Wearing masks to reduce the spread of respiratory viruses: a systematic evidence mapping

Extracorporeal membrane oxygenation technology for adults: an evidence mapping based on systematic reviews

BACKGROUND

Extracorporeal membrane oxygenation (ECMO) is a cutting-edge life-support measure for patients with severe cardiac and pulmonary illnesses. Although there are several systematic reviews (SRs) about ECMO, it remains to be seen how quality they are and how efficacy and safe the information about ECMO they describe is in these SRs. Therefore, performing an overview of available SRs concerning ECMO is crucial.

METHODS

We searched four electronic databases from inception to January 2023 to identify SRs with or without meta-analyses. The Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) tool, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system were used to assess the methodological quality, and evidence quality for SRs, respectively. A bubble plot was used to visually display clinical topics, literature size, number of SRs, evidence quality, and an overall estimate of efficacy.

RESULTS

A total of 17 SRs met eligibility criteria, which were combined into 9 different clinical topics. The methodological quality of the included SRs in this mapping was "Critically low" to "Moderate". One of the SRs was high-quality evidence, three on moderate, three on low, and two on very low-quality evidence. The most prevalent study used to evaluate ECMO technology was observational or cohort study with frequently small sample sizes. ECMO has been proven beneficial for severe ARDS and ALI due to the H1N1 influenza infection. For ARDS, ALF or ACLF, and cardiac arrest were concluded to be probably beneficial. For dependent ARDS, ARF, ARF due to the H1N1 influenza pandemic, and cardiac arrest of cardiac origin came to an inconclusive conclusion. There was no evidence for a harmful association between ECMO and the range of clinical topics.

CONCLUSIONS

There is limited available evidence for ECMO that large sample, multi-center, and multinational RCTs are needed. Most clinical topics are reported as beneficial or probably beneficial of SRs for ECMO. Evidence mapping is a valuable and reliable methodology to identify and present the existing evidence about therapeutic interventions.

Efficacy and safety of traditional Chinese medicine adjuvant therapy for severe pneumonia: evidence mapping of the randomized controlled trials, systematic reviews, and meta-analyses

Background and Objective: Severe pneumonia is a critical respiratory disease with high mortality. There is insufficient evidence on the efficacy and safety of traditional Chinese medicine (TCM) adjuvant therapy for severe pneumonia. This study aims to identify, describe, assess, and summarize the currently available high-quality design evidence on TCM adjuvant therapy for severe pneumonia to identify evidence gaps using the evidence mapping approach. Methods: Systematic searches were performed on English and Chinese online databases (PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, WanFang Data, CQVIP, and SinoMed) to identify papers from inception until August 2023 for inclusion into the review. Randomized controlled trials (RCTs), systematic reviews (SRs), and meta-analyses concerning TCM adjuvant therapy for severe pneumonia or its complications in adults were included. The risk of bias in RCTs was evaluated by using the Cochrane Handbook ROB tool. The Assessment of Multiple Systematic Reviews 2 (AMSTAR-2), the Risk of Bias in Systematic Review (ROBIS) tool, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system were used to assess the methodological quality, risk of bias, and evidence quality of SRs or meta-analyses, respectively. Then, a bubble plot was designed to visually display information in four dimensions. Results: A total of 354 RCTs and 17 SRs or meta-analyses met the inclusion criteria. The published RCTs had several flaws, such as unreasonable design, limited sample size, insufficient attention to non-drug therapy studies and syndrome differentiation, improper selection or use of outcome indicators, and failure to provide high-quality evidence. Sixteen SRs or meta-analyses of methodological quality scored "Critically Low" confidence. Twelve SRs or meta-analyses were rated as "High Risk." Most outcomes were rated as "Low" evidence quality. We found that TCM combined with conventional treatment could improve the clinical total effective rate and the TCM syndromes efficacy. The combined approach could also shorten mechanical ventilation time, infection control time, and length of hospital and ICU stay; significantly reduce temperature, respiratory rate, heart rate, white blood cell counts, levels of C-reactive protein, procalcitonin, blood inflammatory factors, bacteriological response, and D-dimer; decrease CPIS, APACHE II score, and PSI score; improve pulmonary imaging features, arterial blood gas indicators (including arterial oxygen pressure, arterial oxygen saturation, and oxygen index), and lung function (including forced vital capacity and forced expiratory volume in the first second) for severe pneumonia compared with conventional treatment only (p < 0.05). There was no significant difference in adverse reactions and incidence of adverse events (p > 0.05). In addition, compared with conventional treatment only, most SRs or meta-analyses concluded that TCM combined with conventional treatment was "Beneficial" or "Probably beneficial." Conclusion: TCM combined with conventional treatment had advantages in efficacy, clinical signs, laboratory results, and life quality outcomes of severe pneumonia, with no difference in safety outcomes compared with conventional treatment only. QingJin Huatan decoction is the most promising target, and Xuanbai Chengqi decoction has a "Probably beneficial" conclusion. XueBiJing injection and TanReQing injection are two commonly used Chinese herbal injections for treating severe pneumonia, and both are "Probably beneficial." However, there was a need for multicenter RCTs with large sample sizes and high methodological quality in the future. In addition, the methodological design and quality of SRs or meta-analyses should be improved to form high-quality, evidence-based medical evidence and provide evidence for the effectiveness and safety of TCM adjuvant therapy for severe pneumonia.

Use of GRADE in systematic reviews of health effects on pollutants and extreme temperatures: A cross-sectional survey

OBJECTIVES

(i) To analyze trends and gaps in evidence of health effects on pollutants and extreme temperatures by evidence mapping; (ii) to conduct a cross-sectional survey on the use of the Grades of Recommendations Assessment Development and Evaluation (GRADE) in systematic reviews or meta-analyses (SR/MAs) of health effects on pollutants and extreme temperatures.

STUDY DESIGN AND SETTING

PubMed, Embase, the Cochrane Library, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched until July 7, 2022. SR/MAs investigated health effects of pollutants and extreme temperatures were included.

RESULTS

Out of 22,658 studies, 312 SR/MAs were included in evidence mapping, and the effects of pollutants on cancer and congenital malformations were new research hotspots. Among 16 SR/MAs involving 108 outcomes that were rated using GRADE, the certainty of evidence was mostly downgraded for inconsistency (50, 42.7%), imprecision (33, 28.2%), and risk of bias (24, 20.5%). In contrast, concentration-response gradient (26, 65.0%) was the main upgrade factor.

CONCLUSION

GRADE is not widely used in SR/MAs of health effects on pollutants and extreme temperatures. The certainty of evidence is generally low, mainly because of the serious inconsistency or imprecision. Use of the GRADE in SR/MAs of health effects on pollutants and extreme temperatures should strengthen.

Effects of wearing different face masks on cardiopulmonary performance at rest and exercise in a partially double-blinded randomized cross-over study

The use of face masks became mandatory during SARS-CoV-2 pandemic. Wearing masks may lead to complaints about laboured breathing and stress. The influence of different masks on cardiopulmonary performance was investigated in a partially double-blinded randomized cross-over design. Forty subjects (19-65 years) underwent body plethysmography, ergometry, cardiopulmonary exercise test and a 4-h wearing period without a mask, with a surgical mask (SM), a community mask (CM), and an FFP2 respirator (FFP2). Cardiopulmonary, physical, capnometric, and blood gas related parameters were recorded. Breathing resistance and work of breathing were significantly increased while wearing a mask. During exercise the increase in minute ventilation tended to be lower and breathing time was significantly longer with mask than without mask. Wearing a mask caused significant minimal decreases in blood oxygen pressure, oxygen saturation, an initial increase in blood and inspiratory carbon dioxide pressure, and a higher perceived physical exertion and temperature and humidity behind the mask under very heavy exercise. All effects were stronger when wearing an FFP2. Wearing face masks at rest and under exercise, changed breathing patterns in the sense of physiological compensation without representing a health risk. Wearing a mask for 4-h during light work had no effect on blood gases.

Use of traditional Chinese medicine for the treatment and prevention of COVID-19 and rehabilitation of COVID-19 patients: An evidence mapping study

Background: The potential effectiveness of traditional Chinese medicine (TCM) against "epidemic diseases" has highlighted the knowledge gaps associated with TCM in COVID-19 management. This study aimed to map the matrix for rigorously assessing, organizing, and presenting evidence relevant to TCM in COVID-19 management. Methods: In this study, we used the methodology of evidence mapping (EM). Nine electronic databases, the WHO International Clinical Trials Registry Platform (ICTRP) Search Portal, ClinicalTrials.gov, gray literature, reference lists of articles, and relevant Chinese conference proceedings, were searched for articles published until 23 March 2022. The EndNote X9, Rayyan, EPPI, and R software were used for data entry and management. Results: In all, 126 studies, including 76 randomized controlled trials (RCTs) and 50 systematic reviews (SRs), met our inclusion criteria. Of these, only nine studies (7.14%) were designated as high quality: four RCTs were assessed as "low risk of bias" and five SRs as "high quality." Based on the research objectives of these studies, the included studies were classified into treatment (53 RCTs and 50 SRs, 81.75%), rehabilitation (20 RCTs, 15.87%), and prevention (3 RCTs, 2.38%) groups. A total of 76 RCTs included 59 intervention categories and 57 efficacy outcomes. All relevant trials consistently demonstrated that TCM significantly improved 22 outcomes (i.e., consistent positive outcomes) without significantly affecting four (i.e., consistent negative outcomes). Further, 50 SRs included nine intervention categories and 27 efficacy outcomes, two of which reported consistent positive outcomes and two reported consistent negative outcomes. Moreover, 45 RCTs and 38 SRs investigated adverse events; 39 RCTs and 30 SRs showed no serious adverse events or significant differences between groups. Conclusion: This study provides evidence matrix mapping of TCM against COVID-19, demonstrating the potential efficacy and safety of TCM in the treatment and prevention of COVID-19 and rehabilitation of COVID-19 patients, and also addresses evidence gaps. Given the limited number and poor quality of available studies and potential concerns regarding the applicability of the current clinical evaluation standards to TCM, the effect of specific interventions on individual outcomes needs further evaluation.

Effectiveness of reminiscence therapy interventions for older people: Evidence mapping and qualitative evaluation

WHAT IS KNOWN ON THE SUBJECT?: Reminiscence therapy is a common psychosocial intervention in mental health nursing. Numerous secondary studies have explored the effects of reminiscence therapy interventions in older adults, and while the effects are significant, conflicting results remain. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: To date, research on reminiscence therapy has examined different disorders in isolation from one another. By illustrating the evidence gaps between studies, this paper highlights the need for a new evidence-based summary overview of reminiscence therapy research. The results suggest that reminiscence therapy can be beneficial to the improvement of mental health and quality of life for older people. However, we found that the secondary studies were not of high quality and that further high-quality literature supporting the evidence is still needed. WHAT ARE THE IMPLICATION FOR PRACTICE?: Reminiscence therapy may be considered a useful non-pharmacological intervention for older people with mental and psychological problems. However, there is a lack of normative guidelines for reminiscence therapy in terms of intervention time, frequency, and form. The development of a global standard protocol for the application of reminiscence therapy may be necessary for future randomized controlled trials (RCTs).

ABSTRACT

INTRODUCTION: Reminiscence therapy is an alternative to pharmaceutical intervention provided during long-term care, especially for older people with mental and psychological problems. However, the effects of reminiscence therapy remain inconclusive.

AIM

The present study aimed to systematically identify, synthesize and describe the research evidence and quality of systematic reviews (SRs) related to reminiscence interventions for older people through an evidence-mapping approach.

METHODS

Commonly used English and Chinese databases, including PubMed, EMBASE, The Cochrane Library, Web of Science, CNKI, WANFANG, VIP and SinoMed, were searched from inception till 31 March 2022. The study type was restricted to SRs with or without meta-analysis. The methodological quality of the included SRs was assessed by A Measurement Tool to Assess Systematic Reviews (AMSTAR-2). The Microsoft Excel 2019 tool was used for data extraction and coding, and bubble charts were used to synthesize information on the study population, intervention category, original study sample size and classification of findings.

RESULTS

A total of 28 SRs were enrolled, including 514 original studies, 91.4% of which were randomized controlled trials. The main participants of the study were depressed older people (7 publications), older people with dementia (10 publications) and ordinary older people (8 publications). The findings of 26 (92.8%) publications were categorized as either "beneficial" or "potentially beneficial." The primary outcome indicators of the effectiveness of the reminiscence intervention for older people are mental and psychological problems (especially depressive symptoms and cognitive functioning), quality of life and categories of positive psychology (e.g., life satisfaction, happiness and self-esteem). The main factors influencing the intervention effect were the intervention period, residential setting, intervention format (group/individual) and intervention intensity. The intervention settings/contexts were mainly community and long-term care facilities. However, the methodological quality of 27 (96.4%) of the SRs was scored as either "Low" or "Critically Low."

DISCUSSION

Reminiscence therapy has been used to study the mental health and quality of life of older people in various conditions, with significant results. However, due to the limited evidence included in the studies and the low methodological quality, there is still a need to focus on the issue of effectiveness and evidence gaps for different interventions in the field of recall in the future, in addition to efforts to improve the methodological quality and standardize the reporting process for the evaluation of reminiscence intervention systems.

IMPLICATIONS FOR PRACTICE

Reminiscence therapy may be considered a useful non-pharmacological intervention for older people with mental and psychological problems. A standard protocol for reminiscence therapy may be necessary for future studies.

Enhanced Fluctuations in Facial Pore Size, Redness, and TEWL Caused by Mask Usage Are Normalized by the Application of a Moisturizer

Mask wearing is described as one of the main public health measures against COVID-19. Mask wearing induces various types of subjective and objective facial skin damage, such as hair pore dilatation and redness. Facial pore size and redness show morning-to-evening intra-day fluctuations. It remains unknown whether mask usage affects fluctuations in pore size and redness. We measured facial skin hydration, transepidermal water loss (TEWL), pore size, and redness four times a day for 6 weeks in 20 healthy young women. After a 2-week no-mask-usage period (baseline period), all subjects wore unwoven masks for 2 weeks; then, for the following 2 weeks, they applied masks after the topical application of a moisturizer containing a Galactomyces ferment filtrate (GFF) skin care formula (Pitera™). We demonstrated that mask wearing significantly increased the intra-day fluctuations of pore size, redness, and TEWL. In addition, significant correlations were evident among these three parameters. Notably, these mask-induced skin changes were significantly improved, achieving a return to baseline levels, by the application of a GFF-containing moisturizer. In conclusion, mask wearing aggravates intra-day fluctuations in pore size and redness. Appropriate moisturization can minimize this mask-related skin damage, most likely by normalizing the elevated TEWL.