Include or not to include conference abstracts in systematic reviews? Lessons learned from a large Cochrane network meta-analysis including 585 trials

Understanding mental health in breast cancer from screening to Survivorship: an integrative phasic Model and tool

Integrative models of mental illness and health in psycho-oncology are aimed at all types of cancer, although the patients' experiences and issues may vary. This review summarizes the different theories and models of mental illness and health pertaining to the breast cancer experience and proposes an integrative phasic model applicable to the breast cancer trajectory. Five databases were searched for studies related to breast cancer mental health and illness theories and models. The PRISMA checklist form was used to extract the essential information from the included studies. Eleven theories and models on the experience of breast cancer were found. The integrative model based on these theories and models illustrates that the breast cancer experience is conceptualized as a trajectory with seven landmark 'events', each associated with a pathogenic 'challenge' leading to six possible 'symptoms', 1) psychological distress with anxious features, 2) psychological distress with depressive features, 3) non-specific distress 4) psychological distress with trauma-related features 5) low health-related quality of life, and 6) fear of recurrence. The Breast Cancer Psychological Integrative Phasic Model is supported by a simple clinical tool (BreastCancerPsych - Integrative Clinical Tool) that serves as a valuable resource throughout the care trajectory. These integrative phasic model and clinical tool are designed to help mental health clinicians formulate treatments that are tailored to the needs of their patients, especially for trajectories that are not marked by resilience.

Polyp Matching in Colon Capsule Endoscopy: Pioneering CCE-Colonoscopy Integration Towards an AI-Driven Future

Background: Colon capsule endoscopy (CCE) is becoming more widely available across Europe, but its uptake is slow due to the need for follow-up colonoscopy for therapeutic procedures and biopsies, which impacts its cost-effectiveness. One of the major factors driving the conversion to colonoscopy is the detection of excess polyps in CCE that cannot be matched during subsequent colonoscopy. The capsule's rocking motion, which can lead to duplicate reporting of the same polyp when viewed from different angles, is likely a key contributor. Objectives: This review aims to explore the types of polyp matching reported in the literature, assess matching techniques and matching accuracy, and evaluate the development of machine learning models to improve polyp matching in CCE and subsequent colonoscopy. Methods: A systematic literature search was conducted in EMBASE, MEDLINE, and PubMed. Due to the scarcity of research in this area, the search encompassed clinical trials, observational studies, reviews, case series, and editorial letters. Three directly related studies were included, and ten indirectly related studies were included for review. Results: Polyp matching in colon capsule endoscopy still needs to be developed, with only one study focused on creating criteria to match polyps within the same CCE video. Another study established that experienced CCE readers have greater accuracy, reducing interobserver variability. A machine learning algorithm was developed in one study to match polyps between initial CCE and subsequent colonoscopy. Only around 50% of polyps were successfully matched, requiring further optimisation. As Artificial Intelligence (AI) algorithms advance in CCE polyp detection, the risk of duplicate reporting may increase when clinicians are presented with polyp images or timestamps, potentially complicating the transition to AI-assisted CCE reading in the future. Conclusions: Polyp matching in CCE is a developing field with considerable challenges, especially in matching polyps within the same video. Although AI shows potential for decent accuracy, more research is needed to refine these techniques and make CCE a more reliable, non-invasive alternative to complement conventional colonoscopy for lower GI investigations.

A Narrative Review of Ethical Issues in the Use of Artificial Intelligence Enabled Diagnostics for Diabetic Retinopathy

INTRODUCTION

Diabetic retinopathy is one of the leading causes of avoidable blindness among adults globally, and screening programmes can enable early diagnosis and prevention of progression. Artificial intelligence (AI) diagnostic solutions have been developed to diagnose diabetic retinopathy. The aim of this review is to identify ethical concerns related to AI-enabled diabetic retinopathy diagnostics and enable future research to explore these issues further.

METHODS

This is a narrative review that uses thematic analysis methods to develop key findings. We searched two databases, PubMed and Scopus, for papers focused on the intersection of AI, diagnostics, ethics, and diabetic retinopathy and conducted a citation search. Primary research articles published in English between 1 January 2013 and 14 June 2024 were included. From the 1878 papers that were screened, nine papers met inclusion and exclusion criteria and were selected for analysis.

RESULTS

We found that existing literature highlights ensuring patient data has appropriate protection and ownership, that bias in algorithm training data is minimised, informed patient decision-making is encouraged, and negative consequences in the context of clinical practice are mitigated.

CONCLUSIONS

While the technical developments in AI-enabled diabetic retinopathy diagnostics receive the bulk of the research focus, we found that insufficient attention is paid to how this technology is accessed equitably in different settings and which safeguards are needed against exploitative practices. Such ethical issues merit additional exploration and practical problem-solving through primary research. AI-enabled diabetic retinopathy screening has the potential to enable screening at a scale that was previously not possible and could contribute to reducing preventable blindness. It will only achieve this if ethical issues are emphasised, understood, and addressed throughout the translation of this technology to clinical practice.

Efficacy and safety of platelet-rich plasma intracavernous injection for patients with erectile dysfunction: A systematic review, meta-analysis, and meta-regression

Objective

Intracavernous injection might be offered to patients with erectile dysfunction (ED) who did not respond to the first-line oral treatment. Platelet-rich plasma (PRP) might offer improvement in erectile function since it contains numerous growth factors. This study aimed to evaluate the efficacy and safety of PRP intracavernous injection for patients with ED.

Methods

We conducted relevant literature searches on Cochrane Library, Medline, Scopus, and ClinicalTrials.gov databases using specific keywords. The results of continuous variables were pooled into the mean difference (MD) and dichotomous variables into the odds ratio along with 95% confidence interval (95% CI).

Results

A total of six studies were included. Our pooled analysis revealed that PRP intracavernous injection was associated with a significant increase in the erectile function domain of the International Index of Erectile Function at 1 month (MD 3.47 [95% CI 2.62-4.32], p<0.00001, I 2=7%), 3 months (MD 3.19 [95% CI 2.25-4.12], p<0.00001, I 2=0%), and 6 months (MD 3.21 [95% CI 2.30-4.13], p<0.00001, I 2=0%) after the intervention when compared with baseline values. PRP was also superior to a placebo in terms of improvement in erectile function domain of the International Index of Erectile Function score at 1 month (MD 2.83, p<0.00001), 3 months (MD 2.87, p<0.00001), and 6 months (MD 3.20, p<0.00001) post-intervention. The adverse events from PRP injection were only mild without any serious adverse events.

Conclusion

PRP intracavernous injection may offer benefits in improving erectile function in patients with ED with a relatively good safety profile.

The Diagnostic Accuracy of Colon Capsule Endoscopy in Inflammatory Bowel Disease-A Systematic Review and Meta-Analysis

Colon capsule endoscopy (CCE) has regained popularity for lower gastrointestinal investigations since the COVID-19 pandemic. While there have been systematic reviews and meta-analyses on colonic polyp detection using CCE, there is a lack of comprehensive evidence concerning colonic inflammation. Therefore, this systematic review and meta-analysis aimed to assess the diagnostic accuracy of CCE for colonic inflammation, predominantly ulcerative colitis (UC) and Crohn's disease (CD). Methods: We systematically searched electronic databases (EMBASE, MEDLINE, PubMed Central, and Cochrane Library) for studies comparing the diagnostic accuracy between CCE and optical endoscopy as the standard reference. A bivariate random effect model was used for the meta-analysis. Results: From 3797 publications, 23 studies involving 1353 patients were included. Nine studies focused on UC, and ten focused on CD. For UC, CCE showed a pooled sensitivity of 92% (95% CI, 88-95%), a specificity of 71% (95% CI, 35-92%), and an AUC of 0.93 (95% CI, 0.89-0.97). For CD, the pooled sensitivity was 92% (95% CI, 89-95%), and the specificity was 88% (95% CI, 84-92%), with an AUC of 0.87 (95% CI, 0.76-0.98). Overall, for inflammatory bowel disease, the pooled sensitivity, specificity, and AUC were 90% (95% CI, 85-93%), 76% (95% CI, 56-90%), and 0.92 (95% CI, 0.94-0.97), respectively. Conclusions: Despite the challenges around standardised disease scoring and the lack of histological confirmation, CCE performs well in diagnosing inflammatory bowel disease. It demonstrates high sensitivity in both UC and Crohn's terminal ileitis and colitis and high specificity in Crohn's disease. Further studies are needed to evaluate the diagnostic accuracy of other colonic inflammatory conditions.

Coping and emotion regulation: A conceptual and measurement scoping review

The fields of coping and emotion regulation have mostly evolved separately over decades, although considerable overlap exists. Despite increasing efforts to unite them from a conceptual standpoint, it remains unclear whether conceptual similarities translate into their measurement. The main objective of this review was to summarize and compare self-reported measures of coping and emotion regulation strategies. The secondary objective was to examine whether other psychological measures (e.g., resilience) indirectly reflect regulatory strategies' effectiveness, thus representing additionally informative approaches. Results indicated substantial overlap between coping and emotion regulation measures. In both frameworks, two to eight individual strategies were usually captured, but only a third included ≤20 items. Most commonly evaluated strategies were reappraisal/reinterpretation, active coping/problem-solving, acceptance, avoidance, and suppression. Evidence also suggested psychological distress and well-being measures, especially in certain contexts like natural stress experiments, and resilience measures are possible indirect assessments of these regulatory strategies' effectiveness. These results are interpreted in the light of a broader, integrative affect regulation framework and a conceptual model connecting coping, emotion regulation, resilience, psychological well-being and psychological distress is introduced. We further discussed the importance of alignment between individuals, contexts, and strategies used, and provide directions for future research. Altogether, coping and emotion regulation measures meaningfully overlap. Joint consideration of both frameworks in future research would widen the repertoire of available measures and orient their selection based on other aspects like length or strategies covered, rather than the framework only.

Efficacy and safety of selinexor for patients with relapsed and refractory multiple myeloma: A meta-analysis

PURPOSE

Selinexor is a first-in-class, oral selective-inhibitor-of-nuclear-export, granted accelerated approval by FDA (2019) for relapsed and refractory multiple myeloma (RRMM). We sought to quantitatively summarize the selinexor efficacy and safety in RRMM.

METHODS

We searched PubMed, EMBASE, CENTRAL, clinicaltrial.gov, and google scholar, until May 2023, studies about selinexor use in RRMM. The outcome measures of interest were primarily efficacy outcomes, in addition to safety outcomes. Random-effect model analyses were performed, at statistical significance of P<0.05, using the RevMan software.

RESULTS

Meta-analyses of eleven included clinical trials yielded a significant 56.21% overall clinical benefit, 46.91% overall response, 4.89% complete response, 23.41% very good partial response, 24.68% partial response, and 28.06% stable disease rates with selinexor. Due to safety reasons, selinexor caused significant increase in discontinuation rate, 16.80%. Subgroup analyses demonstrated higher efficacy with selinexor plus dexamethasone and proteasome inhibitor combinations than with selinexor alone. The multiple myeloma type, high cytogenetic risk, refractory state, and advanced disease state did not affect performance. Risk of selection, performance, and detection biases were unclear in the included trials.

CONCLUSION

Selinexor led to significant positive responses with an acceptable safety profile in RRMM patients, despite higher rates of safety-related discontinuations. Selinexor-based combinations further enhanced response.

Scoping Review of Fall Risk Assessment Tools for Women Who Receive Maternity Care

OBJECTIVE

To identify and describe fall risk assessment tools used for women who receive maternity care.

DATA SOURCES

PubMed, CINAHL Complete, MEDLINE Complete, Cochrane Library, Scopus, SciELO, and Repositórios Científicos de Acesso Aberto de Portugal (RCAAP).

STUDY SELECTION

We considered reports published until November 28, 2022, that included women during pregnancy, childbirth, or the postpartum period; involved the use of fall risk assessment tools, regardless of context; and were published in English, French, Portuguese, or Spanish.

DATA EXTRACTION

We extracted the following data from the included reports: author(s)/year/country, aim/sample, research design/type of report, tool (i.e., the fall risk assessment tool used), findings, reliability, and validity.

DATA SYNTHESIS

We found 13 reports in which the authors addressed nine fall risk assessment tools. Seven of these tools were applied during pregnancy (Kyle's tool, Pregnant Women Information Form and Assessment Scale for Risk of Falling in Pregnant Women, Obstetric Fall Risk Assessment System), labor (Obstetric Fall Risk Assessment System), the postpartum period (Cooksey-Post Obstetric Delivery Fall Risk Assessment, Kyle's tool, Risk of Falling in Post-partum Women (SLOPE), Obstetric Fall Risk Assessment System, Post-epidural Fall Risk Assessment Score, and Maternal Fall Risk Assessment Scale). The Dionne's Egress Test and the Motor Strength Scale do not address the characteristics of the women who receive maternity care. Psychometric characteristics were available for the Pregnant Women Information Form and Assessment Scale for Risk of Falling in Pregnant Women, Post-epidural Fall Risk Assessment Score, Maternal Fall Risk Assessment Scale, and Risk of Falling in Post-partum Women.

CONCLUSION

Some fall risk assessment tools are used to assess women who receive maternity care without proper validation in this specific population. The use of fall risk assessment tools that are validated for women who receive maternity care may help nurses make clinical judgments when assessing fall risk and implement measures for fall prevention.

Exploring the impact of socially assistive robots on health and wellbeing across the lifespan: An umbrella review and meta-analysis

BACKGROUND

Socially assistive robots offer an alternate source of connection for interventions within health and social care amidst a landscape of technological advancement and reduced staff capacity. There is a need to summarise the available systematic reviews on the health and wellbeing impacts to evaluate effectiveness, explore potential moderators and mediators, and identify recommendations for future research and practice.

OBJECTIVE

To explore the effect of socially assistive robots within health and social care on psychosocial, behavioural, and physiological health and wellbeing outcomes across the lifespan (PROSPERO registration number: CRD42023423862).

DESIGN

An umbrella review utilising meta-analysis, narrative synthesis, and vote counting by direction of effect.

METHODS

14 databases were searched (ProQuest Health Research Premium collection, Scopus, PubMed, Web of Science, ASM Digital Library, IEEE Xplore, Cochrane Reviews, and EPISTEMONIKOS) from 2005 to May 4, 2023. Systematic reviews including the effects of socially assistive robots on health outcomes were included and a pooled meta-analysis, vote counting by direction of effect, and narrative synthesis were applied. The second version of A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2) was applied to assess quality of included reviews.

RESULTS

35 reviews were identified, most focusing on older adults with or without dementia (n = 24). Pooled meta-analysis indicated no effect of socially assistive robots on quality of life (standard mean difference (SMD) = 0.43), anxiety (SMD = -0.02), or depression (SMD = 0.21), although vote counting identified significant improvements in social interaction, mood, positive affect, loneliness, stress, and pain across the lifespan, and narrative synthesis identified an improvement in anxiety in children. However, some reviews reported no significant difference between the effects of socially assistive robots and a plush toy, and there was no effect of socially assistive robots on psychiatric outcomes including agitation, neuropsychiatric symptoms, and medication use.

DISCUSSION

Socially assistive robots show promise for improving non-psychiatric outcomes such as loneliness, positive affect, stress, and pain, but exert no effect on psychiatric outcomes such as depression and agitation. The main mechanism of effect within group settings appeared to be the stimulation of social interaction with other humans. Limitations include the low quality and high amount of overlap between included reviews.

CONCLUSION

Socially assistive robots may help to improve loneliness, social interaction, and positive affect in older adults, decrease anxiety and distress in children, and improve mood, stress, and reduce pain across the lifespan. However, before recommendations for socially assistive robots can be made, a cost-effectiveness analysis of socially assistive robots to improve mood across the lifespan, and a quantitative analysis of the effects on pain, anxiety, and distress in children are required.

Physical Activity, Sedentary Time, and Psychosocial Functioning among Adults with Cancer: A Scoping Review

The post-treatment period (after the completion of primary cancer treatment) is a phase during which adults with cancer are particularly vulnerable to the physical and psychological side effects of treatment. Adopting healthy lifestyle habits during this time is essential to mitigate these effects. This scoping review investigated the associations of physical activity (PA) and sedentary time (ST) with two post-treatment psychosocial indicators among adults with cancer: psychological functioning and quality of life (QoL). An exhaustive search was performed in January 2023 across five databases, namely APA PsycInfo, MedLine, SPORTDiscuss, SCOPUS, and CINAHL, adhering to PRISMA guidelines for scoping reviews. Twenty articles met the inclusion criteria; 16 used a cross-sectional design, while 4 used a longitudinal one. PA and ST were assessed mainly with accelerometers (n = 17), and psychosocial indicators with self-reported questionnaires (n = 20). Most studies linked higher PA levels to reduced anxiety (n = 3) and depression (n = 4) symptoms, and elevated ST to higher psychological symptoms (n = 3). Opposite associations were observed for QoL (n = 5). Altogether, PA appeared to be more strongly related to psychological functioning and QoL than ST. This scoping review highlights associations of PA and ST with psychological functioning and QoL among adults with cancer in the post-treatment period. However, future studies must prioritize longitudinal designs to establish directionality.

The role of nutrition-based index in predicting survival of breast cancer patients: A systematic review and meta-analysis

Background

Prognostic nutritional index (PNI) and Controlling Nutritional Status (CONUT) are two model that incorporates the role of inflammation and nutrition factors to predict the progression of tumor. The primary objective of this investigation is to examine the ability of PNI and CONUT score for predicting the survival in breast cancer patients.

Methods

A comprehensive search was conducted on the Cochrane Library, Scopus, Europe PMC, and Medline databases up until August 14th, 2023, utilizing a combination of relevant keywords. This review incorporates literature that examines the relationship between PNI, CONUT, and survival in breast cancer. We employed random-effect models to analyze the hazard ratio (HR) and present the outcomes together with their corresponding 95 % confidence intervals (CI).

Results

A total of sixteen studies were incorporated. The results of our meta-analysis indicated that high PNI was associated with better overall survival (OS) (HR 0.38; 95%CI: 0.28-0.51, p < 0.00001, I2 = 32 %), but not disease-free survival (DFS) (HR 0.60; 95%CI: 0.33-1.10, p = 0.10, I2 = 78 %) than low PNI in breast cancer patients. Meta-analysis also indicated that high CONUT was associated with worse OS (HR 1.66; 95%CI: 1.21-2.28, p = 0.002, I2 = 78 %) and worse DFS (HR 2.09; 95%CI: 1.60-2.73, p < 0.00001, I2 = 41 %) in breast cancer patients.

Conclusions

This study suggests the prognostic role of both PNI and CONUT score for predicting survival in breast cancer patients.

Relationship between Phenotype Models Based on Waist Circumference and Triglyceride Levels and the Risk of Chronic Kidney Disease: A Systematic Review and Meta-analysis

Background

Chronic kidney disease (CKD) is a leading cause of death worldwide and has a high cost of treatment. Studies have indicated that a combination of waist circumference (WC) and triglyceride (TG) levels can be used to determine the risk of CKD. This study analyzes the risk of CKD using four phenotype models based on WC and TG.

Methods

This meta-analysis analyzes 113,019 participants from 13 studies. We conducted relevant literature searches in the Europe PMC, Medline, and Scopus databases using specific keywords. The results obtained were pooled into odds ratios (ORs) with 95% confidence intervals (CIs) using random-effects models.

Results

Our pooled analysis revealed that the highest significant independent association was between CKD and the high WC-high TG phenotype (adjusted OR, 1.61; 95% CI, 1.39 to 1.88; P<0.00001; I2=59%), followed by the high WC-normal TG phenotype (adjusted OR, 1.33; 95% CI, 1.12 to 1.57; P=0.001; I2=67%), and the normal WC-high TG phenotype (adjusted OR, 1.20; 95% CI, 1.06 to 1.37; P=0.005; I2=29%) when the normal WC-normal TG phenotype was taken as the reference.

Conclusion

Our study suggests that phenotype models based on WC and TG can be used as screening tools to predict the risk of CKD. Our results also indicate that WC plays a larger role than TG in the CKD risk. Further prospective studies are needed to confirm the results of our study.

Modified rice bran arabinoxylan as a nutraceutical in health and disease-A scoping review with bibliometric analysis

Rice bran arabinoxylan compound (RBAC) is a polysaccharide modified by Lentinus edodes mycelial enzyme widely used as a nutraceutical. To explore translational research on RBAC, a scoping review was conducted to synthesise research evidence from English (MEDLINE, ProQuest, CENTRAL, Emcare, CINAHL+, Web of Science), Japanese (CiNii, J-Stage), Korean (KCI, RISS, ScienceON), and Chinese (CNKI, Wanfang) sources while combining bibliometrics and network analyses for data visualisation. Searches were conducted between September and October 2022. Ninety-eight articles on RBAC and the biological activities related to human health or disease were included. Research progressed with linear growth (median = 3/year) from 1998 to 2022, predominantly on Biobran MGN-3 (86.73%) and contributed by 289 authors from 100 institutions across 18 countries. Clinical studies constitute 61.1% of recent articles (2018 to 2022). Over 50% of the research was from the USA (29/98, 29.59%) and Japan (22/98, 22.45%). A shifting focus from immuno-cellular activities to human translations over the years was shown via keyword visualisation. Beneficial effects of RBAC include immunomodulation, synergistic anticancer properties, hepatoprotection, antiinflammation, and antioxidation. As an oral supplement taken as an adjuvant during chemoradiotherapy, cancer patients reported reduced side effects and improved quality of life in human studies, indicating RBAC's impact on the psycho-neuro-immune axis. RBAC has been studied in 17 conditions, including cancer, liver diseases, HIV, allergy, chronic fatigue, gastroenteritis, cold/flu, diabetes, and in healthy participants. Further translational research on the impact on patient and community health is required for the evidence-informed use of RBAC in health and disease.

An Exploration of Wearable Device Features Used in UK Hospital Parkinson Disease Care: Scoping Review

BACKGROUND

The prevalence of Parkinson disease (PD) is becoming an increasing concern owing to the aging population in the United Kingdom. Wearable devices have the potential to improve the clinical care of patients with PD while reducing health care costs. Consequently, exploring the features of these wearable devices is important to identify the limitations and further areas of investigation of how wearable devices are currently used in clinical care in the United Kingdom.

OBJECTIVE

In this scoping review, we aimed to explore the features of wearable devices used for PD in hospitals in the United Kingdom.

METHODS

A scoping review of the current research was undertaken and reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The literature search was undertaken on June 6, 2022, and publications were obtained from MEDLINE or PubMed, Embase, and the Cochrane Library. Eligible publications were initially screened by their titles and abstracts. Publications that passed the initial screening underwent a full review. The study characteristics were extracted from the final publications, and the evidence was synthesized using a narrative approach. Any queries were reviewed by the first and second authors.

RESULTS

Of the 4543 publications identified, 39 (0.86%) publications underwent a full review, and 20 (0.44%) publications were included in the scoping review. Most studies (11/20, 55%) were conducted at the Newcastle upon Tyne Hospitals NHS Foundation Trust, with sample sizes ranging from 10 to 418. Most study participants were male individuals with a mean age ranging from 57.7 to 78.0 years. The AX3 was the most popular device brand used, and it was commercially manufactured by Axivity. Common wearable device types included body-worn sensors, inertial measurement units, and smartwatches that used accelerometers and gyroscopes to measure the clinical features of PD. Most wearable device primary measures involved the measured gait, bradykinesia, and dyskinesia. The most common wearable device placements were the lumbar region, head, and wrist. Furthermore, 65% (13/20) of the studies used artificial intelligence or machine learning to support PD data analysis.

CONCLUSIONS

This study demonstrated that wearable devices could help provide a more detailed analysis of PD symptoms during the assessment phase and personalize treatment. Using machine learning, wearable devices could differentiate PD from other neurodegenerative diseases. The identified evidence gaps include the lack of analysis of wearable device cybersecurity and data management. The lack of cost-effectiveness analysis and large-scale participation in studies resulted in uncertainty regarding the feasibility of the widespread use of wearable devices. The uncertainty around the identified research gaps was further exacerbated by the lack of medical regulation of wearable devices for PD, particularly in the United Kingdom where regulations were changing due to the political landscape.