional symptoms were more common in early-onset SLE, while serositis and cardiopulmonary issues showed variability. Neuropsychiatric symptoms, especially depression, reached up to 67.6%.

CONCLUSION

This study explores the prevalence of extrarenal manifestations of SLE among adult Saudi patients, highlighting significant regional variability in musculoskeletal, dermatological, cardiovascular and neurological symptoms. It addresses a gap in the literature for a region where autoimmune diseases are a growing public health concern. The findings emphasise the need for population-based studies to investigate environmental, genetic and lifestyle factors influencing SLE progression.

Identifying Key Principles and Commonalities in Digital Serious Game Design Frameworks: Scoping Review

BACKGROUND

Digital serious games (DSGs), designed for purposes beyond entertainment and consumed via electronic devices, have garnered attention for their potential to enhance learning and promote behavior change. Their effectiveness depends on the quality of their design. Frameworks for DSG design can guide the creation of engaging games tailored to objectives such as education, health, and social impact.

OBJECTIVE

This study aims to review, analyze, and synthesize the literature on digital entertainment game design frameworks and DSG design frameworks (DSGDFWs). The focus is on conceptual frameworks offering high-level guidance for the game creation process rather than component-specific tools. We explore how these frameworks can be applied to create impactful serious games in fields such as health care and education. Key goals include identifying design principles, commonalities, dependencies, gaps, and opportunities in the literature. Suggestions for future research include empathic design thinking, artificial intelligence integration, and iterative improvements. The findings culminate in a synthesized 4-phase design process, offering generic guidelines for designers and developers to create effective serious games that benefit society.

METHODS

A 2-phase methodology was used: a scoping literature review and cluster analysis. A targeted search across 7 databases (ACM, Scopus, Springer, IEEE, Elsevier, JMIR Publications, and SAGE) was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Studies included academic or industry papers evaluating digital game design frameworks. Cluster analysis was applied to categorize the data, revealing trends and correlations among frameworks.

RESULTS

Of 987 papers initially identified, 25 (2.5%) met the inclusion criteria, with an additional 22 identified through snowballing, resulting in 47 papers. These papers presented 47 frameworks, including 16 (34%) digital entertainment game design frameworks and 31 (66%) DSGDFWs. Thematic analysis grouped frameworks into categories, identifying patterns and relationships between design elements. Commonalities, dependencies, and gaps were analyzed, highlighting opportunities for empathic design thinking and artificial intelligence applications. Key considerations in DSG design were identified and presented in a 4-phase design baseline with the outcome of a list of design guidelines that might, according to the literature, be applied to an end-to-end process of designing and building future innovative solutions.

CONCLUSIONS

The main benefits of using DSGDFWs seem to be related to enhancing the effectiveness of serious games in achieving their intended objectives, such as learning, behavior change, and social impact. Limitations primarily seem to be related to constraints associated with the specific contexts in which the serious games are developed and used. Approaches in the future should be aimed at refining and adapting existing frameworks to different contexts and purposes, as well as exploring new frameworks that incorporate emerging technologies and design principles.

The impact of ACOG's 39-week rule on fetal death rates in the United States: A systematic review

OBJECTIVE

The "39-week rule," implemented in August 2009, strongly discouraged early term deliveries before 39 weeks without accepted ACOG delivery indications. In this study, we evaluated fetal death rates before and after the 39-week rule in the United States (US) by review of published series.

STUDY DESIGN

Systematic literature searches were performed in PubMed, Cochrane Central Register of Controlled Trials, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and Scopus databases (January 2009-June 2023). Searches were focused on the 39-week rule and fetal death. Articles were excluded if they were non-English, included non-US population, or included multiple gestations. The articles were then exported to EndNote for reference management and uploaded to Rayyan for title and abstract screening by two independent reviewers. The study was prospectively registered in PROSPERO.

RESULTS

Of 833 articles identified after initial search, 6 peer-reviewed studies met the inclusion criteria. After combining the data from these studies, there were 8713 fetal deaths/7,294,911 total births (0.12 %) post-implementation of the 39-week rule, and 8523 fetal deaths/7,705,422 total births (0.11 %) pre-implementation. Compared to pre-implementation, the odds of fetal death after implementation of the 39-week rule were 1.08 (95 % CI 1.05-1.11).

CONCLUSIONS

Implementation of ACOG's 39-week rule resulted in an 8 % increased risk of fetal death compared to pre-implementation of the 39-week rule. This is alarming, but must be evaluated in the setting of decreased neonatal morbidity and mortality following the introduction of the 39-week rule.

Understanding patient perception of digital value co-creation in electronic health record through clustering approach

Patients are central to healthcare services, and comprehending their perceptions is crucial for fostering effective value co-creation. This study aimed to investigate the user characteristics and perceptions of value co-creation within the context of Mobile Electronic Health Records (EHR). Using a questionnaire collected from 422 patients, the study employed the K-modes clustering algorithm in R-Studio to group users based on shared characteristics and perceptions of value co-creation. The analysis revealed three distinct user clusters, which are high familiarity-positive perception, low familiarity-positive perception and high familiarity-neutral to negative perception. These clusters characterized by unique attributes such as socio-economic, history of medical visit, intention to use, technological familiarity, and different perception of value co-creation in Mobile EHR systems. Descriptive statistics were used to further interpret the clusters, revealing differences in user characteristics and perception across cluster. The findings emphasize the importance of alignment between user expectations and system interactions. Effective alignment fosters value co-creation through resource access, sharing, integration, and recombination, while misalignment may result in value destruction. This study highlights the need to design and implement Mobile EHR systems that align with the diverse characteristics and of their users to enhance engagement and promote value co-creation.

Group learning contracts in healthcare education: A systematic review

INTRODUCTION/BACKGROUND

Group work plays a crucial role in healthcare education by fostering collaboration, communication, and teamwork skills. However, students often face challenges such as unequal workload distribution, conflict, and anxiety. Group learning contracts have been introduced to improve group dynamics by setting clear expectations, enhancing accountability, and promoting effective collaboration. This systematic review explores the impact of group learning contracts on students' experiences in healthcare education.

METHODS

A comprehensive search across six databases, including Medline, ProQuest, and SCOPUS, identified studies published from inception to 2023. Keywords related to group work, healthcare education, and learning contracts were used. Data extraction and quality appraisal followed the PRISMA guidelines, with the Mixed Methods Appraisal Tool (MMAT) used for bias assessment.

RESULTS

All four studies demonstrated positive outcomes from using group learning contracts. Improvements included better workload distribution, increased communication, reduced anxiety, and enhanced collaboration. One study reported greater effectiveness of these contracts in online learning settings. Some students, however, found the additional paperwork burdensome. Despite overall low bias risk, methodological limitations, including small sample sizes and absence of control groups, were noted.

DISCUSSION

The findings highlight the potential of group learning contracts to mitigate common challenges in group work and enhance students' learning experiences. Aligning with previous research, structured agreements foster accountability and reduce group-related stress.

CONCLUSION

Group learning contracts are valuable tools in healthcare education, promoting positive group dynamics and improving student outcomes. Further research with larger, more diverse samples is needed to confirm these findings and optimize implementation across various educational contexts.

Illuminating the hidden cost: A systematic review of cognitive late effects regarding cancer-related fatigue in treated paediatric brain tumors

Objective

Globally, in 2022, 30,871 children were diagnosed with CNS-tumors. Many have been treated with radiotherapy, and a significant number suffer from chronic late effects, including fatigue. This study aims to investigate previous research on the impact of cancer-related fatigue for neurocognitive function that can be related to radiotherapy in patients who have undergone primary brain radiotherapy before the age of 18.

Methods

Conducted under PRISMA-S framework, this systematic review searched MEDLINE ALL (Ovid), EMBASE (Ovid), CINAHL (EBSCO), and PsycINFO (Ovid) for relevant studies. Criteria for inclusion were children under 18 who underwent radiotherapy for primary brain cancer, focusing on late cognitive side effects, published 2000-2023.

Results

From 4,067 records, 10 studies were included, examining Proton Radiation Therapy (n = 4), X-ray Radiation Therapy (n = 3), and their comparisons (n = 3). The studies used various cognitive tests, and late effects that emerged were neurocognitive functions and disorders, intellectual functioning, specific cognitive functions and daily life, social functioning, and performance. These themes can be encompassed by cancer-related fatigue.

Conclusions

The findings underscore critical need for more in-depth research to understand the health perception variations among children post-primary brain radiotherapy. Furthermore, detailed insights of treatment specifics, disease progression, target volume sizes, and doses to surrounding organs at risk are imperative.

Search filters for systematic reviews and meta-analyses in sleep medicine

Systematic reviews and meta-analyses are increasingly common in sleep research, although the methodological quality level has been a matter of concern. Efforts towards methodological standardization are needed to ensure the reliability of sleep-related systematic reviews. The development of search strategies is a critical step in a systematic review, which often lead to methodological biases. Standardized search filters have been used to facilitate the development of search strategies. However, such filters have not been developed for sleep medicine. The current study aimed at developing a list of PubMed search filters related to sleep medicine, including specific search strategies for different sleep disorders and sleep conditions. First, a list of sleep disorders and conditions was created for which search filters would be developed. This included most conditions listed in the International Classification of Sleep Disorders - 3rd edition. Additional search filters were developed for proposed disorders not recognized as independent clinical entities, and for other sleep-related conditions. All search strategies were designed specifically for PubMed, by combining relevant MeSH terms and free terms. Nine fully independent and unrelated MeSH terms related to sleep were identified. In total, 91 search filters were developed, related to 71 different sleep-related conditions. With the current work, we aimed to provide a list of reliable search filters organized to cover the field in a broad manner, therefore being useful for different types of systematic reviews within sleep medicine, ranging from narrow-focused meta-analyses to broader scoping reviews, mapping reviews, and meta-epidemiological studies.

Natural language processing of electronic health records for early detection of cognitive decline: a systematic review

This systematic review evaluated natural language processing (NLP) approaches for detecting cognitive impairment in electronic health record clinical notes. Following PRISMA guidelines, we analyzed 18 studies (n = 1,064,530) that employed rule-based algorithms (67%), traditional machine learning (28%), and deep learning (17%). NLP models demonstrated robust performance in identifying cognitive decline, with median sensitivity 0.88 (IQR 0.74-0.91) and specificity 0.96 (IQR 0.81-0.99). Deep learning architectures achieved superior results, with area under the receiver operating characteristic curves up to 0.997. Major implementation challenges included incomplete electronic health record data capture, inconsistent clinical documentation practices, and limited external validation. While NLP demonstrates promise, successful clinical translation requires establishing standardized approaches, improving access to annotated datasets, and developing equitable deployment frameworks.

Research priority setting for implementation science and practice: a living systematic review protocol

BACKGROUND

Research priority setting has the potential to bridge knowledge gaps, optimize resource allocation, foster collaborations, and inform funding directions for implementation science and practice when these priorities are properly acted upon. This systematic review aims to determine the extent of research in priority setting for implementation science and practice, examine the methodologies employed, synthesize these research priorities, and identify strategies for evaluating and implementing these priorities.

METHODS

We will conduct a living systematic review following the Cochrane guidance. We will search literature from six databases, the website of James Lind Alliance, five implementation science-focused journals and several related journals, Google Scholar, and the reference lists of included studies. Two reviewers will independently screen studies based on the eligibility criteria. The characteristics of the included documents, their prioritization methods, and outcomes, as well as the evaluation and implementation strategies, will be extracted. We will critically appraise these documents using the nine common themes of good practice for research priority setting, and synthesize data using a narrative approach. We will re-run the search 12 months after the original search date to monitor the development of new literature and determine the time to update the review.

DISCUSSIONS

By conducting this living systematic review, we will gain a comprehensive and dynamic understanding of the potential research gaps and hotspots in implementation science as perceived by researchers and practitioners. The findings of this review will inform the future research directions of implementation science and practice.

SYSTEMATIC REVIEW REGISTRATION

This review has been registered with the Open Science Framework ( https://osf.io/sr69k ).

Quantification of indocyanine green fluorescence angiography in colorectal surgery: a systematic review of the literature

BACKGROUND

Indocyanine green fluorescence angiography (ICGFA) during colorectal surgery associates with reduced post-operative anastomotic complication rates. Because its interpretation is subjective, quantification has been proposed to address inter-user variability. This study reviews the published literature regarding ICGFA quantification during colorectal surgery with a focus on impactful clinical deployment.

METHODS

A systematic review was performed of English language publications regarding clinical studies of ICGFA quantification in colorectal surgery in PubMed, Scopus, Web of Science and Cochrane Library on 29th August 2024, updated to 18th November 2024, following PRISMA guidelines. Newcastle Ottawa scale (NOS) was used to assess quality.

RESULTS

A total of 1428 studies were screened with 22 studies (1469 patients) selected. There was significant heterogeneity of ICGFA methodology, quantification methods and parameter selection and only three studies were NOS "high" quality. Extracorporeal application was most common. Four studies (154 patients) conducted real-time ICGFA analyses (others were post hoc) and four utilised artificial intelligence methods. Eleven studies only included patients undergoing left-sided resection (six focusing specifically on rectal resections). Only one study employed the quantification method to guide intra-operative decision-making regarding colonic transection. Twenty-six different perfusion parameters were assessed, with time from injection to visible fluorescence and maximum intensity the most commonly (but not only) correlated parameters regarding anastomotic complication (n = 18). Other grounding correlates were tissue oxygenation (n = 3, two with hyperspectral imagery), metabolites (n = 2) and surgeon interpretation (n = 5).

CONCLUSION

Quantification of the ICGFA signal for colorectal surgery is feasible but has so far seen limited academic advancement beyond feasibility.

Radiological outcomes of surgical techniques for spastic hip in cerebral palsy: a systematic review and meta-analysis

BACKGROUND

In patients with cerebral palsy (CP), spastic hip is a prevalent complication. Various surgical approaches,, including pelvic osteotomy (PO), femoral osteotomy (FO), combined femoral and pelvic osteotomy (CFPO), and soft tissue surgery (STS), have been used to address this problem. This systematic review and meta-analysis was designed to compare the radiologic outcomes of these interventions for spastic hip in patients with CP.

METHODS

To identify relevant studies, databases were searched using specific keywords. Initially, duplicates were removed, then the titles and abstracts were screened, followed by a comprehensive full-text review. Data extraction took place from the studies that met the inclusion criteria. Subsequently, a meta-analysis was conducted.

RESULTS

The analysis of 6116 hips from 4546 patients across 81 studies demonstrated that PO significantly enhanced the center-edge angle (CEA), reduced the acetabular index (AI) and migration percentage (MP), and improved the Sharp and Tönnis angles. FO led to a substantial decrease in AI and MP, though CEA did not show a significant change, while CFPO resulted in significant improvements across AI, MP, neck-shaft angle (NSA), CEA, Sharp angle, and Tönnis angle. STS did not show significant changes in AI or CEA, but MP was notably reduced. Tone-decreasing procedures, such as selective dorsal rhizotomy and botulinum toxin injections, did not significantly alter MP, whereas guided growth techniques showed a significant reduction. MP improvements in FO decreased over time, with other radiologic parameters remaining relatively stable as follow-up increased. Age-specific trends indicated that children under 6 years primarily underwent tone-decreasing procedures and STS, while those around 7 years favored FO and guided growth, and older children (over 9 years) more commonly underwent PO, CFPO, or percutaneous osteotomy. Comparative analysis showed PO and percutaneous osteotomy were particularly more effective in reducing MP, with PO also being superior for AI improvement; whereas CFPO provided better outcomes for enhancing CEA. No significant differences were found among surgical methods for improving NSA.

CONCLUSIONS

This systematic review and meta-analysis underscores the superior efficacy of PO and CFPO in correcting spastic hip deformity in children with CP. Radiological outcomes demonstrate significant improvements following these procedures. The findings suggest that these approaches are particularly effective for complex cases where procedures such as FO, STS, or TDS may fall short. Future studies should focus on refining surgical protocols and exploring the long-term functional outcomes of these interventions.

Prevalence and proposed aetiologies of dystonias or yips in athletes playing overhand sports: a scoping review protocol

INTRODUCTION

Sports-related dystonia, also called the yips, are often seen in athletes in multiple sports. In this condition, an athlete abruptly loses the ability to perform a repetitive motion performed thousands of times. Such occurrences are often assumed to be psychological in nature, and thus evaluation for other causes is often lacking. All reviews on the topic have failed to focus on athletes in overhand sports. This scoping review will evaluate the available evidence regarding upper extremity focal dystonias (yips) in athletes participating in overhand sports in any worldwide clinical or sport setting.

METHODS AND ANALYSIS

We will conduct our scoping review with guidance from the latest version of the Joanna Briggs Institute's (JBI) Manual for Evidence Synthesis, a widely accepted methodology for conducting reviews. We organised our research question and inclusion criteria to the JBI's mnemonic; Participants: athletes that participate in overhand sports; Concept: upper extremity focal dystonias or yips; and Context: any worldwide clinical or sports setting. Search results were retrieved on 26-27 June 2024, in the following databases: MEDLINE (Ovid) 1946-2024, SPORTDiscus (EBSCOhost) 1800-2024, APA PsycINFO (EBSCOhost) 1872-2024, Embase (Elsevier) 1974-2024, Web of Science Core Collection (Clarivate) 1900-2024, Sports Medicine & Education Index (ProQuest) 1970-2024 and Dissertations and Theses Global (ProQuest) 1861-2024. Using Covidence, two reviewers from a team of three will independently screen titles and abstracts, screen full text articles for inclusion, and independently extract data from our included studies. Results will be presented as a narrative descriptive analysis along with tabular data on the prevalence, diagnostic criteria and treatment for yips in athletes of overhand sports.

ETHICS AND DISSEMINATION

As this describes a scoping protocol, ethical approval is not necessary. Review findings will be submitted to peer-reviewed publications and presentations at local and national conferences.

TRIAL REGISTRATION NUMBER

This protocol is registered with the Open Science Framework.

Assessment of cognitive domains in major depressive disorders using the Cambridge Neuropsychological Test Automated Battery (CANTAB): Systematic review and meta-analysis of cross-sectional and longitudinal studies

Cognitive difficulties are known to persist after remission of symptoms and to affect psychosocial functioning and quality of life. Cognitive function, measured with the Cambridge Neuro-psychological Test Automated Battery (CANTAB), is a reliable approach to measure cognitive function in major depression. This systematic review and meta-analysis appraise cross-sectional and longitudinal studies that used specific CANTAB tests to measure cognitive function in major depression and the effect of treatment (PROSPERO ID: CRD42022355903). 1212 studies were identified and 41 were included, 1793 patients and 1445 healthy controls. Deficits in executive functions were detected with the Stocking Of Cambridge (SOC) 'number of problems solved with minimal number of moves' and 'subsequent thinking time', Intra-Extra Dimensional Set Shift 'number of trials to complete the test', Spatial Working Memory 'strategy score' and 'between errors score', Spatial Span. Memory deficits were detected with Paired Associates Learning 'number of total errors', Pattern Recognition Memory (PRM) '% of correct answers' and 'response latency', Spatial Recognition Memory '% of correct answers', Delayed Matching To Sample (DMS) '% of total responses'. Impaired attention was detected by Rapid Visual Information Processing 'response latency' and probability to detect target'. Mental and motor responses increased when Reaction Time was measured. SOC 'number of problems solved with minimal number of moves', PRM 'response latency' and DMS '% of total responses' improved after a course of treatment. A range of variables including year of publication, age, IQ, severity and duration of illness influenced cognitive changes. The presence of significant cognitive deficits requires novel targeted interventions.

Medication adherence of patients with peripheral arterial disease to antithrombotic therapy: a systematic review

OBJECTIVES

Antithrombotic therapy (ATT) prevents atherothrombotic events (AE) in patients with peripheral arterial disease (PAD). However, the benefit may be compromised by poor medication adherence (MA). Therefore, our primary objective was the proportion of patients with PAD with poor MA in literature following patient-reported, pharmacy-reported or laboratory-reported outcome measurements. Poor MA is a combined outcome of primary non-adherence (inability to initiate a prescription), secondary non-adherence (incorrect daily intake) and non-persistence (discontinuation of daily intake).

DESIGN

Systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

DATA SOURCES

PubMed, EMBASE and Cochrane Library were searched from 2000 to June 2023.

ELIGIBILITY CRITERIA

Publications with a (sub)cohort of patients with PAD that reported on patients' MA to ATT were included.

DATA EXTRACTION AND SYNTHESIS

All articles were reviewed on eligibility and methodological quality by two independent researchers. The data were retrieved and collected in Review Manager Web and the percentages were calculated per subgroup. The risk of bias was assessed by using the Cochrane risk-of-bias tool for randomised controlled trials (RCT) and the methodological index for non-randomised studies score for non-RCTs.

RESULTS

We identified 274 potential records of which 10 studies (32 628 patients) were included. Six studies were RCTs and two prospective and two retrospective studies. Most studies scored a moderate risk of bias and had heterogeneous study designs. Poor MA rates ranged between 2% and 45%. Higher rates of poor MA were found in studies with longer follow-ups, pharmacy-reported outcome measurements and registry-based cohorts.

CONCLUSION

Heterogeneous study designs create a wide dispersion in the proportions. However, poor MA to ATT was found in approximately one-third of the patients with PAD and seemed to increase with longer therapy duration, which highlights the magnitude of this societal challenge. Enhancing patients' MA to ATT might be a key element in reducing the risk of AE, and therefore, more attention to MA in clinical and research settings is warranted.

PROSPERO REGISTRATION NUMBER

CRD42023431803.

Shared Decision-Making Tools Implemented in the Electronic Health Record: Scoping Review

BACKGROUND

Patient-centered care promotes the involvement of patients in decision-making related to their health care. The adoption and implementation of shared decision-making (SDM) into routine care are constrained by several obstacles, including technical and time constraints, clinician and patient attitudes and perceptions, and processes that exist outside the standardized clinical workflow.

OBJECTIVE

We aimed to understand the integration and implementation characteristics of reported SDM interventions integrated into an electronic health record (EHR) system.

METHODS

We conducted a scoping review using the methodological framework by Arksey and O'Malley with guidance from the Joanna Briggs Institute. Eligibility criteria included original research and reviews focusing on SDM situations in a real-world clinical setting and EHR integration of SDM tools and processes. We excluded retrospective studies, conference abstracts, simulation studies, user design studies, opinion pieces, and editorials. To identify eligible studies, we searched the following databases on January 11, 2021: MEDLINE, Embase, CINAHL Complete, Cochrane Library including CENTRAL, PsycINFO, Scopus, and Web of Science Core Collection. We systematically categorized descriptive data and key findings in a tabular format using predetermined data charting forms. Results were summarized using tables and associated narratives related to the review questions.

RESULTS

Of the 2153 studies, 18 (0.84%) were included in the final review. There was a high degree of variation across studies, including SDM definitions, standardized measures, technical integration, and implementation strategies. SDM tools that targeted established health care processes promoted their use. Integrating SDM templates and tools into an EHR appeared to improve the targeted outcomes of most (17/18, 94%) studies. Most SDM interventions were designed for clinicians. Patient-specific goals and values were included in 56% (10/18) of studies. The 2 most common study outcome measures were SDM-related measures and SDM tool use.

CONCLUSIONS

Understanding how to integrate SDM tools directly into a clinician's workflow within the EHR is a logical approach to promoting SDM into routine clinical practice. This review contributes to the literature by illuminating features of SDM tools that have been integrated into an EHR system. Standardization of SDM tools and processes, including the use of patient decision aids, is needed for consistency across SDM studies. The implementation approaches for SDM applications showed varying levels of planning and effort to promote SDM intervention awareness. Targeting accepted and established clinical processes may enhance the adoption and use of SDM tools. Future studies designed as randomized controlled trials are needed to expand the quality of the evidence base. This includes the study of integration methods into EHR systems as well as implementation methods and strategies deployed to operationalize the uptake of the SDM-integrated tools. Emphasizing patients' goals and values is another key area for future studies.

Assessing the impact of telehealth on blood glucose management among patients with diabetes: a systematic review and meta-analysis of randomized controlled trials

INTRODUCTION

The increasing prevalence of diabetes mellites (DM), especially type 2 diabetes mellitus, presents significant challenges for healthcare systems. Effective blood glucose management is essential for preventing serious complications, and telehealth offers a promising approach to improve patient engagement and adherence. The effectiveness of telehealth on blood glucose management should be investigated. The evaluated metric for diabetes management plans in this study was the change in blood glucose levels, specifically HbA1c, as an indicator of glycemic control. The impact of telehealth interventions on these outcomes was analyzed across various patient groups. This review conducts a comprehensive analysis of the current literature to offer insights that can guide clinical practices and inform policymakers about the advantages of telehealth in managing diabetes.

METHODS

In this study, several evidence-based databases and relevant clinical trial registries were searched to evaluate the effects of telehealth on blood glucose management among patients with diabetes. The included studies were randomized controlled trials that compared telehealth with traditional in-person management. Microsoft Excel was used to extract and sort the data before it was exported to STATA/MP 17.0 for analysis. A weighted inverse variance random-effects model with a 95% confidence interval was employed to pool the data. Egger's test and Cochrane I2 statistics were used to assess publication bias and heterogeneity, respectively.

RESULT

This review identified six randomized controlled trials (RCTs) involving a total of 3,995 patients, with 2,022 in the telehealth intervention group and 1,973 in the control group, conducted across the USA, Asia, and Europe. The analysis showed a significant improvement in blood glucose control for patients using telehealth, evidenced by a Standard Mean Difference (SMD) of 0.20 (95% CI: 0.10-0.29; p < 0.001), with USA studies reflecting the highest SMD of 0.24 and diabetic veterans showing an even greater SMD of 0.41.

CONCLUSION AND RECOMMENDATIONS

This study demonstrates that telehealth interventions significantly enhance blood glucose management among patients with diabetes. The findings highlight the need for healthcare systems to prioritize telehealth integration into diabetes management protocols while developing tailored interventions to meet the diverse needs of various patient populations.

A Meta-Visual-Analysis of Single-Case Experimental Design Research

Visual analysis is the primary method to detect functional relations in single-case experimental design (SCED) research. Meta-Visual-Analysis (MVA) is a novel approach used to synthesize SCED data where the estimated effect size measures are principally anchored to primary aspects of visual analysis: change in the magnitude of level, trend, variability, and trend-adjusted level of projected trends. For each of these aspects, percentage point differences between baseline and intervention conditions are estimated and quantified for every participant across studies. MVA effect sizes are standardized, and their aggregates are graphically displayed in a manner similar to individual SCED graphs. MVA graphs are compared and visually analyzed with the aim of better understanding the effectiveness and generality of interventions across SCED studies. In this discussion paper we provide general steps to conduct an MVA and describe MVA's utility in reviewing, organizing, and directing future SCED research syntheses.

Social Determinants of Health Screening Tools for Adults in Primary Care: Protocol for a Scoping Review

BACKGROUND

Social determinants of health (SDH) have been shown to be predictors of health outcomes. Integrating SDH screening tools into primary care may help identify individuals or groups with a greater burden of social vulnerability and promote health equity.

OBJECTIVE

This study aimed (1) to identify the existing screening tools to assess social deprivation in adults in primary care settings; (2) to describe the characteristics of these tools and, where appropriate, their psychometric properties; (3) to describe their validity and reliability in those scales in which validation processes have been conducted; and (4) to identify evidence gaps and provide recommendations for future research.

METHODS

This study protocol was structured according to the Joanna Briggs Institute methodology for scoping reviews and reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Furthermore, since not all SDH assessment tools are published as scientific papers, we will use a slightly modified form of the scoping review framework to retrieve specific information about specific tools for screening SDH in primary care contexts. The following electronic databases will be searched by 2 reviewers: MEDLINE (via PubMed), CINAHL Plus, Web of Science, and Scopus. In addition, the following sources will also be searched for gray literature: DART-Europe E-thesis Portal, OpenGrey, and Google Scholar. After the revision of inclusion and exclusion criteria, the titles, abstracts, and full text of the included studies will be separately screened by 2 reviewers. A PRISMA-ScR flowchart will be used to depict the sources of evidence screened, and data charting will be used to gain in-depth knowledge. The findings of the scoping review will be presented in both narrative and tabular formats, summarizing the existing literature on tools used for SDH in primary care settings. A critical analysis will be undertaken to address the variability in tool validation, cultural adaptability, and integration into different health care systems. Finally, key gaps in the existing evidence will be explored, and research priorities will be proposed, emphasizing the need for screening tools that are culturally sensitive, scalable, and easily integrated into primary care workflows. This critically appraised information may be useful for implementing SDH screening tools in primary care settings and may contribute to future research addressing feasibility and validation studies in different primary health care systems.

RESULTS

The study began in July 2024. Data collection is expected to be completed in April 2025, with publication expected in October 2025.

CONCLUSIONS

This scoping review will provide a comprehensive and critical description of the available tools aimed at screening SDH in primary care settings. Incorporating these tools into routine care has been recognized as a key strategy for addressing health inequalities, given the growing evidence base on the influence of SDH on health outcomes.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/68668.

Best Practices for Implementing Electronic Care Records in Adult Social Care: Rapid Scoping Review

BACKGROUND

In the past decade, the use of digital or electronic records in social care has risen worldwide, capturing key information for service delivery. The COVID-19 pandemic accelerated digitization in health and social care. For example, the UK government created a fund specifically for adult social care provider organizations to adopt digital social care records. These developments offer valuable learning opportunities for implementing digital care records in adult social care settings.

OBJECTIVE

This rapid scoping review aimed to understand what is known about the implementation of digital care records in adult social care and how implementation varies across use cases, settings, and broader contexts.

METHODS

A scoping review methodology was used, with amendments made to enable a rapid review. Comprehensive searches based on the concepts of digital care records, social care, and interoperability were conducted across the MEDLINE, EmCare, Web of Science Core Collection, HMIC Health Management Information Consortium, Social Policy and Practice, and Social Services Abstracts databases. Studies published between 2018 and 2023 in English were included. One reviewer screened titles and abstracts, while 2 reviewers extracted data. Thematic analysis mapped findings against the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework.

RESULTS

Our search identified 2499 references. After screening titles and abstracts, 71 records were selected for full-text review, resulting in 31 references from 29 studies. Studies originated from 11 countries, including 1 multicountry study, with the United Kingdom being the most represented (10/29, 34%). Studies were most often conducted in nursing homes or facilities (7/29, 24%) with older people as the target population (6/29, 21%). Health records were the most investigated record type (12/29, 41%). We identified 45 facilitators and 102 barriers to digital care record implementation across 28 studies, spanning 6 of the 7 NASSS framework domains and aligning with 5 overarching themes that require greater active management regarding implementation. Intended or actual implementation outcomes were reported in 17 (59%) of the 29 studies.

CONCLUSIONS

The findings suggest that implementation is complex due to a lack of consensus on what digital care records and expected outcomes and impacts should look like. The literature often lacks clear definitions and robust study designs. To be successful, implementation should consider complexity, while studies should use robust frameworks and mixed methods or quantitative designs where appropriate. Future research should define the target population, gather data on carer or service user experiences, and focus on digital care records specifically used in social care.

Current and emerging approaches to cochlear immunosuppression with translation to human inner ear stem cell therapy: A systematic review

Hearing loss is a significant health burden across all stages of life. One in 5 people suffer hearing loss, with 5% of the world's population experiencing disabling hearing loss. A large proportion of this loss is the consequence of damage or loss of neurosensory structures, termed "sensorineural" hearing loss. A recent advance in the treatment of sensorineural hearing loss has occurred, with the advent of inner ear stem cell therapy. Focus has pivoted from augmenting existing neural structures to regenerating neural frameworks. To date, stem cell therapy is limited by the host immune system and rejection of donor cells. A better understanding of immunity in the inner is ear required to progress stem cell therapy for hearing loss. This review outlines a contemporary understanding of the inner ear immune system. We discuss concepts of immune dysregulation that may lead to common inner ear pathologies, and, in doing so, review the efficacy of current pharmacotherapies that mitigate end organ damage through a process of immunosuppression. Current literature is appraised through a systematic review exploring two areas of focus; immunosuppression therapies for the treatment of inner ear pathology associated immune dysregulation, and, subsequently, the efficacy of immunosuppressive agents in translational models of inner ear stem cell therapy. Through greater understanding of these concepts, and systematic appraisal of the literature, this review summarises the literature for contemporary immunosuppressive regimes that may facilitate stem cell accommodation in the cochlea and auditory nerve.

A patient journey map for people living with autoimmune pulmonary alveolar proteinosis

INTRODUCTION

Patients with autoimmune pulmonary alveolar proteinosis (PAP) face a complicated journey (physically, emotionally, and financially) to receive the correct diagnosis and treatment. We developed a patient journey map (PJM) to describe the experiences and needs of patients with autoimmune PAP in the USA.

METHODS

This PJM was developed in four stages: (1) analysis of existing literature; (2) patient advisory board meetings (n = 7); (3) an online survey (n = 19); and (4) a validation workshop (n = 6).

RESULTS

Four phases of the patient journey were identified: (1) symptoms and experience before diagnosis; (2) diagnosis; (3) treatment; and (4) ongoing monitoring. Patients reported heterogeneous and indirect diagnostic pathways, often waiting months or years for the correct diagnosis. The majority reported at least one misdiagnosis, most commonly pneumonia. Treatment pathways varied substantially, and current treatments and off-label therapies were frequently described as burdensome, emotionally taxing, and/or financially worrisome. Patients described their journey as an "emotional rollercoaster," especially during pre-diagnosis and treatment. Patients reported common barriers to care, particularly insurance problems and access to expert care. Patients specifically cited the need for improved education on autoimmune PAP within the medical community and increased help with insurance challenges related to current treatments.

CONCLUSIONS

This PJM provides insights on patients' journeys with autoimmune PAP. Patients reported inconsistent, burdensome, and circuitous journeys. This PJM provides the medical community with valuable information on patients' needs and increases awareness of this rare disease. Over time, these factors may improve diagnosis, treatment, and the holistic experience of patients with autoimmune PAP.

Supervised prehabilitation in patients scheduled for spinal surgery - a scoping review

BACKGROUND CONTEXT

Prehabilitation before spinal surgery may enhance patients' ability to withstand physical and mental stress during the perioperative period. It has the potential to reduce complications, accelerate recovery, and deliver sustainable, patient-relevant improvements. However, high-quality evidence remains limited, and it is unclear which prehabilitation concepts, training protocols, and outcomes are most effective for different patient groups.

PURPOSE

To evaluate the current state of research on preoperative interventions before spinal surgery, including the representation of subgroups, types of surgical procedures, and prehabilitation concepts. Additionally, it examines the outcomes analyzed and the methodologies employed in existing studies.

STUDY DESIGN

Scoping review based on a systematic literature search.

METHODS

A comprehensive database search in MEDLINE/PubMed, EMBASE (Ovid), CINAHL (EBSCO), Cochrane Library, Physiotherapy Evidence Database, Web of Science and Scopus was conducted. Exercise- and/or education-based prehabilitation concepts were identified, and findings were clustered and summarized according to PRISMA reporting standards.

RESULTS

Thirty-six reports from 23 studies (50% RCTs), evaluating prehabilitation programs in terms of feasibility, experiences, and effects on physical performance, self-reported function, pain, psychological outcomes and health-economic factors were included. These studies encompassed 2,964 participants scheduled for spinal surgery and reported a wide range of preoperative interventions, settings, and adherence rates. Prehabilitation focused primarily on education (87%) and exercise (35%), either independently or in combination. Most authors have concluded that preoperative interventions benefit patients awaiting spinal surgery, particularly by improving self-reported function, disability, and pain in both the short and long term. However, the findings also highlight the variability in outcomes, strengths, limitations, and recommendations across studies. Notably, 76% of the authors advocated for preoperative preparation, emphasizing the importance of structured, personalized programs and the need for further large-scale clinical trials.

CONCLUSION

Based on the current evidence, preparation for spinal surgery is recommended, provided that it is individualized, multimodal, and interdisciplinary, and addresses patients' specific impairments, resources, and expectations. Future research should focus on identifying subgroups defined by biopsychosocial risk factors that may influence short- and long-term perioperative outcomes.

Effects of School Nurse-Led Asthma Interventions for Students: A Systematic Review

School nurse-led asthma interventions play a critical role in managing asthma among students. This study evaluates the effectiveness and key components of interventions for children with asthma. A systematic search of multiple databases was conducted up to September 2023. Two independent reviewers assessed the risk of bias using the Mixed Methods Appraisal Tool, and descriptive evidence synthesis with albatross plots was used to analyze the findings. Results revealed that school nurse-led asthma interventions positively influenced asthma symptoms, medication use, asthma-related quality of life, and self-management in schoolchildren. However, emergency visits, hospitalization, and absence outcomes remain inconclusive. Effective components identified across studies included chronic disease management, direct care, and collaborative communication. Further, well-designed randomized controlled trials with standardized outcome measurements are needed to examine objective outcomes, including emergency visits, hospitalization, and school absences, and strengthen the evidence base for school nurse-led asthma interventions.

Characteristics of Abstracts Presented at the American Academy of Orthopaedic Surgery Annual Meeting and Their Impact on Publication Rates

INTRODUCTION

The publication rate of abstracts presented at the American Academy of Orthopaedic Surgeons (AAOS) Annual Meetings has increased over the past 15 years. The purpose of this study was to (1) analyze and describe the characteristics of abstracts presented at the 2022 and 2023 AAOS Annual Meetings and (2) evaluate whether certain factors were associated with a higher likelihood of publication.

METHODS

A retrospective analysis of all abstracts presented at the 2022 and 2023 AAOS Annual Meeting was done based on the AAOS ePosters archive. PubMed and Google Scholar databases were searched to determine whether the abstract had been followed by publication in a peer-reviewed journal within 1 year of presentation.

RESULTS

A total of 1,987 abstracts were presented at the AAOS Annual Meeting; most were in adult reconstruction (30.1%), and 44% were published. Most studies had a level of evidence of III (71%), and the use of large databases increased between years (9.4% to 13%). Foot and ankle exhibited the highest publication rates among AAOS subspecialties (61%). Abstracts that were published had a markedly higher sample size and a higher rate of men as first authors (P < 0.001). Hand and wrist (30%) and practice management and rehabilitation (25.8%) had the highest rates of women as first and senior authors, respectively.

CONCLUSION

We found that 44% of the abstracts presented at the 2022 and 2023 AAOS Annual Meetings resulted in publication. Although most abstracts were in adult reconstruction, foot and ankle had the highest publication rate.

LEVEL OF EVIDENCE

III.

Prognostic models for prediction of perioperative allogeneic red blood cell transfusion in adult cardiac surgery: A systematic review and meta-analysis

OBJECTIVES

Identifying cardiac surgical patients at risk of requiring red blood cell (RBC) transfusion is crucial for optimizing their outcome. We critically appraised prognostic models preoperatively predicting perioperative exposure to RBC transfusion in adult cardiac surgery and summarized model performance.

METHODS

Design: Systematic review and meta-analysis.

STUDY ELIGIBILITY CRITERIA

Studies developing and/or externally validating models preoperatively predicting perioperative RBC transfusion in adult cardiac surgery. Information sources MEDLINE, CENTRAL & CDSR, Embase, Transfusion Evidence Library, Web of Science, Scopus, ClinicalTrials.gov, and WHO ICTRP. Risk of bias and applicability: Quality of reporting was assessed with the Transparent Reporting of studies on prediction models for Individual Prognosis or Diagnosis adherence form, and risk of bias and applicability with the Prediction model Risk of Bias ASsessment Tool.

SYNTHESIS METHODS

Random-effects meta-analyses of concordance-statistics and total observed:expected ratios for models externally validated ≥5 times.

RESULTS

Nine model development, and 27 external validation studies were included. The average TRIPOD adherence score was 66.4% (range 44.1%-85.2%). All studies but 1 were rated high risk of bias. For TRUST and TRACK, the only models externally validated ≥5 times, summary c-statistics were 0.74 (95% CI: 0.65-0.84; 6 contributing studies) and 0.72 (95% CI: 0.68-0.75; 5 contributing studies) respectively, and summary total observed:expected ratios were 0.86 (95% CI: 0.71-1.05; 5 contributing studies) and 0.94 (95% CI: 0.74-1.19; 5 contributing studies), respectively. Considerable heterogeneity was observed in all meta-analyses.

DISCUSSION

Future high quality external validation and model updating studies which strictly adhere to reporting guidelines, are warranted.

Neurofeedback for Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis

Importance

Neurofeedback has been proposed for the treatment of attention-deficit/hyperactivity disorder (ADHD) but the efficacy of this intervention remains unclear.

Objective

To conduct a meta-analysis of randomized clinical trials (RCTs) using probably blinded (ie, rated by individuals probably or certainly unaware of treatment allocation) or neuropsychological outcomes to test the efficacy of neurofeedback as a treatment for ADHD in terms of core symptom reduction and improved neuropsychological outcomes.

Data Sources

PubMed (MEDLINE), Ovid (PsycInfo, MEDLINE, Embase + Embase Classic), and Web of Science, as well as the reference lists of eligible records and relevant systematic reviews, were searched until July 25, 2023, with no language limits.

Study Selection

Parallel-arm RCTs investigating neurofeedback in participants of any age with a clinical ADHD or hyperkinetic syndrome diagnosis were included.

Data Extraction and Synthesis

Standardized mean differences (SMDs) with Hedges g correction were pooled in random effects meta-analyses for all eligible outcomes.

Main Outcomes and Measures

The primary outcome was ADHD total symptom severity assessed at the first postintervention time point, focusing on reports by individuals judged probably or certainly unaware of treatment allocation (probably blinded). Secondary outcomes were inattention and/or hyperactivity-impulsivity symptoms and neuropsychological outcomes postintervention and at a longer-term follow-up (ie, after the last follow-up time point). RCTs were assessed with the Cochrane risk of bias tool version 2.0.

Results

A total of 38 RCTs (2472 participants aged 5 to 40 years) were included. Probably blinded reports of ADHD total symptoms showed no significant improvement with neurofeedback (k = 20; n = 1214; SMD, 0.04; 95% CI, -0.10 to 0.18). A small significant improvement was seen when analyses were restricted to RCTs using established standard protocols (k = 9; n = 681; SMD, 0.21; 95% CI, 0.02 to 0.40). Results remained similar with adults excluded or when analyses were restricted to RCTs where cortical learning or self-regulation was established. Of the 5 neuropsychological outcomes analyzed, a significant but small improvement was observed only for processing speed (k = 15; n = 909; SMD, 0.35; 95% CI, 0.01 to 0.69). Heterogeneity was generally low to moderate.

Conclusions and Relevance

Overall, neurofeedback did not appear to meaningfully benefit individuals with ADHD, clinically or neuropsychologically, at the group level. Future studies seeking to identify individuals with ADHD who may benefit from neurofeedback could focus on using standard neurofeedback protocols, measuring processing speed, and leveraging advances in precision medicine, including neuroimaging technology.

Visual and patient-reported outcomes of an enhanced versus monofocal intraocular lenses in cataract surgery: a systematic review and meta-analysis

Understanding the functional outcomes achieved with new enhanced monofocal intraocular lenses (IOLs) is crucial for adequately managing patient expectations. This study evaluated visual and patient-reported outcomes of an enhanced range of field IOL versus other monofocal IOLs in cataract patients. A systematic review and meta-analysis, pre-registered on PROSPERO (CRD42024561611), included studies from Medline (PubMed), Embase (Ovid), and trial registries (2019-2024) focused on binocular cataract surgeries with various IOL models. Primary outcomes assessed were monocular distance-corrected visual acuities (CDVA, DCIVA, DCNVA), defocus curves, and contrast sensitivity; secondary measures included binocular visual acuities and patient-reported outcomes such as spectacle independence and photic phenomena. Out of 31 studies (8 randomized clinical trials, 23 case series), high-certainty evidence indicated no significant difference in CDVA between enhanced and conventional IOLs. However, enhanced IOLs demonstrated better intermediate (DCIVA: -0.11 logMAR, CI 95%: -0.13 to -0.10) and near (DCNVA: -0.12 logMAR, CI 95%: -0.17 to -0.07) visual acuities, supported by defocus curves, though with lower-certainty evidence. No significant differences were observed in contrast sensitivity or photic phenomena, and evidence for positive dysphotopsia was moderate to low. Enhanced IOLs significantly favored intermediate-distance spectacle independence, with an odds ratio of 7.85 (CI 95%: 4.08-15.09), though no differences were observed for distance spectacle independence. Near-distance spectacle independence also favored enhanced IOLs, though with low-certainty evidence. In summary, enhanced IOLs provide improved intermediate and near visual acuities compared to conventional monofocal IOLs, though further studies are needed to confirm outcomes in contrast sensitivity and patient-reported outcomes across various enhanced monofocal IOLs.

Impact of social isolation during the COVID-19 pandemic on the mental health of university students and recommendations for the post-pandemic period: A systematic review

Introduction

Investigating the psychological impact caused by the interruption of social interactions on university students during the pandemic is essential, with a view to developing strategies to preserve mental health and academic performance.

Objective

To analyze the impact of social isolation during the COVID-19 pandemic on the mental health of university students and propose recommendations for the post-pandemic period.

Method

This systematic review was conduced in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in the International Prospective Register of Systematic Reviews (PROSPERO). Database searches were performed up to December 2024 in PubMed, EMBASE, Web of Science, Scopus, CINAHL, and PsycNET, using the terms "COVID-19," "social isolation," "mental health," and "college students." Studies were excluded if they focused on non-college populations, other causes of social isolation, physical health, or specific designs.

Results

The initial search identified 3051 records and 68 studies were included in this review, with sample off 177,537 university students. Anxiety was the most commonly investigated variable (79.4%), followed by depression (75%) and stress (42.6%). Less frequently, studies highlighted the increase in alcohol and drug consumption and suicidal ideation. Some authors also investigated sleep quality, relating insomnia and emotional changes with the reduction in physical exercise. Anxiety symptoms related to online learning directly impacted academic performance. The assessment of the risk of bias showed that of the 68 studies included, 34 had a low risk of bias, 30 had a moderate risk of bias, and 4 had a high risk of bias.

Conclusion

This study highlights the negative impact of the COVID-19 pandemic on the mental health of college students, particularly in relation to symptoms of anxiety, depression, and stress. Post-pandemic interventions should prioritize fostering healthy habits, such as ensuring quality sleep, engaging in moderate physical activity, and raising mental health awareness. Additionally, universities should implement proactive support systems to cultivate a safe and inclusive environment for students.

[How effective are non-pharmacological interventions for family caregivers? A systematic review with meta-analyses]

INTRODUCTION

Informal caregiving is associated with mental disorders and reduced quality of life. The aim of this systematic review was to summarize the results of methodologically high-quality intervention studies on the effectiveness of non-pharmacological interventions on patient-relevant outcomes for family caregivers in Germany.

METHOD

We searched three large scientific literature databases for intervention studies with a control group and a low or moderate risk of bias on the effectiveness of non-pharmacological interventions for family caregivers in Germany.

RESULT

Among 4,376 publications reviewed, 10 intervention studies with good methodological quality were identified. These investigated multi-component interventions or cognitive behavioral therapy for family caregivers of people with dementia (8 studies), stroke (1 study) and with general care dependency (1 study). The control groups received information material as a minimal intervention or usual standard care. Meta-analyses showed a statistically significant slight reduction in depressive symptoms 3-6 months after the start of the study as a result of cognitive behavioral therapy (standardized mean difference -0.27; 95% confidence interval -0.44 - -0.10), but this no longer reached statistical significance after 9-12 months (-0.21; -0.51 - 0.09). Multi-component interventions showed no changes in depressive symptoms either after 3-6 or after 9-12 months (-0.18; -0.40 - 0.03 and -0.14; -0.47 - 0.14, respectively). In contrast, the mental component of quality of life of family caregivers improved statistically significantly in the multi-component intervention groups compared to the control groups: slightly after 3-6 months (0.28; 0.01 - 0.56) and moderately after 9-12 months (0.45; 0.09 - 0.82). The interventions had no effect on the physical component of quality of life.

CONCLUSION

The reduction of depressive symptoms by behavioral therapy interventions for family caregivers appears to be only slight and not sustainable. The mental component of quality of life of people affected may be improved in the longer term by multi-component interventions. Current scientifically examined interventions for informal caregivers do not appear to have a sufficient and sustainable effect. Greater effects could possibly be achieved through more elaborate behavioral approaches, but also structural preventive measures.

Ketamine Versus Etomidate for Rapid Sequence Intubation: A Systematic Review and Meta-Analysis of Randomized Trials

OBJECTIVES

To compare the safety and efficacy of ketamine and etomidate as induction agents to facilitate emergent endotracheal intubation.

DATA SOURCES

We searched MEDLINE, Embase, Cochrane Clinical Trials Register, and ClinicalTrials.gov from inception to April 3, 2024.

STUDY SELECTION

We included randomized controlled trials (RCTs) that compared ketamine to etomidate to facilitate emergent endotracheal intubation in adults.

DATA EXTRACTION

Reviewers screened abstracts, full texts, and extracted data independently and in duplicate. We pooled data using a random-effects model, assessed risk of bias using the modified Cochrane tool and certainty of evidence using the Grading Recommendations Assessment, Development, and Evaluation approach. We pre-registered the protocol on PROSPERO (CRD42023472450).

DATA SYNTHESIS

We included seven RCTs ( n = 2384 patients). Based on pooled analysis, compared with etomidate, ketamine probably increases hemodynamic instability in the peri-intubation period (relative risk [RR], 1.29; 95% CI, 1.07-1.57; moderate certainty) but probably decreases the need for initiation of continuous infusion vasopressors (RR, 0.75; 95% CI, 0.57-1.00; moderate certainty) and results in less adrenal suppression (RR, 0.54; 95% CI, 0.45-0.66; moderate certainty). Ketamine probably has no effect on successful intubation on the first attempt (RR, 1.01; 95% CI, 0.97-1.05; moderate certainty) or organ dysfunction measured as the maximum Sequential Organ Failure Assessment (SOFA) score during the first 3 days in ICU (mean difference, 0.55 SOFA points lower; 95% CI, 1.12 lower to 0.03 higher; moderate certainty) and may have no effect on mortality (RR, 1.00; 95% CI, 0.83-1.21; low certainty) when compared with etomidate.

CONCLUSIONS

Compared with etomidate, ketamine probably results in more hemodynamic instability during the peri-intubation period and appears to have no effect on successful intubation on the first attempt or mortality. However, ketamine results in decreased need for the initiation of vasopressor use and decreases adrenal suppression compared with etomidate.

The relationship between muscle mass changes and protein or energy intake in critically ill children: A systematic review and meta-analysis

Survivorship after pediatric critical illness is high in developed countries, but many suffer physical morbidities afterwards. The increasing focus on follow-up after critical illness has led to more pediatric studies reporting muscle mass changes (using ultrasound), albeit with different results. A systematic literature review was undertaken examining muscle mass changes, assessed by ultrasound of the quadriceps femoris muscle in children who are critically ill. Secondary objectives were to determine if muscle mass was associated with protein intake and/or energy. Databases were searched in July 2024. Eligible experimental or observational studies, published from January 2010 to July 2024 and including children who are critically ill that were aged between ≥37 weeks' gestational age and 18 years who were admitted to the pediatric critical care unit were included. The Joanna Briggs Institute for observational studies critical appraisal instrument was used to assess studies for methodological quality. One hundred and thirty-five studies were screened, and eight prospective cohort studies were included, involving 411 children. Overall, muscle mass changes reported in seven out of eight of the papers showed a pooled mean muscle mass loss of 8.9% (95% confidence interval [CI] 6.6-11.4) from baseline to days 5-7. Five of the eight publications defined muscular atrophy as a decrease in muscle mass of >10%. Using this cutoff, 92 (49.2%) children developed muscular atrophy during their PICU admission. Overall, muscle mass decreased by nearly 10% during a child's first week in PICU, with almost half of children developing muscular atrophy during their admission.

Understanding the effectiveness and underlying mechanisms of lifestyle modification interventions in adults with learning disabilities: a mixed-methods systematic review

Background

Adults with learning disabilities face increased risks of unhealthy lifestyle behaviours, including alcohol consumption, smoking, low physical activity, sedentary behaviour and poor diet. Lifestyle modification interventions that target health-risk behaviours can prevent or reduce their negative effects. The goal of this project was to investigate the effectiveness and underlying mechanisms of lifestyle modification interventions in adults with learning disabilities.

Methods

A systematic review and meta-analysis were conducted to determine the effectiveness of lifestyle modification interventions and their components in targeting health risk behaviours in adults with learning disabilities. Major electronic databases, clinical trial registries, grey literature, and citations of systematic reviews and included studies were searched in January 2021 (updated in February 2022). We included randomised and non-randomised controlled trials targeting alcohol consumption, smoking, low physical activity only, sedentary behaviour and poor diet in adults (aged ≥ 18 years) with learning disabilities. Studies were also coded based on the extent of use of theories and behaviour change techniques in interventions. Risk of bias in studies was assessed using appropriate tools. A realist synthesis of qualitative, quantitative and mixed-methods literature was conducted to complement the systematic review findings by identifying key intervention mechanisms that are likely to improve the health of adults with learning disabilities. Data were synthesised in the form of a programme theory regarding complex causal mechanisms and how these interact with social context to produce outcomes. All findings were integrated into a logic model. A patient and public involvement group provided input and insights throughout the project.

Results

A total of 80 studies with 4805 participants were included in the systematic review. The complexity of lifestyle modification interventions was dismantled by identifying six core components that influenced outcomes. These components could be present in interventions targeting single or multiple health risk behaviors, either as individual elements or in various combinations. Interventions on alcohol and smoking behaviours were found to be effective, but this was based on limited evidence. The effectiveness of interventions targeting low physical activity only or multiple behaviours (low physical activity only, sedentary behaviours and poor diet) was mixed. All interventions had a varying level of statistical significance. The intervention-level network meta-analysis for weight management outcomes showed none of the interventions was associated with a statistically significant change in outcomes when compared to treatment as usual and each other. Similar findings were observed in the component network meta-analysis. A variety of theories and behaviour change techniques were employed in the development and adaptation of interventions. Most studies had a high and moderate risk of bias. A total of 79 studies, reporting the experiences of more than 3604 adults with intellectual disabilities and over 490 caregivers, were included in the realist synthesis. The resulting programme theory highlighted the contexts and mechanisms relating to support involvement, negotiating the balance between autonomy and behaviour change, fostering social connectedness and fun, the accessibility and suitability of intervention strategies and delivery, along with the broader behavioural pathways to lifestyle change. It also brought out the importance of working with people with lived experiences when developing and evaluating interventions. Our logic model, bringing together the findings of both syntheses, provides guidance on the design of future interventions.

Discussion

This study was the first comprehensive mixed-methods evidence synthesis to explore lifestyle modification interventions targeting multiple unhealthy lifestyle behaviours in adults with learning disabilities. We conclude that future research could benefit from codeveloping interventions and population-specific assessment frameworks with people with lived experiences. There is a need for more high-quality research with appropriate outcomes and a focus on qualitative and mixed-methods research to better understand what works for whom and why.

Trial registration

This trial is registered as PROSPERO CRD 42020223290.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR128755) and is published in full in Health Technology Assessment; Vol. 29, No. 4. See the NIHR Funding and Awards website for further award information.

Early-life malnutrition role in memory, emotional behavior and motor impairments in early brain lesions with potential for neurodevelopmental disorders: a systematic review with meta-analysis

OBJECTIVES

The present study aims to evaluate the impact of early exposure to brain injury and malnutrition on episodic memory and behavior.

METHODS

For this, a systematic review was carried out in the Medline/Pubmed, Web of Science, Scopus, and LILACS databases with no year or language restrictions.

RESULTS

Initially, 1759 studies were detected. After screening, 53 studies remained to be read in full. The meta-analysis demonstrated that exposure to double insults worsens episodic recognition memory but does not affect spatial memory. Early exposure to low-protein diets has been demonstrated to aggravate locomotor and masticatory sequelae. Furthermore, it reduces the weight of the soleus muscle and the muscle fibers of the masseter and digastric muscles. Early exposure to high-fat diets promotes an increase in oxidative stress and inflammation in the brain, increasing anxiety- and depression-like behavior and reducing locomotion.

DISCUSSION

Epigenetic modifications were noted in the hippocampus, hypothalamus, and prefrontal cortex depending on the type of dietetic exposure in early life. These findings demonstrate the impact of the double insult on regions involved in cognitive and behavioral processes. Additional studies are essential to understand the real impact of the double insults in the critical period.

Orthorexia nervosa in dietitians and dietetics students-prevalence, risk factors, and interventions: a scoping review using a systematic approach

CONTEXT

Orthorexia nervosa (ON) is characterized by compulsive behaviors and increased concerns about healthful eating. Dietitians appear to be especially vulnerable to ON, and it is still debatable whether the disordered eating behaviors motivate individuals to enroll in nutrition programs, or whether these behaviors result from an exaggerated preoccupation with healthy eating triggered during their nutrition studies.

OBJECTIVE

The aim was to provide an overview of the present state of knowledge about the prevalence, risk factors, and interventions addressing ON among dietitians and dietetics students. More specifically, it was examined whether dietitians and dietetics students differ from students attending different education programs or other health professionals with regard to the severity and risk factors of ON, and whether the extent of ON changes during the progression in the nutrition education years of study.

DATA SOURCES

MEDLINE (Ovid), PubMed, EMBASE (Ovid), PsycInfo (EBSCO), CINAHL (EBSCO), Cochrane, ProQuest Central, CABI, ProQuest Dissertations, Google Scholar, ScienceDirect, and SpringerLink were searched on May 8, 2021, and updated on November 12, 2022.

DATA EXTRACTION

Records were screened for eligibility; study characteristics, methodology, and findings of included articles were extracted; and the methodological quality assessed using the AXIS tool. Each step was preceded by a calibration exercise and conducted independently and in duplicate by pairs of 2 reviewers. Any disagreements were resolved through discussions.

DATA ANALYSIS

A narrative synthesis was performed, whereby the characteristics, methodologies, and results of included studies were compared.

CONCLUSIONS

Results were inconclusive; yet, a general status of the relatively "high" prevalence of ON among dietitians and dietetics students was established, stressing the need for systematic research to understand and mitigate orthorexic tendencies in this group. It is still too early to answer questions pertaining to prevalence, risk factors, interventions, and differences between dietetics students and other majors when it comes to severity and progress of ON throughout the continuing years of study, or between dietitians and other professional groups.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework Identifier: DOI 10.17605/OSF.IO/BY5KF.

Eye-Tracking Metrics as a Digital Biomarker for Neurocognitive Disorders in Multiple Sclerosis: A Scoping Review

Multiple sclerosis (MS) is an autoimmune disease classified as neurodegenerative because it can be associated with the more or less progressive development of neurological symptoms and cognitive deficits. In recent years, various studies have started to investigate eye movements in relation to cognitive impairment in persons with MS by means of eye-tracking equipment. However, the high heterogeneity of the paradigms used in different studies, as well as the different methodologies included, makes it difficult to provide a complete and precise picture of this important research and clinical issue. The purpose of the present in-depth scoping review was to map the existing literature in this field to determine which metrics may be relevant when dealing with the neurocognitive profile of people with MS. From the analyses of the included studies, the anti-saccade latency and errors were the most frequently proposed metrics. Correlation analyses between these metrics and cognitive measures showed significant associations between them, calling for a deeper investigation of this promising research and clinical field. The results of the present scoping review strongly suggest that eye tracking may play a crucial role in clinical practice during the early detection of neurocognitive disorders. There is a great need for primary research that addresses the full complexity of MS in its different phenotypes and the disease-related variables from a multidisciplinary perspective. Future research should clarify whether oculomotor dysfunction in MS follows or precedes cognitive deficits.

A scoping review of automatic and semi-automatic MRI segmentation in human brain imaging

INTRODUCTION

AI-based segmentation techniques in brain MRI have revolutionized neuroimaging by enhancing the accuracy and efficiency of brain structure analysis. These techniques are pivotal for diagnosing neurodegenerative diseases, classifying psychiatric conditions, and predicting brain age. This scoping review synthesizes current methodologies, identifies key trends, and highlights gaps in the use of automatic and semi-automatic segmentation tools in brain MRI, particularly focusing on their application to healthy populations and clinical utility.

METHODS

A scoping review was conducted following Arksey and O'Malley's framework and PRISMA-ScR guidelines. A comprehensive search was performed across six databases for studies published between 2014 and 2024. Studies focused on AI-based brain segmentation in healthy populations, and patients with neurodegenerative diseases, and psychiatric disorders were included, while reviews, case series, and studies without human participants were excluded.

RESULTS

Thirty-two studies were included, employing various segmentation tools and AI models such as convolutional neural networks for segmenting gray matter, white matter, cerebrospinal fluid, and pathological regions. FreeSurfer, which utilizes algorithmic techniques, are also commonly used for automated segmentation. AI models demonstrated high accuracy in brain age prediction, neurodegenerative disease classification, and psychiatric disorder subtyping. Longitudinal studies tracked disease progression, while multimodal approaches integrating MRI with fMRI and PET enhanced diagnostic precision.

CONCLUSION

AI-based segmentation techniques provide scalable solutions for neuroimaging, advancing personalized brain health strategies and supporting early diagnosis of neurological and psychiatric conditions. However, challenges related to standardization, generalizability, and ethical considerations remain.

IMPLICATIONS FOR PRACTICE

The integration of AI tools and algorithm-based methods into clinical workflows can enhance diagnostic accuracy and efficiency, but greater focus on model interpretability, standardization of imaging protocols, and patient consent processes is needed to ensure responsible adoption in practice.

Socio-cognitive determinants affecting insulin adherence/non-adherence in late adolescents and young adults with type 1 diabetes: a systematic review

Non-adherence to insulin treatment is common in adolescents and young adults (AYAs) with type 1 diabetes (T1D) and is associated with increased morbidity and mortality. However, the socio-cognitive determinants (SCDs) of adherence in AYAs with T1D are less frequently represented in systematic reviews. This systematic review aimed to investigate the key SCDs associated with adherence/non-adherence to insulin treatment in AYAs in the age range of 17-24 years with T1D. A systematic review in PubMed, Embase, Web of Science, and PsycINFO was conducted. The search took place from 2021, to January 1st, 2022, and was repeated on June 5-7, 2022 and from July 18 to July 24, 2023. The methodological quality of studies was assessed by the National Heart, Lung, and Blood Institute quality assessment tool for observational cohort and cross-sectional studies. Six articles representing 973 AYAs with T1D were included for data extraction. The identified SCDs included risk perceptions, attitude, family and friends' social support, self-efficacy, and information factors. However, there was inconsistency in correlational findings among studies. The identified SCDs influencing insulin adherence in AYAs with T1D could serve as targets for patients' consultations and tailored interventions to improve adherence and overall health outcomes, as well as for policymakers to integrate these interventions into diabetes care planning. However, further research in the area of factors affecting insulin adherence in quality-designed studies that use detailed and comprehensive measures for assessing adherence is needed.

Smart Contracts and Shared Platforms in Sustainable Health Care: Systematic Review

BACKGROUND

The benefits of smart contracts (SCs) for sustainable health care are a relatively recent topic that has gathered attention given its relationship with trust and the advantages of decentralization, immutability, and traceability introduced in health care. Nevertheless, more studies need to explore the role of SCs in this sector based on the frameworks propounded in the literature that reflect business logic that has been customized, automatized, and prioritized, as well as system trust. This study addressed this lacuna.

OBJECTIVE

This study aimed to provide a comprehensive understanding of SCs in health care based on reviewing the frameworks propounded in the literature.

METHODS

A structured literature review was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) principles. One database-Web of Science (WoS)-was selected to avoid bias generated by database differences and data wrangling. A quantitative assessment of the studies based on machine learning and data reduction methodologies was complemented with a qualitative, in-depth, detailed review of the frameworks propounded in the literature.

RESULTS

A total of 70 studies, which constituted 18.7% (70/374) of the studies on this subject, met the selection criteria and were analyzed. A multiple correspondence analysis-with 74.44% of the inertia-produced 3 factors describing the advances in the topic. Two of them referred to the leading roles of SCs: (1) health care process enhancement and (2) assurance of patients' privacy protection. The first role included 6 themes, and the second one included 3 themes. The third factor encompassed the technical features that improve system efficiency. The in-depth review of these 3 factors and the identification of stakeholders allowed us to characterize the system trust in health care SCs. We assessed the risk of coverage bias, and good percentages of overlap were obtained-66% (49/74) of PubMed articles were also in WoS, and 88.3% (181/205) of WoS articles also appeared in Scopus.

CONCLUSIONS

This comprehensive review allows us to understand the relevance of SCs and the potentiality of their use in patient-centric health care that considers more than technical aspects. It also provides insights for further research based on specific stakeholders, locations, and behaviors.

A Systematic Review and Meta-Analysis on the Effect of Nature Exposure Dose on Adults with Mental Illness

Time spent in nature leads to significant physical and mental benefits, but research is mixed on how much time in nature is necessary to affect change in adults' mental health. This meta-analysis aimed to answer the question: what effect does length and interval of nature dosage have on adults with mental illness? The authors defined nature exposure as an experience in nature lasting at least 10 minutes and taking place in an actual natural setting. Because some studies indicated single experiences of exposure to nature (one-time) while others utilized multiple exposures to nature (interval), these studies were separated to determine differences between one-time versus interval exposure to nature. Following Cochrane Handbook for Systematic Reviews of Interventions and PRISMA reporting guidelines, this review included 78 studies published between 1990 and 2020. The present study found that one-time and interval nature exposure yielded different results for adults with a diagnosed mental illness and adults with symptoms of mental illness. Notably, shorter nature exposure delivered in intervals appeared to show positive significant effects, even more than one-time exposure. This finding has important implications for public health and green space preservation, as being outside for as little as 10 minutes and even in urban nature can improve adults' mental health.

What services are currently provided to people with heart failure with preserved ejection fraction in the UK, and what are their components? A protocol for a scoping literature review

AIMS

Heart failure (HF) with preserved ejection fraction (HFpEF) is increasing in incidence and is increasingly the most common HF diagnosis. Patients with HFpEF are often excluded from specialist HF services, which has negative impacts on their healthcare experiences and health-related outcomes. As emerging evidence-based treatments are being incorporated into clinical guidelines, it is timely to focus on the management of this phenotype. This review aims to explore literature around care provision for HFpEF in the UK, to characterize and assess HFpEF care pathways against current standards, and to generate evidence to create an optimized framework of care.

METHODS AND RESULTS

A scoping review of the evidence from six databases will be performed, alongside a search of grey literature search and consultation with relevant experts. Given the expected heterogeneity, multiple lines of synthesis are anticipated. Data analysis will follow best practice guidelines for the synthesizing methodologies selected. Patient and public representatives will assist with analysis and in identifying priority components for HFpEF clinical services.

CONCLUSION

This scoping literature review will enable an in-depth examination of the current health service provision for those with HFpEF in the UK. Synthesis of key components of services and illumination of challenges and barriers will inform current and future practice. There is a long history of specialist HF care in the UK, including seminal work on nurse-led care. Therefore, evidence derived from this review will likely be useful to HF services across Europe. The proposed combination of the search across both peer-reviewed literature and grey literature, combined with patient and public involvement, will identify the key components of a framework of care for those with HFpEF.

REGISTRATION

This scoping review protocol was published on the public Open Science Framework platform (no registration reference provided) and can be accessed at: https://osf.io/5gufq/.

Barriers to healthcare professionals screening, recognizing, and managing delirium in the adult patients receiving specialist palliative care: a mixed-methods systematic review

BACKGROUND

Delirium frequently occurs in palliative care settings, yet its screening, identification, and management remain suboptimal in clinical practice. This review aims to elucidate the barriers preventing healthcare professionals from effectively screening, recognizing, and managing delirium in adult patients receiving specialist palliative care, with the goal of developing strategies to enhance clinical practice.

METHODS

A mixed-methods systematic review was conducted (PROSPERO: CRD42024563666). Literature was sourced from PubMed, Web of Science, Embase, CINAHL, The Cochrane Library, and Clinical Trials databases from their inception to November 16, 2024, without language restrictions. Studies that were primary quantitative, qualitative, and mixed-methods research, and reported the barriers to healthcare professionals' screening, recognition, and management of delirium in adult patients receiving specialist palliative care (including inpatient hospice/hospital care, consultation teams, and outpatient/community services) were included. Studies were excluded if they did not permit barrier factor extraction, had duplicate or incomplete data, or were case reports or conference abstracts. The Mixed Methods Appraisal Tool (MMAT) version 2018 was employed to evaluate the methodological quality of included studies. Data synthesis used the convergent-integrated JBI mixed-methods approach.

RESULTS

21 articles that meet the selection criteria have been identified, with 11 quantitative, 8 qualitative and 2 mixed-methods, collectively involving 857 patients and 649 healthcare professionals. Four themes were identified from the includes studies: (1) Individual level: knowledge and understanding gaps among healthcare professionals; (2) Operational level: implementation challenges in clinical practice; (3) Organizational level: structural and resource deficiencies; (4) Contextual level: specific impacts of situational factors.

CONCLUSION

The systematic review uncovered a complex interplay of barriers spanning individual, operational, organizational, and contextual levels in palliative settings. To address these challenges, recommended strategies include developing targeted training programs, implementing standardized delirium assessment tools, improving guideline accessibility, and promoting interdisciplinary collaboration to enhance delirium screening and management in palliative care.

Comparison of behind-the-ear vs. off-the-ear speech processors in cochlear implants: A systematic review and narrative synthesis

BACKGROUND

Cochlear implants (CI) with off-the-ear (OTE) and behind-the-ear (BTE) speech processors differ in user experience and audiological performance, impacting speech perception, comfort, and satisfaction.

OBJECTIVES

This systematic review explores audiological outcomes (speech perception in quiet and noise) and non-audiological factors (device handling, comfort, cosmetics, overall satisfaction) of OTE and BTE speech processors in CI recipients.

METHODS

We conducted a systematic review following PRISMA-S guidelines, examining Medline, Embase, Cochrane Library, Scopus, and ProQuest Dissertations and Theses. Data encompassed recipient characteristics, processor usage, speech perception, and non-audiological factors. Studies were assessed for quality and risk of bias by using Newcastle-Ottawa Scale (NOS).

RESULTS

Nine studies involving 204 CI recipients, with a mean age of 49.01 years and 6.62 years of processor use, were included. Audiological results indicated comparable performance in quiet environments, with a slight preference for OTE in noisy conditions. For non-audiological factors, OTE processors excelled in comfort, handling, and aesthetics, leading to higher satisfaction. More data on medical complications and long-term implications is needed.

CONCLUSION

OTE processors may offer comparable performance to BTE processors in certain conditions, though not universally across all audiological outcomes. Interpretation depends on settings, processor generation, and testing paradigms. However, non-audiological factors might favour OTE. Understanding current literature may guide professionals in selecting suitable processors for CI recipients.

Determining the impact of mobile-based self-care applications on reducing anxiety in healthcare providers: a systematic review

BACKGROUND

Healthcare providers (HCP) face various stressful conditions in hospitals that result in the development of anxiety disorders. However, due to heavy workloads, they often miss the opportunity for self-care. Any effort to diminish this problem improves the quality of Healthcare providers and enhances patient safety. various applications have been developed to empower Healthcare providers and reduce their anxiety, but these applications do not meet all their individual and professional needs. The objective of this study was to investigate the impact of mobile-based self-care applications on reducing anxiety in healthcare providers.

METHODS

In this study, keywords such as anxiety, self-care, healthcare providers, and mobile health were used to search PubMed, Scopus, and Web of Science for papers published in the recent ten years (2014-2024). We used the PRISMA diagram to report the results. Ten out of 2515 retrieved articles that addressed the effect of mobile-based self-care applications on Healthcare providers' anxiety were included for analysis. Data were extracted using a data collection form designed based on the research objective. We used this form to collect data including the author's name, publication year, country, study type, intervention duration, study objectives, platform used, Modules presented in technologies, Methods of reducing anxiety, questionnaire details, and Effectiveness assessment. Data collected from the studies were analyzed by SPSS-21 using frequency and percentage.

RESULTS

Based on the results, studies were conducted in nine different countries, and the intervention duration and strategies for reducing anxiety using self-care applications ranged from two weeks to four months. The impact of mobile health applications, their content, and intervention strategies on reducing anxiety were positive. The anxiety-reduction strategies were varied among applications. Anxiety reduction strategies in this study included mindfulness, cognitive-behavioral therapy, physical activities, breathing exercises, dietary regimes, and nature exploration through virtual reality. Cognitive-behavioral therapy and mindfulness constituted the most frequently applied reduction techniques across the studies to reduce anxiety in Healthcare providers.Furthermore, the findings revealed the effectiveness of interventions in reducing other mental disorders such as anxiety, stress, depression, drug abuse, and psychotropic drug use of Healthcare providers.

CONCLUSION

The use of mobile health applications with practical strategies is effective in reducing anxiety and can also reduce other anxiety disorders in Healthcare professional.

Effects of Breathing Exercises on Neck Pain Management: A Systematic Review with Meta-Analysis

Background: Given the relationship between reduced pulmonary and respiratory muscle function in neck pain, incorporating breathing exercises into neck pain management may be beneficial. Purpose: The purpose of this study was to investigate the benefits of breathing exercises for treating neck pain. Methods: We searched PubMed (MEDLINE), PEDro, CINAHL, Scopus, and EMBASE databases, up to the 28 of February 2024. Randomized controlled trials evaluating the impact of breathing exercises on reducing pain and disability in both persistent and recent neck pain were selected. A meta-analysis was conducted for each outcome of interest; however, if quantitative methods were not possible, a qualitative synthesis approach was used. The risk of bias was assessed using the Cochrane RoB 2.0 Tool (version 22 August 2019). We used the GRADE approach to judge the certainty of the evidence. Results: Five studies were included. Meta-analysis showed a statistically significant reduction in pain (standardized mean difference (SMD), -10.16; 95% CI: -14.82, -5.50) and disability (SMD, -0.80; 95% CI: -1.49, -0.11), in favor of breathing exercises. Qualitative synthesis for pulmonary functional parameters resulted in a statistically significant improvement for FVC, MIP, MEP, and MVV, in favor of breathing exercises. Conclusions: Breathing exercises showed significant short-term effects in reducing pain and disability for persistent neck pain. They also provided benefits for functional respiratory parameters. However, the evidence certainty is low.

Examining the integration of artificial intelligence in supply chain management from Industry 4.0 to 6.0: a systematic literature review

Background

This study examines the integration of Artificial Intelligence (AI) in supply chain management (SCM) during the transition from Industry 4.0 to Industry 6.0. The focus is on improving operational efficiency, promoting human-centric collaboration, and advancing sustainability within supply chains. As industries progress, the need to incorporate AI technologies that improve decision-making and operational resilience while ensuring sustainable practices becomes increasingly critical. This systematic review aims to explore how AI is transforming SCM through these industrial transitions.

Methods

Utilising the PRISMA framework, a systematic review was conducted to gather and analyse relevant literature published between 2010 and 2023. A comprehensive search of databases including Web of Science, Scopus, IEEE Xplore, Google Scholar, and ScienceDirect was performed. The review involved rigorous screening for eligibility and thematic analysis using Atlas-ti software to identify key themes and patterns related to AI integration in SCM.

Results

The findings indicate that AI integration significantly improves SCM by improving demand forecasting, inventory management, and overall decision-making capabilities. Industry 5.0 focuses on human-AI collaboration, improving customisation and problem-solving. AI technologies also contribute to sustainability by optimising resource utilisation and reducing environmental impacts. However, challenges such as cybersecurity risks and workforce skill gaps need to be addressed to fully leverage AI's potential.

Conclusion

Integrating AI in SCM not only improves operational efficiency and sustainability but also promotes resilience against disruptions. The insights from this review offer valuable guidance for both academics and practitioners aiming to optimise supply chain operations through AI technologies from Industry 4.0 to Industry 6.0. The study underlines the importance of a balanced approach that integrates technological developments with human-centric and sustainable practices.

Effects of oxytocin administration on non-social executive functions in humans: a preregistered systematic review and meta-analysis

BACKGROUND

Oxytocin has received considerable research attention for its role in affiliative behaviors, particularly regarding its pro-social effects. More recent evidence has pointed to a broader role of oxytocin signaling, which includes non-social cognitive processes. However, meta-analytic data on oxytocin's effects on non-social cognition is currently limited.

METHODS

We registered plans for a systematic review and meta-analysis on the effects of oxytocin administration on non-social executive functions prior to data collection via a time-stamped protocol. We performed searches in PubMed, Europe PubMed Central, and the Bielefeld Academic Search Engine. We conducted a meta-analysis of 20 effect estimates from 13 eligible studies. Subgroup meta-analyses and a test for publication bias were also performed.

RESULTS

We found no overall significant effect of oxytocin administration on non-social executive functions (p = 0.30; Hedges' g = 0.07). However, effect sizes across sub-categories of executive function varied, where the effect of oxytocin administration was the largest for cognitive flexibility (p = 0.02; Hedges' g = 0.2). Publication bias was assessed using Robust Bayesian Meta-Analysis, which yielded moderate support for the absence of publication bias (BFPB = 0.32).

CONCLUSION

Our analysis suggests that oxytocin's effects may extend beyond social cognitive processing as data synthesis provided evidence supporting a role in non-social cognitive flexibility. The data and analysis output from this meta-analysis can be viewed in a point-and-click web application.

Evidence mapping on barriers in accessing prenatal healthcare services among homeless women: a scoping review

INTRODUCTION

Prenatal care is crucial, but accessing healthcare services has been a challenge for pregnant homeless women in Africa. The majority in this marginalised group are not screened for common pregnancy complications such as preeclampsia, infection, and stillbirth. Therefore, this scoping review aims to explore the barriers to accessing prenatal healthcare services for pregnant homeless women in Africa.

METHODS

This scoping review was conducted using the methodological framework developed by Arksey and O'Malley. Four electronic databases: CINHAL complete, Scopus, PubMed and Web of Science were searched. In addition, a manual search was done on Google Scholar and other websites for grey literature. The search was confined to 20 years (2004 to 2024). The reference lists of the articles searched and included in the study were examined for additional titles that satisfied the inclusion criteria.

RESULTS

Out of 3910 titles screened, only three (n = 3) studies met the eligibility inclusion criteria in this study. Two out of the three studies that were included were conducted in Ethiopia while one was conducted in South Africa. All of the studies used qualitative research methods. Across the 3 studies, the ages of the participants ranged from 15 to 45 years. Two major themes were identified, namely: Theme 1: the barrier to accessing prenatal healthcare services and Theme 2: Social Support needs. Theme 1 has four categories that emerged: lack of awareness; fear of stigma and discrimination; previous negative experiences; and financial constraints. Theme 2 emerged with two categories: psychological and emotional needs; and nutritional needs during pregnancy.

CONCLUSION

This study identified barriers and facilitators to access prenatal healthcare services among pregnant homeless women as a multifaceted issue, rooted in stigma and discrimination, lack of awareness, and negative experiences with healthcare providers. There is a need for interventions to improve access, health and well-being for this marginalised group-from the government, stakeholders, and nongovernmental organisations.

Value Cocreation and Codestruction in Digital Health Services: Protocol for a Systematic Review

BACKGROUND

To successfully design, develop, implement, and deliver digital health services that provide value, they should be cocreated with patients. However, occasionally, the value may also be codestructed. In the field of health care, the concepts of value cocreation and codestruction still need to be better established within emerging digital health services. Studying these concepts is essential for developing effective and sustainable patient-centered care.

OBJECTIVE

The aim of the study is (1) to understand the antecedents, decisions, and outcomes of value cocreation and codestruction in digital health services, (2) to define the dynamics between value cocreation and codestruction, and (3) to map future research areas of value cocreation and codestruction within digital health services.

METHODS

The systematic review will be conducted in accordance with the Joanna Briggs Institute methodology for mixed method systematic reviews and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The review considers scientific qualitative, quantitative, or mixed method studies published in English, Finnish, or Swedish that concern either value cocreation or codestruction in digital health services. Studies focusing on physical robotics and online health communities, as well as non-peer-reviewed and nonscientific papers, will be excluded. The searches were conducted using Scopus and MEDLINE during this protocol creation. Critical appraisal will be done using suitable checklists for qualitative, quantitative, and mixed method studies. The review will adhere to a convergent integrated approach as outlined in the Joanna Briggs Institute methodology for mixed methods systematic reviews.

RESULTS

The searches resulted in a total of 837 records. The antecedents, decisions, and outcomes of value cocreation and codestruction in the context of digital health services will be described in a finalized systematic review. In the outcomes, our main interest is the effect on patient outcomes and experiences and professional experiences.

CONCLUSIONS

Since our study involves diverse scientific fields, there is a risk that our search does not capture all relevant papers. To mitigate this risk, we used 2 large databases for the searches. In addition, the value cocreation or codestruction terms may not have been used in all studies focusing on the collaborative roles of patients and providers, especially in the medical field, and that may be difficult to capture. The review reveals the current understanding of value cocreation and codestruction in digital health services and shapes the research agenda for these phenomena. Value cocreation can be used to both design and efficiently use digital health services trying to maximize the value for patients.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/63015.

Larger sample sizes are needed when developing a clinical prediction model using machine learning in oncology: methodological systematic review

BACKGROUND AND OBJECTIVES

Having a sufficient sample size is crucial when developing a clinical prediction model. We reviewed details of sample size in studies developing prediction models for binary outcomes using machine learning (ML) methods within oncology and compared the sample size used to develop the models with the minimum required sample size needed when developing a regression-based model (Nmin).

METHODS

We searched the Medline (via OVID) database for studies developing a prediction model using ML methods published in December 2022. We reviewed how sample size was justified. We calculated Nmin, which is the Nmin, and compared this with the sample size that was used to develop the models.

RESULTS

Only one of 36 included studies justified their sample size. We were able to calculate Nmin for 17 (47%) studies. 5/17 studies met Nmin, allowing to precisely estimate the overall risk and minimize overfitting. There was a median deficit of 302 participants with the event (n = 17; range: -21,331 to 2298) when developing the ML models. An additional three out of the 17 studies met the required sample size to precisely estimate the overall risk only.

CONCLUSION

Studies developing a prediction model using ML in oncology seldom justified their sample size and sample sizes were often smaller than Nmin. As ML models almost certainly require a larger sample size than regression models, the deficit is likely larger. We recommend that researchers consider and report their sample size and at least meet the minimum sample size required when developing a regression-based model.