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Cochrane Handbook for Systematic Reviews of Interventions

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... 6,7 The unrecognized inclusion of non-randomized studies in systematic reviews of RCTs may undermine the quality of the evidence, bias the conclusions, and negatively affect patient care. 5,8,9 While there has been a consistent rise in the number of RCTs conducted in the orthopaedic literature, 10 there is evidence of methodological flaws in orthopaedic RCTs, including use of inadequate randomization and failure to report method of randomization. 8,11,12 While previous studies have assessed the quality of randomization in RCTs, there has been little consideration of the RCTs included in systematic reviews. ...
... A strength of this study was the use of an objective definition of adequate randomization based on the Cochrane RoB-2 Tool. 5 Only the trials explicitly rated as having adequate randomization according to the tool, using specific free-text descriptions in the reporting of randomization, were considered to be adequately randomized for our study. This increases replicability, though it may underestimate the use of adequate randomization. ...
... Poor critical appraisal at the systematic review level and methodological understanding at the RCT level is an example of avoidable research waste. 29 Importantly, including non-randomized trials may result in misleading conclusions in systematic reviews, 5,8,9,30 which may then impact practice, given the reliance on systematic reviews in clinical practice guidelines. ...
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Aims Systematic reviews of randomized controlled trials (RCTs) are the highest level of evidence used to inform patient care. However, it has been suggested that the quality of randomization in RCTs in orthopaedic surgery may be low. This study aims to describe the quality of randomization in trials included in systematic reviews in orthopaedic surgery. Methods Systematic reviews of RCTs testing orthopaedic procedures published in 2022 were extracted from PubMed, Embase, and the Cochrane Library. A random sample of 100 systematic reviews was selected, and all included RCTs were retrieved. To be eligible for inclusion, systematic reviews must have tested an orthopaedic procedure as the primary intervention, included at least one study identified as a RCT, been published in 2022 in English, and included human clinical trials. The Cochrane Risk of Bias-2 Tool was used to assess random sequence generation as ‘adequate’, ‘inadequate’, or ‘no information’; we then calculated the proportion of trials in each category. We also collected data to test the association between these categories and characteristics of the RCTs and systematic reviews. Results We included 917 unique RCTs. We found that 374 RCTs (40.8%) reported adequate sequence generation, 61 (6.7%) were inadequate, 410 (44.7%) lacked information, and 72 (7.9%) were observational studies incorrectly included as RCTs within the systematic review. Publication year, an author with statistical or epidemiological qualifications, and journal impact factor were each associated with adequate randomization. We found that 45 systematic reviews (45%) included at least one inadequately randomized RCT or an observational study incorrectly treated as a RCT. Conclusion There is evidence of a lack of random allocation in RCTs included in systematic reviews in orthopaedic surgery. The conduct of RCTs and systematic reviews should be improved to minimize the risk of bias from inadequate randomization in RCTs and mislabelling of non-randomized studies as RCTs. Cite this article: Bone Jt Open 2024;5(12):1072–1080.
... Систематичният преглед е формален, систематичен и структуриран подход за преглед на цялата научна литература по дадена тема [4]. Метаанализът е статистически метод, използван за комбиниране на числените резултати от такива изследвания, ако е възможно [5,6]. Често проучванията дават резултати, които са твърде различни, за да се комбинират с помощта на статистически техники. ...
... Систематичните прегледи често включват и метаанализ, но невинаги. Най-добре е да се направи и метаанализ, ако данните от изследванията, които се преразглеждат систематично, позволяват това [5,6]. ...
... документален метод -анализ на данни от систематичен преглед на специализирана медицинска научна литература. Систематичният преглед е извършен в съответствие с препоръките на Cochrane Collaboration [5] и Ръководството за предпочитани елементи за докладване на сис-ability of one BMP with another, etc. -all these questions still do not have a clear answer [2]. ...
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Aims: To analyze reports of adverse drug reactions (ADRs) occurring during and after treatment of rheumatologic diseases with biological medicinal products (BMPs), published in scientific literature; determine the type, frequency, grade of severity and evaluate the causality with the ongoing treatment. Materials and methods: The literature search was conducted in MEDLINE and PubMed databases for the period from November 2002 to November 2016. We found 710 publications and 225 publications were selected for data extraction. We carried out descriptive and variational analyses as basic statistical analyses. We defined mean values, standard deviation, minimum, maximum, 95% confidence intervals. Results: We assessed the results using PICOS instrument – population, intervention, comparison, results and study design. The analyzed population included 137,564 patients with rheumatic diseases. Original articles and reviews account for the largest share of publications - 183 (81.33%). The most frequently used medicinal products were monoclonal antibodies. We found data of 284 types of ADRs. The most commonly reported ADRs were: common infections; development (activation) of tuberculosis infection; malignancies. ADRs were found in 12,979 patients, i.е. in 9,43 % of the population there was at least one ADR. Discussion: Our systematic review has shown increased interest in the pharmacovigilance of the biological medicinal products. The larger share of scientific publications, however, use non-standardized terminology to describe ADRs, which is not in line with the current pharmacovigilance concept. Ignorance of the notions, inaccurate and incorrect handling of scientific-regulatory terminology and errors in ADRs reporting and publication in scientific literature do not allow for systematic reviews in this field. Key words: Biological medicinal products, adverse drug reactions, rheumatological diseases, scientific publications, systematic review
... The design of the protocol conforms to the guidelines specified in the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols 2015 [13]. This protocol will be performed according to principles outlined in the Cochrane Handbook for Systematic Reviews of Interventions [14]. The study has been registered with the International Prospective Register of Systematic Reviews (PROSPERO). ...
... The search strategy will be based on the guidelines provided by the Cochrane Handbook for Systematic Reviews of Interventions [14]. ...
... The Cochrane Risk of Bias 2 (RoB 2) tool was employed [14], two researchers will individually evaluate the potential for bias. The evaluation and assessment of all the studies will be conducted based on participant blinding, allocation concealment, outcome assessment blinding, result data integrity, selective outcome reporting, along with potential biases. ...
Article
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Introduction Diabetic peripheral neuropathy (DPN), a prevalent complication among individuals diagnosed with type 2 diabetes, has a significant impact on both the well-being of patients and their financial situation. Acupuncture has been employed for thousands of years within China and is regarded as one of the primary characteristic therapies of traditional Chinese medicine. Research has indicated that acupuncture has the potential to enhance microcirculation, decrease the generation of free radicals, and augment nerve conduction velocity. There had been several meta-analyses of acupuncture on DPN. Nevertheless, there has been inadequate attention given to the assessment of blood glucose control, and scores related to quality of life. Hence, we get additional evidence by enhancing the quantity and quality of studies to draw more distinct findings. Methods We will conduct a comprehensive search for reports published from the beginning until June 2023 using various databases including Web of Science, Embase, Cochrane Library, PubMed, AMED, Wanfang database, VIP database, China National Knowledge Infrastructure, and Chinese Biomedical Literature database. Only randomized controlled trials will be considered, with no exclusion of quasi-randomized control trials. Articles in both English and Chinese will be taken into account without any limitations on publication dates. The data will be extracted, managed, and analyzed by two researchers working independently. The primary outcomes will include improvement of symptom scores, change of nerve conduction velocity, and quality of life scores. Additional outcomes will encompass blood glucose levels after fasting and 2 hours after eating, levels of glycosylated hemoglobin, and any adverse events associated with acupuncture. We plan to use the RevMan V.5.4 application and the random-effects model for conducting the meta-analysis. The assessment of potential prejudice can be conducted by Cochrane’s ’risk of bias’ 2 (RoB 2) tool. Registration: PROSPERO (registration number: CRD42023425203). Discussion Our goal is to perform a meta-analysis that offers an unbiased approach to treating individuals with type 2 DPN. At the same time, it also provides doctors with more choices in the treatment of diabetes peripheral neuropathy.
... The extracted data is shown in Table 1. Two investigators (RS, MS) independently assessed the risk of bias using a quality assessment checklist [24]. Any disagreement between the two authors was resolved by discussion. ...
... Oncu et al. 2019 [48] Immediate implant placement was done. The quality of the studies as assessed by the risk of bias tool [24] shown in Figures 2-3 were considered as having "low risk", "unclear risk" or "high risk" based on the assessment of the following biases: a) selection bias; b) performance bias; c) detection bias; d) reporting bias; and e) attrition bias. Five studies [25,26,32,33,36] showed high risk in selection bias assessment as randomization was either not done or it wasn't clear if randomization was done properly. ...
... All studies that measured the effects of interventions on the outcomes of adolescent girls (10)(11)(12)(13)(14)(15)(16)(17)(18)(19) years and female young adults (15-24 years)) were considered. ...
... The quality of the procedures used in the included studies was assessed by two authors on the basis of techniques for evaluating the risk of bias (ROB) in a randomized trial (RCT) on the basis of the Cochrane Handbook for Systematic Reviews Version 6.3 [14]. Six parameters were measured: ...
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Introduction: Adolescent health remains a significant public health concern in Africa and Latin America, resulting in adverse consequences for young women’s health, education, and socioeconomic empowerment . This review aimed to identify potential interventions and their effects on reducing adolescent pregnancy. Methods: The PRISMA 2020 guidelines were used to conduct the review. We searched electronic databases for studies published between 2014 and 2024. We included interventional studies evaluating adolescent pregnancy. Two authors extracted data and assessed study quality using the Cochrane risk of bias tool. The primaryoutcomes were adolescent pregnancy and meta-analysis sub grouped outcomes into economic, educational, health, and combined interventions employing a Mantel-Hazel method and inverse variance method using Stata software. A risk ratio (RR) was obtained viathe random effect module among the subgroups. PROSPERO registered the study under ID: Reg. CRD42022369044. Results: Our search yielded 8,175 studies, 13 of which met theinclusion criteria. Meta-analysis revealed the following outcomes. Socioeconomic interventions RR 1.0153 (95% CI 0.9267; 1.1125, P value=0.7441), educational interventions RR 0.8476 (95% CI 0.5998; 1.1980, P value=0.3490), health interventions RR 1.0614 (95% CI 0.9908; 1.1369, P value=0.0895), and combined interventions RR 0.9880 (95% CI 0.8824; 1.1062, P value =0.8338). Subgroup analysis for African women revealed 18.2% odds of reducing adolescent pregnancy OR 0.8180 (95% CI 0.5696; 1.1746), and for Latin American women, 22.7% increased the risk of adolescent pregnancy from the interventions OR 1.2271 (0.7996; 1.8831). The subgroup analysis revealedno statistically significant findings, with a P value of 0.1563. Conclusion: The findings confirm a limited reduction in the rates of adolescent pregnancies by combined approaches in Africa compared with those inLatin America,despite overall results indicating no statistically significant effects from all interventions. Therefore, policymakers must prioritize programming for rigorous game changing interventional research in Africa and Latin America.
... A systematic literature search was conducted in June 2023 (Supplementary Table 1), using the methods of the Cochrane Collaboration for Systematic Reviews of Interventions [19]. We searched studies included in PubMed, the Cochrane Central Register of Controlled Trials, EMBASE, Chinese National Knowledge Infrastructure (CNKI), and Wanfang Data Information Site. ...
... Meanwhile, the search was limited to humans. We applied the Cochrane sensitivity-maximizing and Cochrane sensitivity and precisionmaximizing strategies as our special search strategies [19]. ...
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Background Use of elective high frequency oscillatory ventilation (HFOV) compared with conventional mechanical ventilation (CMV) results in a small reduction in the risk of chronic lung disease (CLD) or death, but the evidence is weak. Our objective was to explore whether elective HFOV was associated with less CLD or death as compared with CMV in preterm infants administered surfactant. Methods We conducted a systematic review and meta-analysis, including 1835 ventilated participants from 11 randomized controlled trials comparing elective HFOV with CMV between February 1993 and February 2014. The primary outcome was the incidence of CLD or death. Results Compared with CMV, elective HFOV was associated with less CLD or death (relative risk (RR) 0.76, 95% confidence interval (CI) 0.61–0.94, p = 0.01) (p = 0.01, I² = 55%), CLD (RR 0.71, 95%CI 0.53–0.93, p = 0.01) (p = 0.03, I² = 50%), and ≥2nd stages of retinopathy of prematurity (RR 0.77, 95%CI 0.62–0.94, p = 0.01) (p = 0.42, I² = 0%). In the subgroup of > 1 dose of surfactant, compared with CMV, elective HFOV was also related to less CLD or death (RR 0.87, 95%CI 0.77–0.98, p = 0.02) (p = 0.10, I² = 42%). No differences were found in the incidences of death, grade 3 or 4 of intraventricular hemorrhage, periventricular leukomalacia, airleak and necrotizing enterocolitis between the two groups. Conclusion Elective HFOV is superior to CMV in reducing the incidence of CLD or death in ventilated preterm infants administered surfactant, especially in the subgroup of >1 dose of surfactant. Trial registry International Prospective Register of Systematic Reviews: No.: CRD42022301033; URL: https://www.crd.york.ac.uk/PROSPERO/.
... An overall summary risk estimate and the corresponding 95% confidence interval along with a forest plot were generated using the random-effects model (DerSimonian and Laird) [71]. A random effects model was chosen as the studies varied on several aspects including exposure characterization, outcome measurement, population characteristics, and adjustment for confounders [72]. ...
... For the overall summary effect estimate, we used the most commonly reported distance buffer across studies, this was either jurisdictional area level comparisons or large buffers such as ≤ 25 km, ≤ 30 km etc. The I-square statistic and its corresponding p-values were used to characterize the heterogeneity in the measures of association across the studies [71]. Egger's test and funnel plot were used to assess potential publication bias. ...
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Introduction Ionizing radiation is a human carcinogen, and there is a public concern but limited evidence that it increases the incidence of cancer among those who live near nuclear power plants (NPPs). Previous analyses of thyroid cancer in these populations have been inconsistent, and the last synthesis was published nearly a decade ago. To address these gaps, we undertook a systematic review and meta-analysis. Methods A search strategy was developed and applied to PubMed, Scopus, and Web of Science databases. A total of 2006 publications were identified, with 11 studies of thyroid cancer incidence that met the inclusion criteria. Study quality was assessed using the Office of Health Assessment and Translation (OHAT) tool. Summary risk estimates relating residential proximity to the NPPs and thyroid cancer were generated using a random effects model. Heterogeneity in the risk estimates was assessed for study features that included: distance to the NPP, study quality, and biological sex. Results The 11 studies were categorized as either highly (n = 8) or plausibly (n = 3) prone to bias, primarily due to the reliance on ecological study designs. The meta-analysis summary relative risk of thyroid cancer among those who live close to NPPs (defined by ≤ 25 km distance or jurisdictional areas (e.g., community, county) relative to those who lived further away was 1.09 (95% CI: 0.93–1.29). The risk estimates were higher for studies that modelled more proximal residential distances (≤ 5 km) to NPPs than larger distances (≤ 25 km and jurisdictional areas). We found that the summary risk (RR=1.29, 95% CI: 0.77-2.16) was stronger among those studies less prone to bias. A non-significant increased risk was found among both men and women, but there was no evidence of sex differences in risk. Conclusion Overall, the findings suggest that living near a nuclear power plant increases the risk of thyroid cancer. The small number of studies on this topic, and the finding of higher risks in studies less prone to bias highlights the need for better-designed studies.
... This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 12 12 and was conducted according to the Cochrane Handbook for Systematic Review of Interventions. 13 The study protocol was registered in PROSPERO (CRD42024547119) before conducting the study. ...
... Where the aforementioned data were not provided in the study, SE and quartiles were used to calculate the SD of the corresponding outcomes. 13 We conducted a Bayesian meta-analysis to investigate the effect of CT on patients with type 2 diabetes using the "brms" package in R software. This package provides a more flexible modeling approach and enables an intuitive interpretation of results by reporting probabilities. ...
Article
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This study aimed to investigate the effects of concurrent aerobic and strength training (CT) in patients with type 2 diabetes and determine the most effective dose of CT. From the inception of the databases to March 2024, we conducted a systematic search of four electronic databases (PubMed, Embase, Web of Science, and Cochrane Library) to identify randomized controlled trials (RCTs) on CT intervention in patients with type 2 diabetes. Two independent authors assessed the risk of bias of the study using the Cochrane Risk of Bias Assessment Tools. Results analyzed included glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), body mass index, body fat percentage, blood pressure, and VO 2 max. Pairwise and dose-response meta-analyses using Bayesian hierarchical random-effects modeling were performed to analyze the effects of CT in patients with type 2 diabetes. From the inception of the databases to March 2024, we conducted a systematic search of four electronic databases (PubMed, Embase, Web of Science, and Cochrane Library) to identify randomized controlled trials (RCTs) on CT intervention in patients with type 2 diabetes. Two independent authors assessed the risk of bias of the study using the Cochrane Risk of Bias Assessment Tools. Results analyzed included glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), body mass index, body fat percentage, blood pressure, and VO 2 max. Pairwise and dose-response meta-analyses using Bayesian hierarchical random-effects modeling were performed to analyze the effects of CT in patients with type 2 diabetes. A total of 1948 participants (935 males) were included in 23 RCTs. The male/female ratio of participants was 52/48; the mean age range was 50–65 years. The results show that CT significantly reduced HbA1c levels (MD=−0.48%, 95% CrI: −0.55 to −0.40), with some heterogeneity among different levels (SD=0.31, 95% CrI: 0.17 to 0.51), and the model converged well. Similarly, FBG levels were also significantly improved (MD=−0.48 mmol/L, 95% CrI: −0.55 to −0.40), with greater heterogeneity (SD=17.73, 95% CrI: 11.23 to 28.09). Additionally, we found a non-linear dose-response relationship between CT and HbA1c levels, with an optimal dose of 1030 METs-min/week (MD=−0.47%, 95% CrI: –0.68 to –0.26, SE=0.11). CT significantly improves several health indicators in patients with type 2 diabetes. A non-linear dose-response relationship was observed between the training dose of CT and HbA1c, and it is recommended that 270 min of moderate-intensity CT or 160 min of vigorous-intensity CT be performed weekly. PROSPERO registration number: CRD42024547119. Keywords: meta-analysis; concurrent aerobic and strength training.
... A series of seven research questions based on the PICO technique (Population, Intervention, Context, and Outcome) [4][5] are constructed to meet our research goal. Table 1 shows the criteria in detail. ...
... The elements and architecture of Textto-Speech synthesizer 4. Outcome It needs to detect elements that are important to researchers. ...
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Introduction: For more than four thousand years, Sanskrit, one of the most important languages, has served us. Owing to the philological, social, scientific, and pharmacological significances, Sanskrit needs to be preserved. It can only be done, when it will reach to young minds and people will get the resources to learn, read and use this language. Context: In the last two decades, few researchers have tried to implement Sanskrit Text-to-Speech (STTS) Systems. In this study, we seek to establish the current state-of-art of STTS by comprehensively identifying and analyzing the previous work. Methods and Procedures: Accordingly, the article represents findings of the Systematic Literature Review (adhered to the model of Kitchenham and Charter) that collected the most relevant literature produced from 2002 to 2024. After the search conducted on 7 databases, the papers were identified as primary studies and were analyzed in detail. Outcome and Results: The outcome of this systematic literature review (SLR) depicted that there is a lack of Sanskrit Text-to-Speech system (STTS) related work and publications in high-quality journals. It also elucidates the framework for the development and execution of the Sanskrit Text-to-Speech system (STTS). Conclusion and Implications: This paper examines the possible methodologies, methods, challenges, and limitations of the Sanskrit Text-to-Speech system (STTS) in order to gain a better understanding of the research dynamics in speech synthesis. Additional
... This study is a systematic review and meta-analysis and was prepared following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) principles used by Liberati et al., 14 the Cochrane Group fundamentals, and the recommendations made by Higgins and Green. 15 ...
... The analysis methods were based on Cheng et al., 17 and the recommendations for reporting effect sizes using the Cochrane Collaboration. 15 The analysis was performed using R ver. 4.3.2 and meta package. ...
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The primary objective of the present review was to report the safety profile of oral ketorolac in adults using the systematic review and meta‐analysis methodology based on clinical trials. The present study is a PRISMA‐based systematic review and risk ratio (RR) meta‐analysis of the adverse events reported in clinical trials that used oral ketorolac; the review includes 50 clinical trials. The RR for the comparison of a single intake of oral ketorolac versus placebo, including all types of adverse events, was RR = 2.59, IC95% (1.5102; 4.4360) with p = 0.02, the RR for the comparison of a multiple intakes of oral ketorolac versus placebo for all types of adverse events was RR = 1.39, IC95% (0.95; 2.05) with p = 0.093, the RR for the comparison of a single intake of oral ketorolac versus active drugs for all types of adverse events was RR = 0.61, IC95% (0.49; 0.77) with p < 0.0001, the RR for the comparison of multiple intakes of oral ketorolac versus active drugs for all types of adverse events was RR = 0.78, IC95%(0.65; 0.93) with p = 0.006. Multiple intakes of 5, 10, or 20 mg of oral ketorolac, in treatment over 1–10 days, do not increase the risk of adverse events compared to placebo and show a tendency to reduce the risk of adverse events compared to active drugs. When a single intake of ketorolac (5, 10, 20, or 30 mg) is compared to a placebo, the risk increases only for trivial and mild adverse events.
... Any discrepancies were resolved by a third reviewer who did not screen the articles initially. Data were extracted in duplicate by the three reviewers in a Research Electronic Data Capture (REDCap) database (197). Variables included study design and information, participant characteristics, intervention RUTF properties and ingredients, compliance to RUTF, and main outcomes. ...
... All participants will be assigned a study identification number at enrolment that will be used on all the data collection forms, helping ensure privacy. The anonymized data will be entered a secure, password-protected Research Electronic Data Capture (REDCap) database accessed by members of the study team only (197). Once recruitment and laboratory analysis are complete, data will be analyzed using R (Version 4.2 or above) (230,231). ...
Thesis
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Ready-to-use Therapeutic Food (RUTF) has improved severe acute malnutrition (SAM) recovery. However, further improvements are needed. The evidence for the effectiveness of lower dairy RUTF is uncertain. Furthermore, WHO-approved RUTFs do not meet the Food Agricultural Organization's required minimum protein quality, potentially impeding SAM survivors' growth. Additionally, the incidence and risk factors for clinical deterioration in critically ill children with SAM post-stabilization are unclear. This thesis aimed to 1) Synthesize the evidence of the effectiveness of lower dairy-sourced protein RUTF against WHO-approved RUTF. 2) Design a proof-of-concept randomized control trial (PoC-RCT) that compares the effectiveness of a higher protein quantity and quality RUTF to WHO-approved RUTF in treating SAM. 3) Assess the incidence, risk factors and outcomes of failed introduction of RUTF among critically ill children with SAM. A systematic review and meta-analysis of the evidence of the effectiveness of RUTF with <50% dairy-sourced protein against WHO-approved RUTF in treating SAM was conducted. I designed a novel higher-protein RUTF and a PoC-RCT to test the potential effectiveness of a higher-protein RUTF in improving linear growth during SAM treatment. Lastly, using a secondary analysis of a cohort, I assessed the incidence and associated factors of clinical deterioration among critically ill children with SAM when transitioning to RUTF. Lower dairy RUTFs were not as effective as WHO-approved RUTFs in achieving weight gain (standardized mean difference:-0.20; 95% CI:-0.26,-0.15) but did not differ in linear growth (mean difference:-0.05; 95% CI:-0.13, 0.04). A PoC-RCT assessing the effectiveness of a novel higher-protein RUTF compared to WHO-approved RUTF was designed. Lastly, among critically ill children with SAM, a longer stabilization was associated with a lower hazard of clinical deterioration (hazard ratio 0.92, 95%CI iii 0.86-0.98). There is a need to investigate RUTFs that are as effective as the WHO-approved RUTF in improving weight gain and enhance linear growth. There is also a need to identify clinical features that necessitate a longer clinical stabilization among critically ill children with SAM. The findings from the PoC-RCT will be critical in informing the potential effectiveness of higher-protein RUTF in improving linear growth during SAM treatment. iv
... We did not conduct meta-regression because fewer than 10 studies in the model with RR were available. 24 We performed sensitivity analyses excluding the studies with some concerns about bias identified by the RoB2 tool 25 for RCTs and NOS 26 for observational studies. We used Egger's test and funnel plots to examine publication bias. ...
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Introduction In people living with chronic obstructive pulmonary disease (COPD), we aimed to estimate: (1) the prevalence of glucocorticoid‐induced hyperglycaemia (GIH); (2) whether the prevalence of GIH varies by age, baseline diabetes status, treatment duration, ascertainment of glycaemia, definition of hyperglycaemia, study design and year of publication; and (3) the relative risk (RR) of new‐onset hyperglycaemia in exposed vs non‐exposed to systemic glucocorticoids. Methods We searched electronic databases until 9 November 2023 for randomised controlled trials and observational studies including adults diagnosed with COPD, with or without diabetes at baseline, using systemic glucocorticoids equivalent to prednisolone ≥5 mg/day for ≥3 days if exposed. Hyperglycaemia was defined as a blood glucose above a study‐specific cut‐off. We extracted data on study and participant characteristics, exposure and outcome. We performed random‐effects meta‐analysis to calculate pooled prevalence estimate of GIH. Prevalence was expressed as the proportion of people who developed hyperglycaemia among all exposed to systemic glucocorticoids during follow‐up. We calculated RR of new‐onset hyperglycaemia in exposed vs non‐exposed to systemic glucocorticoids from eight studies. Results Of 25,806 citations, we included 18 studies comprising 3642 people of whom 3125 received systemic glucocorticoids and 1189 developed hyperglycaemia. Pooled prevalence of GIH was 38.6% (95%CI 29.9%–47.9%) with significant heterogeneity, I ² = 96% ( p < 0.010), which was partially explained by differences in study design. Pooled RR = 2.39 (95%CI 1.51–3.78). Publication bias was present. Conclusion The prevalence of GIH was 38.6%. Being treated with systemic glucocorticoids for COPD was associated with 2.4 times higher risk of new‐onset hyperglycaemia versus no glucocorticoid treatment.
... Our approach followed the Population, Exposure, Concept / Context, Outcome and Study (PECOS) [27] framework and identified studies eligible for inclusion using the following criteria: ...
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Introduction: Despite the broad improvement in air quality, air pollution remains a major leading global risk factor for ill health and deaths each year. Air pollution has a significant impact on both health and economic growth in Africa. This paper reviews the health impacts of air pollution and the benefits of air pollution mitigation and prevention on climate change. Methods: We conducted a narrative review and synthesized current literature on the health impact of air pollution in the context of changing climate in Africa. Results: Particulate matter (PM2.5) concentrations in Africa pose significant health risks due to various sources, including household fuels and industrial emissions. Limited air quality monitoring hampers accurate assessment and public health planning. Africa’s rapid urbanization exacerbates air pollution, impacting vulnerable populations disproportionately. Renewable energy adoption and improved monitoring infrastructure are crucial for mitigating air pollution’s economic and health impacts. Recommendations include adopting air quality standards, identifying pollution sources, and prioritizing interventions for vulnerable groups. Integrating renewable energy into development plans is essential for sustainable growth. African leaders must prioritize environmental policies to safeguard public health amid ongoing industrialization. Conclusions: Air pollution prevention remains a vital concern that requires leaders to engage stakeholders, and other opinion leaders in society. African leaders should proactively explore new avenues to integrate non‑polluting renewable energy sources such as solar power, wind and hydropower into their national development plans.
... The values of Hedges' g can be interpreted as units of standard deviation of the effect, where 0.2, 0.5, and 0.8 represent small, medium, and large effect sizes, respectively [26]. However, if a standard difference (SD) was not provided, standard errors, 95% confidence intervals, p-values, or t-statistics were used to calculate SD values [27]. Finally, to calculate the change in SD before and after the intervention, we assumed a fixed correlation coefficient of R = 0.5 to estimate the effect of within-group correlation. ...
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Background During long-term treatment, breast cancer survivors (BCSs) often experience decreased sleep quality and quality of life and increased fatigue. The interplay between these factors continually worsens the physical and psychological states of BCSs. Although yoga exercise has been shown to improve these adverse outcomes, the exact dose required is unknown. The purpose of our study was to determine the optimal yoga dose for improving cancer-related fatigue, sleep quality, and quality of life in BCSs. Methods A systematic search of MEDLINE, Embase, the Cochrane Library, and Web of Science was conducted from the beginning of the database search until March 2024 to identify randomized controlled trials on the effects of yoga exercise on BCS-specific outcomes. Paired and dose–response meta-analyses were performed using Bayesian hierarchical random-effects models to analyze these effects. Results A total of 2423 breast cancer survivors were included in the 32 studies, with 1252 in the yoga intervention group and 1171 in the control group. Yoga intervention improved fatigue (standard mean difference [SMD]: − 0.55; 95% CrI, − 0.64 to − 0.45. Standard deviation [SD]: 0.32; 95% CrI, 0.23 to 0.45. RSRF ≤ 1.01), sleep quality (SMD: − 0.29; 95% CrI, − 0.43 to − 0.15. SD: 0.56; 95% CrI, 0.35 to 0.88. RSRF ≤ 1.01), and quality of life (SMD: 0.42; 95% CrI, 0.30 to − 0.53. SD: 0.32; 95% CrI, 0.23 to 0.45. RSRF ≤ 1.01) in BCS. It has a nonlinear dose–response relationship, a U-shaped dose–response relationship with fatigue and quality of life, and a positively correlated dose–response relationship with sleep quality. The optimal exercise dose for improving both fatigue and quality of life was 510 METs-min/week, and sleep quality significantly improved when the dose exceeded 160 METs-min/week. Yoga was less effective for fatigue during treatment compared to post-treatment, while its effects on quality of life and sleep quality remained relatively stable throughout both periods. Furthermore, with increasing age, the benefits of yoga interventions for improving fatigue and sleep quality in BCS decrease, while the benefits for improving quality of life increase. Conclusions This meta-analysis provided critical information on the optimal weekly dose of yoga exercise (220 min/week) to improve fatigue, sleep quality, and quality of life in patients with BCSs. Practitioners should consider the therapeutic stage and age of BCSs when developing yoga strategies to maximize the benefits. Implications for Cancer Survivors For BCS, personalized yoga interventions tailored to treatment stages and age, coupled with regular effectiveness assessments, can significantly enhance recovery and improve quality of life.
... Cochran's Q and inconsistency I² tests analyzed the statistical heterogeneity of treatment effects among studies. I 2 values over 50% indicated substantial heterogeneity [17]. Pooled-effect estimates were obtained by comparing the standardized mean difference between bond strengths of etch-and-rinse and self-etch modes. ...
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Objectives This systematic review aimed to detect whether acid etching pretreatment would enhance the bond strength of universal adhesives (UAs) to caries-affected dentin before and after aging. Methodology Two independent researchers reviewed materials published until August 2024 in five databases (Web of Science, PubMed, SciELO, Scopus, Science Direct, and Cochrane Library). The eligibility criteria contained in vitro studies that assessed the bond strength of UAs to caries-affected dentin using etch-and-rinse and self-etch modes, with or without aging. Statistical meta-analysis was performed using inverse variance method by the Review Manager program (p < 0.05). Results In total, 26 studies were included in the quantitative analysis. Studies have mostly focused on mild UAs. The application of acid etching did not impact the bond strength of ultra-mild and mild UAs (p > 0.05). Aging considerably reduced the bond strength of mild UAs in etch-and-rinse or self-etch modes (p < 0.05). Bond strength to caries-affected dentin was considerably lower than that to sound dentin in both etching modes (p < 0.05). Conclusions Pretreatment with phosphoric acid did not affect the bond strength of mild and ultra-mild UAs to caries-affected dentin. The aging process led to a decrease in the bond strength of mild UAs to caries-affected dentin, irrespective of the application strategy.
... This systematic review was prepared according to the Cochrane Handbook for Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). [4][5][6] This systematic review could not be registered in the International Prospective Register of Systematic Reviews (PROSPERO) as it is only dedicated to reviews of studies in humans or animals, and this is a review of in vitro studies. ...
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Background: The aim of this study was to compare the mechanical properties of the polymer brackets with metal and ceramic brackets and verify if the polymer brackets could be used clinically. Materials and Methods: A thorough search was conducted in four electronic databases, including Scopus, PubMed, Cochrane, Ovid, and Lilacs, with article selection based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis standards. A computerized search of the database was done from January 1990 to June 2024. Two independent reviewers were involved in study selection, data extraction, and synthesis. Disagreements were resolved by discussion with a third reviewer. The risk of bias was assessed by the quality assessment tool for in vitro studies (QUIN tool). The outcomes measured included permanent deformation, hardness, and torquing capacity. Results: Ten studies were selected after excluding duplicates, screening, and complete text reading to identify the articles that met the eligibility criteria. All ten studies showed medium risk based on the quality assessment tool for in vitro studies (QUIN Tool). Conclusion: The following findings were obtained: Polymer brackets have lower mechanical properties in terms of torque loss, fracture resistance, hardness, and torsional creep compared to metal brackets. Among the polymers listed in the studies, it was found that polyamide exhibited low hardness and polyoxymethylene exhibited the highest torque loss. Torque deformation was highest with a ceramic-reinforced polymer bracket, followed by pure polymer. Torque deformation was minimal with metal slot-and ceramic-reinforced polymers, followed by metal slot-reinforced polymers.
... Disagreements were resolved through consensus. The exploration of publication bias and heterogeneity through Egger's test, meta-regression, and funnel plot was not executed due to the high chance of falsepositive results due to the review being less than ten studies, as recommended by Cochrane (Higgins et al. 2008). ...
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Background Osteoarthritis (OA) is a common joint disorder causing pain and stiffness, with limited effective treatment options. Methotrexate, known for its anti-inflammatory properties in rheumatoid arthritis, is being explored as a treatment for OA. This study evaluates Methotrexate's efficacy compared to placebo in reducing OA symptoms, such as stiffness in the knee and hand, and its impact on pain, physical function. Methods We systematically searched PubMed, Google Scholar, Embase, Web of Science, and Cochrane databases for randomized controlled trials (RCTs), analyzing the efficacy of Methotrexate compared to placebo in patients with OA. We pooled risk ratios (RR) for binary outcomes. For continuous outcomes, we used standard mean difference (SMD) and mean difference (MD) with 95% confidence intervals (CI). Outcomes included were related to knee and hand pain, knee stiffness, and similar outcomes. We used R version 4.4.1 for statistical analyses. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach evaluated the quality of evidence. Results This analysis included 5 RCTs comprising 465 patients, of whom 229 were randomized to Methotrexate. The age ranged from 52.4 to 67.5 years among studies. Compared with placebo, Methotrexate significantly reduced knee and hand stiffness at the end of follow-up (SMD − 0.36; 95% CI − 0.57 to − 0.15; p< 0.01), knee and hand stiffness at 6 months of follow-up (SMD − 0.48; 95% CI − 0.70 to − 0.27; p< 0.01). Conclusion Methotrexate significantly reduced knee stiffness in both knee and hand OA. However, current literature might be underpowered, more robust RCTs are necessary to validate these findings.
... The systematic review study protocol was developed using guidelines provided by the Cochrane Collaboration [29]. The protocol detailed the research question and outcomes of interest, outlined a search strategy and the process of data extraction, and provided criteria for rating the quality of evidence (Supplemental Materials). ...
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Many domesticated dogs show signs of anxiety, negatively impacting their own and their owner’s mental and physical health. A systematic review evaluating whether pressure wraps decrease clinical signs of anxiety in dogs was completed to identify relevant studies. The main outcomes of interest included behavioral and physiological measures. A total of 229 studies were identified, of which four met the inclusion criteria. Commercially available pressure wraps and a telemetry vest were used in the reviewed studies. Three experimental studies included brief exposure to recorded firecracker or thunderstorm sounds or separation from their owner as anxiety-invoking stimuli. A non-experimental study evaluated the use of pressure wraps for dogs with thunderstorm phobia living in their home environment exposed to naturally occurring thunderstorms. The risk of bias in domains related to the blinding of investigators or study participants was generally high. Domains with moderate risk of bias often reflected incomplete reporting of research methods and imprecision due to small sample sizes. Most studies reported minimal benefits on behavior or heart rate in the absence of adverse side effects. Our review suggests there is weak and limited evidence to support the beneficial effect of pressure wraps in reducing physiological or behavioral signs of anxiety. Confidence in the available literature is low due to the moderate-to-high risks of bias and inconsistent findings. Further studies are needed regarding the efficacy of these products.
... We followed the Cochrane Handbook of Systematic Reviews of Interventions (Higgins and Green 2008) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Moher, Liberati, and Fau 2009) during this metaanalysis. The protocol of this systematic review and meta-analysis was registered on the INPLASY website (https://inplasy.com/ ...
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Long‐chain n–3 polyunsaturated fatty acid (PUFA) consumption in maternal and infants has been positively associated with cognitive and visual development. Tails even meta‐analysis showed mixed results. To evaluate the effects of maternal and infant n–3 PUFA supplementation on childhood psychomotor and cognitive development, PubMed, Embase, the Cochrane Library, PsycINFO and clinicaltrials.gov were searched. Randomized controlled trials were included to evaluate the effect on child cognitive and psychomotor outcomes of n–3 PUFA supplementation in mothers or infants (age ≤ 2 years). Findings were pooled with mean differences (MD) with 95% confidence intervals (95% CIs). Heterogeneity was explored using I² and subgroup analyses, stratified for maternal (pregnancy and/or lactation) and infant (preterm infant and term infant). We identified 47 articles, with 14 trials on mothers and 33 on infants. Pooled results showed that infants' mental development index (MDI) increased with n–3 PUFA supplementation (MD = 2.91, 95% CI: 1.32–4.51, I² = 65.1%). Subgroup analysis of MDI also demonstrated a benefit in preterm infants (MD = 4.16, 95% CI: 1.40–6.93, I² = 49.5%) and term infants (MD = 2.28, 95% CI: 0.27–4.29, I² = 70.1%). No significant association was found in subgroup analyses of supplementation to mothers during pregnancy or lactation period. Supplementation did not increase the psychomotor development index (PDI) in the mother or infant group. Language composite score increased for infants whose mothers accepted supplementation in pregnancy or breastfeeding (MD = 8.57, 95% CI: 5.09–12.04, I² = 70.2%). The cognitive composite score did not improve in any subgroup. Intelligence Quotient (IQ) increased in the infants' group with n–3 PUFA supplementation (MD = 2.54, 95% CI: 0.45–4.63, I² = 66.0%). Furthermore, IQ in term infants also improved (MD = 2.91, 95% CI: 0.24–5.57, I² = 69.2%). The funnel plot and Egger's test confirmed no publication bias in any endpoints. Supplementation with n–3 PUFA during pregnancy or breastfeeding in mothers has increased language abilities. Furthermore, direct supplementation in term infants can improve intelligence in later childhood. However, insufficient evidence supports the claim that supplementation improves cognitive abilities.
... Following the Cochrane recommendations [32], we constructed a systematic narrative synthesis using the information contained in each published source study's text and tables to summarize and explain that study's characteristics and findings. We listed, tabulated, and qualitatively reported the characteristics of our reviewed studies, including the participants, outcome measure (s), and the study quality (risk of bias). ...
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Emerging research suggests that the increasing population of Arab immigrants and refugees living in the United States (U.S.) has a greater risk for depression and anxiety than other groups. The purpose of this meta-analysis was to estimate the prevalence of depression and anxiety for Arabs in the U.S., to examine the moderating effects of key demographic variables (gender, immigration status, ethnicity) and study characteristics (research design and quality) on the prevalence of anxiety and depression, and to evaluate the direct effects of additional demographic and study characteristics on prevalence rates. Using guidelines from the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P), we searched PubMed, Embase, CINHAL, ProQuest, and the Web of Science databases for articles published between January 2000 and March 2023. Two reviewers each individually extracted the articles’ data and evaluated the reported study’s methodological quality using a well-established checklist. Statistical analyses consisted of random effects models to estimate the pooled prevalence of depression and anxiety across all studies, separate random effects models for distinct demographic (e.g., immigration status) and methodologic (e.g., study quality) subgroups that might have unique prevalence rates, and a meta-regression to identify additional variables (e.g., age of individuals) that might influence prevalence rates. Our review included 17 studies with a total sample population size of 22, 558 participants. Results indicated that the estimated prevalence of depression overall was 48% (CI 34, 63%) and 58% (CI 33, 83%) for the prevalence of anxiety. Our subgroup analyses uncovered notable variations in prevalence rates based on gender composition, immigration status, ethnicity, and research quality while results of the meta-regressions demonstrated effects of publication year and age of the Arab individual on the estimated prevalence of depression and anxiety. The high prevalence rates for depression and anxiety identified through this meta-analysis are very concerning and underscore the urgent need to address mental health concerns in Arab communities. Results of subgroup and meta-regression analyses suggest that refugees, individuals from specific countries of origin, and younger Arabic persons may need particular attention by clinicians in screening for and treating their depression and anxiety. Our results also signify the need for further high-quality studies to more rigorously assess prevalence of these mental health problems, since we found evidence of potential publication bias and approximately one third of the studies in the review had less optimal methodological quality based on our evaluation. Ultimately, in-depth research regarding the causes of anxiety or depression among Arab individuals will be essential to the development of culturally competent interventions that may reduce their very high prevalence rates.
... Cochrane Q-test and I 2 statistics was used to detect heterogeneity, as such 25%, 50%, and 75% I 2 values were used as cut off points for mild, moderate and significant heterogeneity, respectively. 19,20 Possible causes of heterogeneity were investigated using subgroup analysis with reference to publication year, African Regions, type of centers, type of study setting, type of publication, and primary focus of the study. These findings were presented graphically using a forest plot. ...
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Objective. To systematically review studies to provide the pooled estimate of undernutrition among children and adolescents with cancer living in sub-Saharan African countries. Methods. The review followed the recommendations outlined in the PRISMA statement. Online searches were performed on electronic databases such as PubMed, Scopus, Embase, and Hinari; gray literature sources: such as Google, Google Scholar, and university repositories were also searched. A random effect model was used to drive the pooled prevalence, and was reported at a 95% Confidence Interval (CI). Heterogeneity was assessed using subgroup analysis and univariable meta-regression. The effect of each study on the overall prevalence was assessed using leave-one-out sensitivity analysis. In all the models, statistical significance was set at P-value <.05. Result. A total of 623 articles were identified, and 21 articles were retrieved for the final analysis. The overall pooled prevalence of undernutrition was 41.34% (95% CI: 31.64%, 51.04%). The highest prevalence of undernutrition was observed from studies that used Arm Muscle Area (AMC) for age to assess undernutrition: 61.66% (95% CI: 47.59%, 75.72%). The protocol for this review has been registered at PROSPERO (CRD42024510052). Conclusion. The prevalence of undernutrition in sub-Saharan African countries was considerably high. Therefore, policy directions and cost-effective approaches that sustainably address undernutrition among pediatric patients with cancers are needed.
... The risk of bias in the clinical trials was evaluated in accordance with the guidelines set forth by the Cochrane Collaboration [31]. The Rob2 (Revised Cochrane risk of bias tool for randomized trials; current version, 22 August 2019 version) was used to evaluate the clinical trials in accordance with the following domains: randomization process, deviation from intended intervention, missing outcome data, measurement of the outcome, and selection of the reported results [32]. ...
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Major depressive disorder (MDD) and diabetes mellitus (DM) remain among the most prevalent diseases and the most significant challenges faced by medicine in the 21st century. The frequent co-occurrence and bidirectional relationship between the two conditions necessitates the identification of treatment strategies that benefit both. The purpose of this study was to systematically review and meta-analyze data on the efficacy and safety of agomelatine (AGO) in the treatment of patients with depression with comorbid diabetes to explore its potential mechanism of action in both diseases and its impact on diabetic parameters. Following PRISMA guidelines, a total of 11 studies were identified, both preclinical and clinical trials. Agomelatine has shown great potential as a treatment option for patients with diabetes and comorbid depression and anxiety. In addition to improving depressive and anxiety symptoms, it is also beneficial in glycemic control. A meta-analysis demonstrated a statistically significant reduction in glycated hemoglobin (HbA1C) and fasting blood glucose (FBG) levels following AGO administration over a period of 8–16 weeks. The administration of agomelatine was found to result in a significantly greater reduction in HbA1C than that observed with the selective serotonin reuptake inhibitor (SSRI) medications (namely fluoxetine, sertraline, and paroxetine) during 12–16 weeks of therapy. Furthermore, AGO has been found to be at least as effective as SSRIs in reducing depressive symptoms and more effective than SSRIs in reducing anxiety symptoms. The safety of such treatment is similar to SSRIs; no severe adverse events were reported, and the incidence of some side effects, such as insomnia and sexual dysfunction, are even less often reported. Particularly promising is also its potential action in improving some diabetic complications reported in preclinical trials. This might be through mechanisms involving the reduction in oxidative stress, anti-inflammatory effects, and potentially noradrenergic or NMDA receptor modulation. Further clinical studies on larger sample sizes, as well as elucidating its mechanisms of action, especially in the context of diabetic complications, are needed. Research should also focus on identifying the patient subpopulations most likely to benefit from agomelatine treatment.
... 17,18 Values of I 2 greater than 50% are indicative of important heterogeneity. 17,19 The critical value for rejecting the null hypothesis was set at a level of 0.05 (twotailed). The pooled data for each outcome were reported as difference between experimental and control groups and their 95% confidence intervals (95% CI). ...
... We conducted a thematic synthesis [31] of qualitative studies that reported experiences of violence by people in insecure migration status. This report follows the Cochrane guidance for undertaking a systematic review [32] and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting checklist [33]. The protocol was prospectively registered on PROSPERO [CRD42021268772] [34]See Appendix 1. ...
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Background The global movement of people in the context of strict immigration laws and policies places significant numbers of people in insecure migration status worldwide. Insecure status leaves people without recourse to legal, governmental or social protection from violence and abuse. This review synthesized qualitative studies that reported how migrants associated physical and physically enforced sexual violence they experienced with their insecure migration status. Methods We conducted a qualitative evidence synthesis of 31 studies published between 1 January 2000 and 31 May 2023, with data from Europe, North America, East Asia, South Asia, the Middle East and Africa. Our thematic synthesis produced 14 inductive descriptive codes, four descriptive themes and three analytical themes. Results We generated robust qualitative evidence showing that women experienced sexual violence while in transit or without status in a host state, and that they associated that violence with their insecure migration status. This was the case across the various geographic routes and destination countries. We found evidence that women associated intimate partner violence with lacking (legal) access to support because of their insecure migration status. We found evidence that women connected their unwillingness to leave violent circumstances, and therefore their prolonged or repeated exposure to violence, with a fear of immigration removal produced by their insecure migration status. Conclusion To protect people in insecure migration status from experiencing violence that they associated with their migration status, it’s necessary to ensure that the reporting of violence does not lead to immigration enforcement consequences for the victim.
... 95% CI = -0.19 to 0.07; p = 0.35) with no heterogeneity among the studies (I 2 = 0%, heterogeneity p = 1.00, Figure 2), but was able to significantly decrease the ocular symptom score on 7 days (MD = -0.09; 95% CI = -0.16 to -0.01; p = atic Reviews of Interventions [19,20]. No ethical approval or patient consent was needed because the meta-analysis was performed by using previously published studies. ...
... O estudo consiste em uma revisão sistemática, envolvendo a busca de estudos relevantes publicados na literatura acadêmica, com vistas a localizar conceitos, evidências, temas e estratégias que forneça explicações relacionadas a questão de pesquisa e apresentar a síntese qualitativa dos resultados (Higgins;Green, 2008;Siddaway et al., 2019). ...
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Aprender a aprender envolve mecanismos mentais para se adquirir e reter conhecimentos. Esse processo requer a mediação ativa do professor a fim de engajar os estudantes em uma aprendizagem reflexiva e no desenvolvimento de habilidades metacognitivas. Diante disso, o objetivo desse estudo é apresentar ações voltadas para o desenvolvimento da competência "aprender a aprender" e habilidades de autonomia na aprendizagem no contexto do ensino de enfermagem, baseada em uma revisão sistemática de literatura. A metodologia atendeu as diretrizes da declaração PRISMA, resultando em vinte e dois estudos para análise exploratória de mecanismos e práticas acadêmicas empregadas. Observou-se que, ao longo do tempo, práticas voltadas para o aprender a aprender estão ancoradas em estratégias cognitivas e metacognitivas que levam à autoaprendizagem, e mais recentemente, há maior incidência do uso de mediadores tecnológicos como ambientes virtuais de aprendizagem, gamificação, redes sociais e escape room. Os resultados apontaram que as intervenções no campo do ensino em saúde representam experiências positivas, e ainda que o aspecto metacognitivo associado à gamificação pode contribuir ainda mais para o desenvolvimento da competência de aprender a aprender.
... The presence of statistical heterogeneity was checked using the Chi-square test (Cochran Q test) at a p-value of ≤ 0.05. Heterogeneity between the studies was checked using I 2 statistics, and we considered an I 2 75% and above as significant heterogeneity [21]. ...
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Background The burden of pediatric HIV/AIDS, mother-to-child transmission rate, and unintended pregnancy among HIV-positive women remain high in sub-Saharan Africa, including Ethiopia. Provision of contraceptives is an undeniable strategy to overcome the risks. However, pooled data to provide informed decisions on modern contraceptive use among HIV-positive women attending ART clinics in Ethiopia are meager. Hence, this review aimed to estimate the magnitude of modern contraception, and revisable long act contraceptives methods (RLCM) use and associated factors among HIV positive ART clinic attending women. Methods A systematic review and meta-analysis was conducted using PubMed, Google, Cochrane library, Web of Science, Google Scholar, and Scopus database. A funnel plot and Egger’s regression test were used to assess publication bias. Heterogeneity of studies was assessed using I-square statistics and the Joanna Briggs Institute (JBI) quality assessment tool was applied to ensure the quality of the included articles. We employed a random-effect model to pool the national utilization of modern contraceptives and the effect size of associated factors. We conducted sub-group analysis by regions to control heterogeneity and to detect variation. Results A total of 21 studies were included in the meta-analysis. The magnitude of pooled utilization of modern contraceptive and RLCM was 60% [95% CI: 52–68] and 11%, [95% CI: 8–14], respectively. In the random effect model, young women [OR = 2.36, 95% CI: 1.78–3.13], attending secondary school and above [AOR = 1.34, 95% CI: 1.06–1.69], having two or more live children [AOR = 1.84, 95% CI: 1.46–2.34], discussion with a husband [AOR = 2.92, 95% CI: 2.39–3.57], CD4 > 250cells/mm³ [AOR = 1.59, 95% CI: 1.08–2.33], and using HAART [AOR = 1.71, 95% CI: 1.35–2.15] increased odds of modern contraceptive methods utilization. Conclusion Overall the utilization of RLCM among modern contraceptive users HIV positive women is low. Therefore, to improve the uptake of RLCM among modern contraceptive users HIV positive women, policymakers and program designers need to take into account age and educational levels of women and programs which enhance reproductive health consultation habit between couples. Moreover, integration of family planning services to ART clinics needs to be strengthened.
... 62,63 There is also insufficient evaluation of the safety and efficacy of ketamine in real-world settings. 64 Moreover, while a diverse set of study populations was included in this analysis, the samples were often disparate, indicating sample heterogeneity and consequently raising questions about the generalizability of the findings. ...
Article
Background Inadequate response to first- and second-line pharmacological treatments for psychiatric disorders is commonly observed. Ketamine has demonstrated efficacy in treating adults with treatment-resistant depression (TRD), with additional off-label benefits reported for various psychiatric disorders. Herein, we performed a systematic review and meta-analysis to examine the therapeutic applications of ketamine across multiple mental disorders, excluding mood disorders. Methods We conducted a multidatabase literature search of randomized controlled trials and open-label trials investigating the therapeutic use of ketamine in treating mental disorders. Studies utilizing the same psychological assessments for a given disorder were pooled using the generic inverse variance method to generate a pooled estimated mean difference. Results The search in OVID (MedLine, Embase, AMED, PsychINFO, JBI EBP Database), EBSCO CINAHL Plus, Scopus, and Web of Science yielded 44 studies. Ketamine had a statistically significant effect on PTSD Checklist for DSM-5 (PCL-5) scores (pooled estimate = ‒28.07, 95% CI = [‒40.05, ‒16.11], p < 0.001), Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) scores (pooled estimate = ‒14.07, 95% CI = [‒26.24, ‒1.90], p = 0.023), and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores (pooled estimate = ‒8.08, 95% CI = [‒13.64, ‒2.52], p = 0.004) in individuals with PTSD, treatment-resistant PTSD (TR-PTSD), and obsessive compulsive disorder (OCD), respectively. For alcohol use disorders and at-risk drinking, there was disproportionate reporting of decreased urge to drink, increased rate of abstinence, and longer time to relapse following ketamine treatment. Conclusions Extant literature supports the potential use of ketamine for the treatment of PTSD, OCD, and alcohol use disorders with significant improvement of patient symptoms. However, the limited number of randomized controlled trials underscores the need to further investigate the short- and long-term benefits and risks of ketamine for the treatment of psychiatric disorders.
... This meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) Statement and recommendations from Cochrane Collaboration Handbook for Systematic Reviews of Interventions [15]. We prospectively registered our research protocol in the International Prospective Register of Systematic Reviews (PROSPERO) on 2024 (ID CRD42024555273). ...
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Objective We aim to perform a systematic review and meta-analysis to analyze the efficacy and safety of low-cost meshes compared to polypropylene meshes for IHR. Methods We searched Pubmed, Embase, Cochrane, and Web of Science for randomized controlled trials (RCTs) comparing low-cost and standard meshes for IHR. Low-cost mesh was defined as a material non-designed for medical use. The primary outcomes analyzed were postoperative pain, recurrence, surgical site infection (SSI), seroma, and hematoma rates. Statistical analysis was done using R software. Results 8 RCTs were ultimately included in our study with 788 patients, of which 394 (50%) underwent IHR repair with low-cost mesh. Surgical techniques employed were Lichtenstein repair in 7 studies, and laparoscopic totally extraperitoneal (TEP) repair in 1 RCT. No statistically significant differences for both superficial (2.8% vs. 2.8%; RR 0.98; 95%CI 0.4–2.43; P = 0.97; I² = 0%), deep SSI (0% vs. 0.31%; RR 0.33; 95%CI 0.01–7.91; P = 0.5; I² = 0%) and overall SSI (3.6% vs. 4.3%; RR 0.83; 95%CI 0.42–1.66; P = 0.6; I² = 0%) were evidenced. Recurrence rate at 1 year was similar between the groups analyzed (0.66% vs. 0%; RR 2.95; 95%CI 0.31–27.95; P = 0.35; I² = 0%). No differences were found for hematoma (12.6% vs. 12.6%; RR 0.99; 95%CI 0.67–1.47; P = 0.98; I² = 0%) and seroma (1.97% vs. 2.33%; RR 0.83; 95%CI 0.29–2.4; P = 0.73; I² = 0%) rates. Conclusion This meta-analysis found similar postoperative complication rates for both low-cost and standard polypropylene meshes following IHR. PROSPERO registration ID CRD42024555273.
... We conducted an umbrella review of meta-analyses and systematic reviews following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) (Moher et al., 2015). The methodology of our study was based on the Cochrane protocol for overviews of reviews and the Joanna Briggs Institute approach for umbrella reviews (Aromataris et al., 2014;Jpt, 2008). Our umbrella review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO ID: CRD42024546080). ...
... The determination for such an analysis will be at the discretion of the authors, with appropriate statistical input, contingent upon their assessment of discernible dissimilarities among study subpopulations (such as international, elite, and amateur cohorts), exposure types (per 1000hrs, 100rides,100 riders), and reported outcome metrics. This decision-making process aligns with the guidelines advocated by Higgins and Green and Borenstein et al. (13,14). As per the IOC consensus statement extension for the reporting of injuries and illness in cycling. ...
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Introduction The sport of cycling has witnessed phenomenal growth over the past decade. Globally, over 200 million television hours across five continents watched the recent inaugural World Championships in Glasgow, in 2023. The Union Cycliste Internationale (UCI), the world cycling governing body, has highlighted its mission to “promote and support research in cycling epidemiology and medicine, especially for the benefit of lesser-known disciplines” within its 2030 Agenda. This paper outlines a proposed protocol to conduct a systematic review that comprehensively analyses and synthesises the existing literature about cycling-related injuries and illness across all competitive disciplines. Methods The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines will be followed through each stage of this systematic review. Cycling is an umbrella term used for many individual disciplines. Investigation of all types of injuries and/or illnesses sustained during training and/or competition among competitive athletes across all disciplines will be included in this review. A computerised, systematic literature search will be conducted in electronic databases MEDLINE, Scopus, Embase, and Cochrane Library. Independent screening by two reviewers in a two-step process: title/abstract screening followed by full-text review. The reference lists of included articles will be searched to identify any other potentially relevant articles. Narrative synthesis and tabular/charted presentation of the extracted data will be included. Discussion This protocol paper outlines the methodology to conduct a systematic review of injuries and illness across all competitive cycling disciplines. The aims of outlining this systematic review protocol are to aid research transparency, help reduce publication bias, prevent selective publication, and prevent the selective reporting of results. Future systematic reviews based on the proposed protocol will summarise the known prevalence, incidences, locations and burden of injury and illness across the sport of cycling. Trial Registration This study has been registered with the PROSPERO International Prospective Register of Systematic Reviews (registration number CRD42024502703).
... Data were analyzed through a narrative synthesis and, whenever possible, through a meta-analysis. For the meta-analyses that added diferent tools, we calculated the standardized diference of means and its standard error [27]. Te meta-analysis was performed by another researcher. ...
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Purpose: Fibromyalgia is a chronic disease that mainly affects women, deteriorating the quality of life of these patients. Resistance exercise (RE) has been shown to be beneficial in this disease. The objective of this study is to evaluate the effectiveness of RE for depression, fatigue, and sleep quality in women with fibromyalgia. Design and Methods: A systematic review with meta-analysis was conducted until September 1, 2024. Seven databases were searched as follows: PubMed, Cochrane Library, Web of Science, Scopus, Physiotherapy Evidence Database, Dialnet, and Cumulative Index to Nursing and Allied Health Literature. Randomized clinical trials were conducted in women with a diagnosis of fibromyalgia, including RE as the only intervention in any of the groups and to assess depression, fatigue, and sleep quality. For meta-analyses, we calculated the standardized difference of means and its standard error. A random-effects model was used. The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB 2). PROSPERO Registration: CRD42021256162. Findings: Eleven trials were included in the systematic review and eight in the meta-analysis (n = 664). RE showed statistically significant improvements in depression (SMD = −0.54; 95% CI [−0.92, −0.16], p=0.005) and fatigue (SMD = −0.83; 95% CI [−1.41–0.25], p=0.005). No significant differences were found in sleep quality (SMD = −0.99; 95% CI [−2.40, 0.43], p=0.17). In general, the methodological quality of the included trials was good. Practice Implication: RE is an effective tool to improve depression and fatigue in women with fibromyalgia, achieving clinically relevant improvements of more than 50% in symptoms related to depression. RE did not show benefits for sleep quality, although this finding may be due to a lack of studies. More studies are needed to determine the effectiveness of RE on sleep quality.
... I 2 > 50% indicates substantial heterogeneity. [22] Tau2 was used to quantify the variance of the effect sizes. Forest plots were used to present the effect size of included studies. ...
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Purpose of Review Supplementation of nicotinamide mononucleotides (NMN) has been claimed to improve metabolic function. We reviewed human randomised controlled trials (RCTs) of NMN to evaluate its effect on markers of glucose and lipid metabolism. Recent Findings Eight RCTs on NMN (dosage ranged 250–2000 mg/d for a duration of 14 days to 12 weeks) involving a total of 342 middle-age/older adults (49% females, mainly non-diabetic) reporting at least one outcome on glucose control or lipid profile published in 2021–2023 were reviewed. The random-effects meta-analyses indicated no significant benefit of NMN on fasting glucose, fasting insulin, glycated hemoglobin, homeostatic model assessment for insulin resistance and lipid profile. Summary Based on the small number of RCTs involving mainly relatively healthy adults, short-term supplementation of NMN of 250-2000 mg/d did not show significantly positive impacts on glucose control and lipid profile.
Article
This overview of reviews synthesizes the effectiveness of obesity prevention interventions in children and adults on BMI/zBMI, following JBI and Cochrane Handbook guidelines. The protocol was prospectively registered in OSF in September 2020. Searches for eligible reviews were run in five databases and gray literature in May 2022. Systematic reviews published in 2010 and assessed BMI/zBMI outcomes of obesity prevention interventions were eligible. Screening, data extraction, and quality assessment were performed independently and in duplicate using standardized tools. For similar interventions, the more recent, higher‐quality review was included. Thirty reviews reporting on 60 discrete interventions (i.e., a specific intervention component), mapped to 14 of 21 IOM sub‐domains, were included. Nine interventions were classified as effective in improving BMI outcomes, including digital health or counseling interventions for adults in ‘healthcare environments’, behavioral interventions for children (broadly nutrition education), physical education curriculum modifications, and policies targeting food and beverages in ‘School environments’. This review extends on previous reviews by consolidating evidence from high‐quality, recent reviews to identify effective intervention components. Thus, this review provides direction for implementation efforts and highlights research gaps, where future research is warranted. However, as primary studies were not directly analyzed, gaps may reflect a lack of systematic reviews rather than primary research.
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Background This study aimed to investigate the role of physical exercises as a non-pharmacological intervention for ameliorating post-stroke dysregulated homeostatic parameters. Methods Embase, PubMed, PEDro, ISI Web of Science and CENTRAL were searched until April 2024. Parallel randomised controlled trials (RCTs) analysing the effect of post-stroke physical exercises (PSPE) on homeostatic parameters such as blood glucose, oxygen consumption (VO 2 ), high-density lipoprotein (HDL), low-density lipoprotein (LDL), systolic (SBP) and diastolic blood pressure (DBP) in individuals with stroke were selected. Results Sixteen RCTs (n=698) were included. PSPE reduced fasting glucose levels (MD=−0.22; 95% CI −0.22 to −0.02; p=0.00) and increased the VO 2 (MD=2.51; 95% CI 1.65 to 3.37; p=0.00) and blood HDL levels (MD=0.07; 95% CI 0.00 to 0.13; p=0.00). However, we did not observe beneficial effects on LDL, SBP and DBP parameters. Further analyses demonstrated that both low and moderate exercises are more suitable for improving blood glucose and VO 2 in this population. Discussion PSPE have the potential to improve dysregulated post-stroke parameters by reducing blood glucose levels and increasing VO 2 and HDL levels. However, the small size and limited number of included studies limited the precision of our results. Further research is needed to comprehensively analyse the effects of PSPE, particularly on LDL levels and blood pressure. PROSPERO registration number CRD42023395715.
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Esse trabalho é um adendo ao conteúdo publicado e divulgado sobre revisão bibliográfica, dando ênfase a revisão integrativa que está sendo disseminada e adotada por diversas áreas cientificas, a qual se mostrou uma metodologia aplicável para analisar as políticas de combate à fome. O objetivo desse trabalho é explanar sobre a revisão integrativa, como uma alternativa para estudar sobre políticas públicas de combate fome, com base na experiência metodológica utilizada na análise das intervenções encontradas na América Latina e Caribe. A partir do estudo construído com uma revisão integrativa é possível coletar e utilizar informações/dados para formalizar trabalhos, pesquisas, análises e métricas reconhecidas cientificamente para contribuir com a formulação de políticas públicas, planejamento e os trabalhos governamentais. Esse trabalho representa um arcabouço teórico, que utiliza fontes secundárias, mediante uma pesquisa bibliográfica e com base na experiência de publicações de pesquisadores das diversas áreas científicas, que utilizaram a revisão integrativa como metodologia em seus estudos. No desenvolvimento desse trabalho, evidenciamos, por meio das pesquisas com delineamento quase-experimental e experimental utilizados na revisão integrativa, a contribuição de estudos de cunho científico na construção do arcabouço teórico sobre políticas públicas desenvolvidas na América Latina e no Caribe e, para tanto, foi possível enfatizar o efeito das políticas públicas no combate à fome. Ao longo deste trabalho, aprimoraram-se os conhecimentos teóricos na área de políticas públicas, bem como na abordagem sobre revisão bibliográfica.
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To ascertain the effects of prolonging flushing intervals (FIs) for Totally Implantable Venous Access Devices (TIVADs) on catheter-related complications in the off-treatment period. A preliminary search of PubMed, EMBASE, Cochrane, Web of Science, Web of Science, Scopus, CNKI, and SinoMed was conducted from inception to 6th June 2023, using the keywords “vascular access devices”, “interval”, “occlusion”, and “complication”. Two independent reviewers performed studies screening, quality assessment, and data extraction. The methodological quality of included articles was assessed using the Newcastle–Ottawa Scale (NOS) and Risk of Bias (ROB) tools. Meta-analysis and trial sequential analysis (TSA) was performed to calculate the risk ratios and 95% confidence interval (CI). Eleven studies with 4,924 participants were included. Extending FIs to two or three months increased the risk of catheter occlusion compared to one-month intervals [RR = 1.50 (1.18–1.92), P = 0.001], but this finding was not confirmed by sensitivity analysis and TSA. Extending FIs to three months showed no significant effect on overall complications rates [RR = 1.21 (0.99–1.48), P = 0.49], consistent with sensitivity analysis and TSA results. For other catheter-related complications, the results showed extending the FIs to three months was feasible, but with weak measurements due to insufficient data. Data from the current included studies tended to support the feasibility of extending the flushing interval to every three months, with no expected increase in catheter occlusion or overall catheter complications. However, due to the inherent limitations of the included study, the findings of the current study should be interpreted with caution.
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Background Stakeholder engagement is widely considered democratic, transparent, and essential in the shared decision-making process for improving health services. However, the integrated evidence of stakeholders’ engagement activities in maternal and newborn health (MNH) services in the context of low- and middle-income countries (LMICs) is lacking. Therefore, this review aims to generate synthesised evidence of different practices for stakeholder engagements, characteristics of stakeholder engagements and outcomes of stakeholder engagements in improving the MNH services uptake and delivery. Methods The systematic review reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. The literature was searched in PubMed, CINAHL, PsycINFO, Science Direct and Scopus databases. The identified records were screened using Covidence software, and data were extracted from included records using a predefined template. The mixed methods appraisal tool was used to assess the quality of the included studies. The spectrum of stakeholder engagement provided by the International Association for Public Participation (IAP2) was used as a guiding framework for synthesising the evidence related to stakeholder engagement. Results A total of 1473 records were identified through the initial search after removing the duplicates. Twenty-six studies were included in the final review. The review results related to service users and other stakeholders’ engagement are presented under three overarching themes: (i) Methods and contexts of stakeholders’ engagement, (ii) Outcomes of stakeholders’ engagement, and (iii) Facilitators and barriers to stakeholders’ engagement. Conclusion Various participatory approaches were utilised to engage the service users and other stakeholders in improving MNH service uptake and delivery. A wide range of service user- and provider-led outcomes were identified due to stakeholder engagement. Trial registration PROSPERO registration number: CRD42022314613.
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Como citar este artículo: Zambrano W, Bustillos R L. Efectividad del fluoruro diamino de plata en el tratamiento de caries radicular en el adulto mayor. una revisión sistemática. ROLA 2025; 20(1): 150-168. EFECTIVIDAD DEL FLUORURO DIAMINO DE PLATA EN EL TRATAMIENTO DE CARIES RADICULAR EN EL ADULTO MAYOR. Una revisión sistemática Effectiveness of silver diamine fluoride in the treatment of root caries in the elderly. A systematic review
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Background: Oral health outcomes in children with Congenital Heart Defects (CHD) have significant implications. The aim of this systematic review and meta-analysis is to update the current understanding of oral health outcomes in children with CHD and compare caries prevalence between CHD children and healthy controls. Methods: All studies between 2014 and 2024 comparing oral health status between children with and without CHD were considered for inclusion. Studies had to use the DMF/dmf index (Decayed, Missing, Filled Teeth or Surface index), in permanent and deciduous teeth. Two separate meta-analyses were conducted: one analyzing DMFS scores and another focusing on dmft scores. Medline, Central, and Embase databases were screened. Twelve articles were included in the qualitative synthesis, and two studies were finally included in each quantitative synthesis. Results: Several studies identified significant differences in oral health outcomes, suggesting that children with CHD are at a higher risk of dental caries compared with healthy controls, particularly as they become older. However, the differences were not uniformly observed across all studies and age groups. Based on the meta-analysis, there was no statistically significant difference in either DMFS scores (MD: 0.07 [95% CI: −0.13, 0.27]; p = 0.48) or in dmft scores (MD: 1.39 [95% CI: −1.05, 3.83]; p = 0.26). Conclusions: This systematic review and meta-analysis highlight a possible increased risk of dental caries in children with CHD, although results were not statistically significant and varied across studies. More standardized and rigorous studies are required to provide clearer insights into oral health outcomes for this population.
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Introduction In the context of migraine preventive therapy, new therapeutic modalities such as monoclonal antibodies targeting the calcitonin gene-related peptide receptor (CGRP) or ligand offer potential advantages over traditional preventive treatments. Methods This systematic literature review gathered recent real-world evidence from Spain on the use of galcanezumab, a CGRP-targeting treatment, in migraine patients. The review included observational studies in English or Spanish, published from August 2020 to August 2023, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane guidelines. Results A total of 29 publications involving 2,592 Spanish adult patients were identified, reporting relevant information on clinical outcomes (treatment effectiveness and safety), treatment persistence and patterns (switching from other therapies and time to discontinuation and restart), and patient-reported outcomes (including satisfaction with treatment). The most frequently reported variables were related to the clinical effectiveness of galcanezumab, demonstrating a significant reduction in monthly migraine days and monthly headache days. Additionally, adverse impact of headache per HIT-6 (Headache Impact Test-6) and disability per MIDAS (Migraine Disability Assessment) also improve. Studies also showed that up to 12-month persistence to galcanezumab ranged from 76.8 to 59.8%. Serious adverse events were rare. None of the publications included health-related quality of life data, either generic or migraine-specific. One study highlighted that galcanezumab treatment would offer high patient satisfaction for people with migraine. Conclusion The real-world evidence on the use of galcanezumab treatment among the Spanish population shows that its effectiveness, persistence, safety, and impact on health burden align with findings from clinical trials and observational studies conducted in other countries. Future studies should incorporate health-related quality of life data to gain a more holistic understanding of this treatment’s impact.
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Systematic reviews (SRs) employ standardized methodological processes for synthesizing empirical evidence to answer specific research questions. These processes include rigorous screening phases to determine eligibility of articles against strict inclusion and exclusion criteria. Despite these processes, SRs are a significant undertaking, and this type of research often necessitates extensive human resource requirements, especially when the scope of the review is large. Given the substantial resources and time commitment required, we investigated a way in which the screening process might be accelerated while maintaining high fidelity and adherence to SR processes. More recently, researchers have turned to artificial intelligence-based (AI) software to expedite the screening process. This paper evaluated the agreement and usability of a novel machine learning program, Sciome SWIFT-ActiveScreener (ActiveScreener), in a large SR of mental health outcomes following treatment for PTSD. ActiveScreener exceeded the expected 95% agreement of the program with screeners to predict inclusion or exclusion of relevant articles at the title/abstract assessment phase of the review and was reported to be user friendly by both novice and seasoned screeners. ActiveScreener, when used appropriately, may be a useful tool when performing SR in a clinical context.
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Background Knee osteoarthritis (OA) is a leading cause of disability, with current treatment options often falling short of providing satisfactory outcomes. Autologous-cultured adipose-derived mesenchymal stem cells (ADMSCs) and stromal vascular fractions (SVFs) have emerged as potential regenerative therapies. Methods A comprehensive search was conducted among multiple databases for studies up to June 2023. The risk of bias was assessed in randomized and non-randomized studies, adhering to PRISMA guidelines. The study has been registered with PROSPERO (CRD 42023433160). Results Our analysis encompassed 31 studies involving 1,406 patients, of which, 19 studies with 958 patients were included in a meta-analysis, examining both SVF and autologous-cultured ADMSC methods. Significant pain reduction was observed with autologous-cultured ADMSCs starting at 3 months (MD = −2.43, 95% CI, −3.99, −0.86), whereas significant pain mitigation in response to SVF therapy was found to start at 12 months (MD = −2.13, 95% CI, −3.06, −1.21). Both autologous-cultured ADMSCs and SVF provided significant improvement in knee function starting at 12 months (MD = −9.19, 95% CI, −12.48, −5.90 vs. MD = −9.09, 95% CI, −12.67, −5.51, respectively). We found no evidence of severe adverse events linked directly to ADMSC therapy. Conclusion Autologous-cultured ADMSCs offer a promising alternative for more rapid pain relief in knee OA, with both ADMSCs and SVF demonstrating substantial long-term benefits in joint function and cartilage regeneration, in the absence of any severe ADMSC-related adverse events.
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Background and Objectives: Evisceration and incisional hernia (IH) represent a significant morbidity following open or laparoscopic colorectal surgery where midline laparotomy or extraction incision (EI) are performed. We executed a systematic review to evaluate primary mesh closure of laparotomy or EI in colorectal resections of benign or malignant conditions. Methods: A comprehensive literature search was performed using PubMed, Science Direct, Cochrane, and Google Scholar databases for studies comparing prophylactic mesh to traditional suture techniques in closing laparotomy in open approach or EI when minimally invasive surgery was adopted in colorectal procedures, regardless of the diagnosis. Both IH and evisceration were identified as primary outcomes. Secondary outcomes included surgical site infections (SSI), postoperative seroma, and length of hospital stay (LOS). Results: Six studies were included in our analysis with a total population of 1398 patients, of whom 411 patients had prophylactic mesh augmentation when closing laparotomy or EI, and 987 underwent suture closure. The mesh closure group had a significantly lower risk of developing IH compared to the conventional closure group (OR 0.23, p = 0.00001). This result was significantly consistent in subgroup analysis of open laparotomy or EI of laparoscopic surgery subgroups. There was no statistically notable difference in evisceration incidence (OR 0.51, p = 0.25). Secondary endpoints did not significantly differ between both groups in terms of SSI (OR 1.20, p = 0.54), postoperative seroma (OR 1.80, p = 0.13), and LOS (MD −0.54, p = 0.63). Conclusions: primary mesh reinforcement of laparotomy or EI closure in colorectal resections lessens IH occurrence. No safety concerns were identified; however, further high-quality research may provide more solid conclusions.
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Background Tandem Spinal Stenosis (TSS) is a disease characterised by the narrowing of the spinal canal in two or more non-adjacent areas of the spine, often affecting both the cervical and lumbar vertebrae. Doctors and patients increasingly favour non-surgical treatments that have the function of relieving symptoms and improving outcomes. This systematic review aims to evaluate the effectiveness and safety of non-surgical therapies for TSS and comprehensively summarise existing evidence. Methods and analysis We will conduct comprehensive searches, both manual and electronic, of literature published up to 30 September 2024; database searches will commence after the publication of this agreement, with an estimated commencement date of 1 December 2024, and the end date is 31 May 2025, without language restrictions. Key databases such as MEDLINE, PubMed, EMBASE, Web of Science, Cochrane Library, WHO International Clinical Trial Registration Platform, China National Knowledge Infrastructure, China Biomedical Literature Database, China Scientific Journal Database and Wan-Fang Database will be explored. In addition, we will include resources such as library journals and conference abstracts. Following the identification and screening of all randomised controlled trials focusing on non-surgical treatments for TSS, two investigators will perform a meta-analysis of the included studies. The findings will be summarised as the risk ratio for binary data and the standardised or weighted mean difference for continuous data. Ethics and dissemination Ethical approval is not required, as the review does not involve individual patient data. The review’s findings will provide clinicians with evidence on using non-surgical treatments for TSS, disseminated through peer-reviewed publications or conferences. PROSPERO registration number CRD42024496634.
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Objective: This systematic review aims to assess the effectiveness of respiratory physiotherapy techniques in oxygenation, chest X-ray findings, and lung auscultation in paediatric patients aged 0 to 18 years diagnosed with atelectasis. Methods: A comprehensive search was conducted in the PubMed, PEDro, Web of Science, and Cochrane Library databases. Results: Eight randomised clinical trials were included, involving 430 children ranging from 35 weeks of gestational age to 14 years. These trials evaluated various respiratory physiotherapy techniques and their effects on oxygenation and chest radiograph outcomes. The methodological quality of the studies ranged from acceptable to good, according to the PEDro scale. Conclusions: Recent evidence indicates that respiratory physiotherapy is effective and safe in the paediatric population with atelectasis. Both manual and instrumental techniques demonstrated efficacy, with instrumental techniques showing superior outcomes in many cases.
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