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Chapter 8: assessing risk of bias in included studies
... Since assessments took place in the context of the full Cochrane review, which was started before publication of the current Cochrane RoB-2 tool, all assessments are based on the first version of the RoB tool. 16 All risk-of-bias assessments were conducted independently by two authors, and discrepancies were settled by a third review author. ...
... Moreover, funnel plots were drawn to examine publication bias if at least ten effect estimates were available. 16 Two authors (J.P.R. and J.M.S.-W.) independently conducted all GRADE assessments and solved any discrepancies by discussion. [17][18][19][20] ...
Background
Medications are commonly used to treat co-occurring psychopathology in persons with borderline personality disorder (BPD)
Aims
To systematically review and integrate the evidence of medications for treatment of co-occurring psychopathology in people with BPD, and explore the role of comorbidities.
Method
Building on the current Cochrane review of medications in BPD, an update literature search was done in March 2024. We followed the methods of this Cochrane review, but scrutinised all identified placebo-controlled trials post hoc for reporting of non BPD-specific (‘co-occurring’) psychopathology, and explored treatment effects in subgroups of samples with and without defined co-occurring disorders. GRADE ratings were done to assess the evidence certainty.
Results
Twenty-two trials were available for quantitative analyses. For antipsychotics, we found very-low-certainty evidence (VLCE) of an effect on depressive symptoms (standardised mean difference (SMD) −0.22, P = 0.04), and low-certainty evidence (LCE) of an effect on psychotic–dissociative symptoms (SMD −0.28, P = 0.007). There was evidence of effects of anticonvulsants on depressive (SMD −0.44, P = 0.02; LCE) and anxious symptoms (SMD −1.11, P < 0.00001; VLCE). For antidepressants, no significant findings were observed (VLCE). Exploratory subgroup analyses indicated a greater effect of antipsychotics in samples including participants with co-occurring substance use disorders on psychotic–dissociative symptoms ( P = 0.001).
Conclusions
Our findings, based on VLCE and LCE only, do not support the use of pharmacological interventions in people with BPD to target co-occurring psychopathology. Overall, the current evidence does not support differential treatment effects in persons with versus without defined comorbidities. Medications should be used cautiously to target co-occurring psychopathology.
... Study quality for the included studies was also assessed using the Cochrane Risk of Bias tool [27]. The tool includes a description and a judgment for each entry in a riskof-bias table, wherein each entry addresses a specific feature of the study. ...
... Risk of bias was assessed according to the following domains: (1) random sequence generation; (2) allocation concealment; (3) blinding of participants and personnel; (4) blinding of outcome assessors; (5) incomplete outcome data; (6) selective outcome reporting; and (7) other potential bias (free of expertise bias). Risk of bias within each domain was assessed based on criteria provided by the Cochrane Handbook [27]. ...
Older adults demonstrate gait impairments that increase their risk for falls. These age-related mobility impairments are in part due to declines in muscle mass and strength. High-intensity exercise can improve muscle strength and mobility but may not be tolerable for older adults due to musculoskeletal injury and pain. Blood flow restriction (BFR) with lower-intensity exercise offers a strategy that may be more tolerable for older adults, but whether BFR improves gait and mobility in older adults is unclear. The purpose of this systematic review and meta-analysis was to determine the effect of BFR on gait and mobility in healthy older adults. PubMed, Embase, Cochrane Library, and CINAHL were systematically searched for articles utilizing BFR in older adults. Articles were included if adults were over 60 years, did not have chronic health conditions, had undergone randomized controlled trials, and presented objectively measured gait outcomes. The search identified 1501 studies, of which 9 were included in the systematic review and 8 studies in the meta-analysis. Outcome measures included the Timed Up and Go (TUG), 6-Minute Walk Test (6MWT), 400 m walk test, Short Physical Performance Battery (SPPB), and 10 m walk test. Meta-analyses found improvements in the TUG (mean difference (MD) = −0.71; 95% CI = −1.05, −0.37; p < 0.001) and SPPB (MD = −0.94; 95% CI = −1.48, −0.39; p < 0.001) in BFR compared to no BFR. There were no differences in gait speed (MD = 0.59; 95% CI = −0.22, 1.41; p = 0.16). BFR may be effective for gait and mobility tasks over shorter distances. Clinicians may consider incorporating BFR to improve mobility and gait function in older adults.
... The seven main sources of bias in this evaluation tool are "random sequence generation, allocation concealment, selective reporting, blinding of participants and staff, blinding of outcome assessment, incomplete outcome data, and other sources of bias." These were independently evaluated by the authors, who then classified the bias risk as "high risk," "low risk," or "unclear risk" (Higgins et al., 2008). ...
... The Cochrane tool was used to conduct the risk of bias assessment, which is shown in fig. (2) (Higgins et al.,2008). Overall quality of the included study was low, one two studies were considered moderate risk of bias and the remainder were considered at high risk. ...
The McKenzie exercise supports self-care treatment through frequent exercise and focuses on extension, including ROM exercise, manipulation, and patient education. An anterior weight bearing of the cervical spine results from FHP, which is characterized by an increase in the upper cervical convexity and a
decrease in the lower cervical convexity. This study found that the McKenzie exercises were useful for improving posture in FHP patients.
... Assessment of risk of bias for included studies according to "The Cochrane Collaboration's tool for assessing risk of bias in randomized trials"(24). ...
Introduction
Although depressive disorders are frequently associated with relapses, the sustained efficacy of therapies after their termination has been insufficiently investigated.
Objective
The aim of this study was to evaluate the current evidence of enduring effects of psychotherapy, antidepressants and their combination after the end of treatment.
Methods
PubMed and PsychINFO were systematically screened according to PRISMA guidelines (except for preregistration). Only randomized controlled trials (RCTs) between 1980 and 2022 comparing the efficacy of psychotherapy, antidepressants and their combination in adult depression at follow-up at least 12 months after termination of therapy, which could be acute phase, maintenance or relapse prevention therapy, were included. Risk of bias was assessed by using the Cochrane risk of bias tool.
Results
In total 19 RCTs with a total of 1154 participants were included. Psychotherapy was significantly superior to pharmacotherapy regarding relapse rates and Beck Depression Inventory scores at follow-up after acute treatment in two of nine RCTs. Combined treatment performed significantly better than pharmacotherapy, but not psychotherapy, regarding relapse and remission in five out of nine RCTs at least 12 months after treatment termination. Pairwise meta-analyses indicated a superiority of combined treatment compared to pharmacotherapy alone regarding relapse, recurrence, and rehospitalization rates (RR=0.60, 95%-CI: 0.37-0.97, p=.041) and for psychotherapy compared to pharmacotherapy alone regarding relapse and recurrence rates (RR=0.58, 95%-CI: 0.38-0.89, p=.023), however comparative treatment effects between psychotherapy and combined treatment were insignificant.
Conclusions
Current findings suggest a superiority of psychotherapy and combined treatment over pharmacotherapy alone in major depressive disorder depression. Major limitations were a low number of studies reporting follow-up data after termination of study periods and a heterogeneity in definitions of treatment outcomes. Practice guidelines and participatory decision-making processes for the choice of treatment should consider the current knowledge on long-term effects of antidepressant therapy methods more than has been the case to date.
... Two reviewers will independently assess the risk of bias in all included studies, and in the case of a disagreement, a third reviewer will arbitrate. We will use the Cochrane Collaboration's tool for assessing the risk of bias in RCTs [22]. The tool covers six categories of bias: performance bias, attrition bias, reporting bias, detection bias, selection bias and other bias. ...
Background
Across sub-Saharan Africa, adolescents face the triple tragedy: unintended pregnancies, unsafe abortion, and sexually transmitted infections including HIV due to various reasons, among them, poor parent-adolescent communication on sexual and reproductive health. Effective interventions such as improving parent‒adolescent communication has been recognized as a protective factor for adolescent sexual and reproductive health outcomes. Research shows that parent-adolescent communication is associated with reduced adolescent engagement in risky sexual behaviours, including early sexual initiation, lower rates of teenage pregnancy, sexually transmitted infections, and increased self-efficacy in decision making. Despite the potential role of parent-adolescent communication in promoting optimal adolescent sexual and reproductive health, limited research evidence exists on interventions to improve parent-adolescent communication on sexual and reproductive health in sub-Saharan African countries. The aim of this systematic review is to assess the role of parent-adolescent communication intervention programs in improving sexual and reproductive health outcomes.
Methods
We will pool evidence from published literature from January 1990 up to and including February 2024 from multiple databases: PubMed, Web of Science, Scopus, African Journals Online, JSTOR, Directory of Open Access Journals, and Google Scholar. Articles published in the English language will be included. Two reviewers will conduct screening for titles, abstracts, and full texts, while a third reviewer will arbitrate in cases of lack of concurrence. Experimental, quasi-experimental and observational study designs will be included.. A data extraction tool based on Microsoft Excel will be used to extract data items from different studies. We will focus on the following outcomes: initiation of sexual activity, use of condoms and contraceptives, reduced risky sexual behaviours such as unprotected sex, and lower rates of teenage pregnancy. When feasible, articles will be combined for statistical meta-analysis. Effect sizes, either reported as weighted mean differences for continuous data or as odds ratios for binary data, will be presented as proportions with 95% confidence intervals. We will use the random effects model to meta-analyse the include studies as we expect considerable variability across study designs. This will provide an average effect size that accounts for variability of results within studies. Sensitivity analysis will also be conducted to assess the robustness of the findings or conclusions of the meta-analysis. The review findings will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Discussion
This review provides insights into parent-based intervention programs that have been implemented in sub-Saharan African countries to improve adolescent sexual and reproductive health via promotion of parent-adolescent sexuality communication. The findings will guide further research on this issue as well as inform policy makers on which interventions have a potential effect in improving adolescent sexual and reproductive health.
Protocol Registration Number: CRD42024525191 (PROSPERO), Date of registration: 27/03/2024.
... Sai lệch được đánh giá bằng bộ công cụ rủi ro sai lệch Cochrane [10] đã điều chỉnh để phù hợp với nghiên cứu này với các tiêu chỉ chọn mẫu ngẫu nhiên, làm mù, có nhóm chứng, dữ liệu kết quả đầy đủ hay không đầy đủ (Phụ lục 1). ...
Synbiotics có nhiều tác động tích cực đối với sức khỏe của con người. Nghiên cứu này nhằm tổng hợp, phân tích các cập nhật về bổ sung synbiotics, tác dụng của synbiotics đối với sức khỏe và tình trạng dinh dưỡng của trẻ em, từ đó khuyến nghị các hướng phát triển tiếp theo của synbiotics trong cải thiện dinh dưỡng và sức khỏe của trẻ em tại Việt Nam. Phương pháp nghiên cứu sử dụng nguồn dữ liệu tại các cơ sở dữ liệu, thư viện điện tử y học uy tín PubMed/MEDLINE, Scopus, EMBASE, ISI Web of Science và Cochrane Library và công cụ tìm kiếm Google và Google Scholar. Kết quả:18 nghiên cứu từ 2016 đến 2024 được đưa vào nghiên cứu. Kết quả cho thấy bổ sung synbiotics có thể có tác dụng hỗ trợ kiểm soát cân nặng ở trẻ em thừa cân béo phì, hỗ trợ tích cực điều trị táo bón cơ năng và tiêu chảy ở trẻ em. Synbiotics cũng có tác dụng tăng cường miễn dịch và hỗ trợ điều trị các bệnh lý dị ứng, miễn dịch và có tác động đáng chú ý trên người bệnh mắc chứng rối loạn tăng động giảm chú ý. Tuy nhiên cần có nhiều nghiên cứu với mẫu lớn, thời gian can thiệp đủ lâu để có thể đưa ra các khuyến cáo đầy đủ bằng chứng hơn.
... According to the Cochrane Handbook for Systematic Reviews, this umbrella review was conducted (22) . The study followed the guidelines of the 'Grading of Recommendations Assessment Development, and Evaluation' handbook (23) and the 'The Preferred Reporting Items for Overviews of Reviews' statement (24) (online Supplementary Table S1). ...
Multiple reviews have examined the impact of nutritional interventions in patients with burn injuries; however, discrepancies among results cast doubt about their validity. We implemented this review to assess the impact of various nutritional interventions in adult patients with burn injuries. We conducted a thorough search of PubMed, Scopus and Web of Science databases until 1 August 2024, to identify relevant meta-analyses of intervention trials, examining the impact of nutritional interventions on burn patients. We adopted the random-effect models to determine the pooled effect sizes while employing the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to examine evidence certainty. Thirty-three original intervention trials from eleven meta-analyses were entered in our review. Early enteral nutrition could substantially reduce overall mortality (relative risk (RR): 0·36, 95 % CI: 0·19, 0·68, GRADE = moderate certainty), hospital stay (mean difference (MD): −15·3, 95 % CI: −20·4, −10·2, GRADE = moderate certainty) and sepsis risk (RR: 0·23, 95 % CI: 0·11, 0·45, GRADE = moderate certainty). Glutamine showed a notable decrease in the length of hospital stay (MD: −6·23, 95 % CI: −9·53, −2·94, GRADE = low certainty). However, other nutritional interventions, including combined immunonutrition, branched-chain amino acids, fish oil, ornithine α -ketoglutarate and trace elements, did not significantly affect the assessed clinical outcomes. Early enteral nutrition might impose a beneficial effect on mortality, hospital stay length and incidence of sepsis with moderate evidence. Lower length of hospital stay was also seen in burn patients supplemented with glutamine, although the evidence was weak.
... Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess the risk of bias (RoB) for observational and cross-sectional studies (Study Quality Assessment Tools 2021). For randomized controlled clinical studies, the Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0 was used (Higgins et al. 2017). Two reviewers (A.K.S. and R.C.) independently assessed the risk of bias, and any disagreement concerning any entry was resolved by discussion. ...
The management of oral leukoplakia (OL) is challenging because of a high risk for recurrence and malignant transformation (MT), and recurrent OL is associated with a higher risk of MT than nonrecurrent OL. The present meta-analysis aimed to examine the association between OL recurrence and surgical techniques used for their management as well as their clinicopathological factors. Electronic searches were conducted in EMBASE, PubMed, Scopus, and Web of Science to retrieve studies reporting OL recurrence after surgery. The pooled proportion of OL recurrence after surgical excision was estimated. Subgroup analyses were conducted based on the surgical technique, data type, grades of epithelial dysplasia, anatomical subsites, clinical type and size of the lesion, surgical margin, and risk habits. Meta-regression analyses were conducted to identify the association between age, sex, and follow-up duration and OL recurrence. The risk of MT based on the recurrence status was also estimated. A network meta-analysis was performed to determine the surgical modality associated with the least OL recurrence. Eighty studies with a total of 7,614 samples and various surgical modalities (laser-based techniques, conventional scalpel surgery, cryosurgery, and photodynamic therapy) were included in the meta-analysis. A pooled proportion of recurrence of 22% was observed. Laser-based surgeries resulted in fewer OL recurrences than other surgical modalities, and the combination of laser excision and vaporization was identified to be the best treatment approach. OL in the retromolar area and multiple sites, nonhomogeneous OL, advanced age, female sex, inadequate surgical margin, retrospective data, and betel quid chewing habit were significantly associated with higher OL recurrence. Recurrent OL showed a 7.39 times higher risk of MT than nonrecurrent OL. These results suggest that the combination of laser excision and vaporization might reduce OL recurrence. Furthermore, OL in older patients, females, and nonhomogeneous OL need close monitoring after any surgical therapy.
... Methodological quality and reliability of included studies was assessed by authors using risk-of-bias assessment tool which criteria outlined in the Cochrane Handbook for Systematic Reviews of Intervention [30]. This tool analysed six domains related to risk of bias: (i) random sequence generation; (ii) allocation concealment; (iii) blinding of participants and personnel; (iv) incomplete outcome data; ...
The aim of this systematic review and meta-analysis is to evaluate the performance of classification metrics of machine learning-driven radiomics in diagnosing hepatocellular carcinoma (HCC). Following the PRISMA guidelines, a comprehensive search was conducted across three major scientific databases—PubMed, ScienceDirect, and Scopus—from 2018 to 2022. The search yielded a total of 436 articles pertinent to the application of machine learning and deep learning for HCC prediction. These studies collectively reflect the burgeoning interest and rapid advancements in employing artificial intelligence (AI)-driven radiomics for enhanced HCC diagnostic capabilities. After the screening process, 34 of these articles were chosen for the study. The area under curve (AUC), accuracy, specificity, and sensitivity of the proposed and basic models were assessed in each of the studies. Jamovi (version 1.1.9.0) was utilised to carry out a meta-analysis of 12 cohort studies to evaluate the classification accuracy rate. The risk of bias was estimated, and Logistic Regression was found to be the most suitable classifier for binary problems, with least absolute shrinkage and selection operator (LASSO) as the feature selector. The pooled proportion for HCC prediction classification was high for all performance metrics, with an AUC value of 0.86 (95 % CI: 0.83–0.88), accuracy of 0.83 (95 % CI: 0.78–0.88), sensitivity of 0.80 (95 % CI: 0.75–0.84) and specificity of 0.84 (95 % CI: 0.80–0.88). The performance of feature selectors, classifiers, and input features in detecting HCC and related factors was evaluated and it was observed that radiomics features extracted from medical images were adequate for AI to accurately distinguish the condition. HCC based radiomics has favourable predictive performance especially with addition of clinical features that may serve as tool that support clinical decision-making.
... High-quality evidence comes from methodically sound studies that minimize systematic errors through their design and execution, such as double-blind randomized controlled trials [12]. In contrast, low-quality evidence stems from studies with methodological flaws, such as inadequate control of confounding factors, small sample sizes, or bias, which limit the credibility and generalizability of their findings [13]. Comprehensive evaluations form the foundation for assessing the implementation and effectiveness of SP measures, providing information that guides the setting of priorities, the allocation of funds, and the development and refinement of SP strategies. ...
Background
Suicide prevention requires diverse, integrated, and evidence-based measures. Comprehensive evaluation of interventions and reliable suicide data are crucial for guiding policy-making and advancing suicide prevention efforts. This study aimed to analyze current issues and gaps in the evaluation of suicide prevention measures and the quality of suicide data in Germany, Austria, and Switzerland to derive specific recommendations for improvement.
Methods
Online, semi-structured interviews were conducted with 36 experts in suicide prevention from Germany, Austria, and Switzerland, covering insights from policy, science, and practice. The interviews took place between September 2022 and February 2023, were audio-recorded, transcribed verbatim, and analyzed using the Framework method.
Results
While solid evidence supports the effectiveness of some suicide prevention interventions, experts indicated that the evaluation of many other measures is weak. Conducting effectiveness studies in suicide prevention presents a range of methodological and practical challenges, including recruitment difficulties, choosing adequate outcome criteria, ethical considerations, and trade-offs in allocating resources to evaluation efforts. Many interviewees rated the quality of national suicide statistics in Germany, Austria, and Switzerland as comparatively high. However, they noted limitations in the scope, timeliness, and reliability of these data, prompting some regions to implement their own suicide monitoring systems. None of the three countries has national routine data on suicide attempts.
Conclusion
While some challenges in evaluating suicide prevention measures are inevitable, others can potentially be mitigated. Evaluations could be enhanced by combining traditional and innovative research designs, including intermediate outcomes and factors concerning the implementation process, and employing participatory and transdisciplinary research to engage different stakeholders. Reliable suicide data are essential for identifying trends, supporting research, and designing targeted prevention measures. To improve the quality of suicide data, a standardized monitoring approach, including uniform definitions, trained professionals, and cross-sector agreement on leadership and financing, should be pursued. This study provides actionable recommendations and highlights existing good practice approaches, thereby supporting decision-makers and providing guidance for advancing suicide prevention on a broader scale.
... Two authors (A.M. and S.S.) independently screened titles and abstracts, and discrepancies were resolved through discussion with senior authors (K.H. and H.S.). The risk of bias of the included studies was assessed using RoB2 instructions, with discrepancies resolved by consulting the senior authors [18]. Results are provided in Supporting Information S1: Table 2. ...
Background
It remains controversial whether adding ezetimibe to low/moderate‐intensity statins has a more beneficial impact on the treatment efficacy and safety of patients with existing atherosclerotic cardiovascular disease (ASCVD) compared to high‐intensity statin regimens.
Hypothesis
A combination of low/moderate‐intensity statins plus ezetimibe might be more effective and safer than high‐intensity statin monotherapy.
Methods
We searched databases for randomized controlled trials comparing lipid profile alterations, drug‐related adverse events, and MACE components between high‐intensity statin monotherapy and low/moderate‐intensity statin plus ezetimibe combination therapy. Pooled risk ratios (RR), mean differences (MD), and 95% confidence intervals (95% CI) were estimated using a random‐effects model.
Results
Our comprehensive search resulted in 32 studies comprising 6162 patients treated with monotherapy against 5880 patients on combination therapy. Combination therapy was more effective in reducing low‐density lipoprotein cholesterol (LDL‐C) levels compared to monotherapy (MD = −6.6, 95% CI: −10.6 to −2.5); however, no significant differences were observed in other lipid parameters. Furthermore, the combination therapy group experienced a lower risk of myalgia (RR = 0.27, 95% CI: 0.13–0.57) and discontinuation due to adverse events (RR = 0.61, 95% CI: 0.51–0.74). The occurrence of MACE was similar between the two treatment groups.
Conclusions
Adding ezetimibe to low/moderate‐intensity statins resulted in a greater reduction in LDL‐C levels, a lower rate of myalgia, and less drug discontinuation compared to high‐intensity statin monotherapy in patients with existing cardiovascular disease. However, according to our meta‐analysis, the observed reduction in LDL‐C levels in the combination group did not correlate with a reduction in MACE compared to the high‐intensity statin group.
... As the article focuses on highlighting the interventions used in pre-clinical in vivo studies, the SYRCLE's risk of bias tool and the Cochrane Risk of Bias tool were used (Hooijmans et al. 2014) (Higgins and Altman 2008). The signaling questions based on which the bias was assessed have been presented in Table 2. ...
Modern dietary habits and stressed lifestyle have escalated the tendency to develop functional gastrointestinal disorders (FGIDs) through alteration in the gut-brain-microbiome axis. Clinical practices use symptomatic treatments, neglect root causes, and prolong distress in patients. The past decade has seen the evolution of various interventions to attenuate FGIDs. But clinical translation of such studies is very rare mostly due to lack of awareness. The aim of this review is to meticulously integrate different studies and bridge this knowledge gap. Literature between 2013 and 2023 was retrieved from PubMed, ProQuest, and Web of Science. The data was extracted based on the PRISMA guidelines and using the SYRCLE’s risk of bias and the Cochrane Risk of Bias tools, quality assessment was performed. The review has highlighted molecular insights into the coexistence of FGIDs, stress, and gut dysbiosis. Furthermore, novel interventions focusing on diet, probiotics, herbal formulations, and phytoconstituents were explored which mostly had a multitargeted approach for the management of the diseases. Scientific literature implied positive interactions between the interventions and the gut microbiome by increasing the relative abundance of beneficial bacteria and reducing stress-related hormones. Moreover, the interventions reduced intestinal inflammation and regulated the expression of epithelial tight junction proteins in different in vivo models. This systematic review delves deep into the preclinical interventions to manage coexisting FGIDs, stress, and gut dysbiosis. However, in most of the discussed studies, long-term risks and toxicity profile of the interventions are lacking. So, it is necessary to highlight them for improved clinical outcomes.
... The risk of bias of the included randomized clinical controlled trials was evaluated using the Cochrane risk of the bias assessment tool, and a plot was generated using Rob 2.0 Cluster (https://www.riskofbias.info/welcome/rob-2-0-tool). [8] The scale was applied for randomized control trials to judge each included study on the selection of studies, comparability, and the ascertainment of either the exposure or outcome of interest. ...
To review the literature on the effect of mandibular advancement therapy (MAT) on inflammatory biomarkers in obstructive sleep apnea (OSA). The present systematic review addresses the following focus question: What is the effect of MAT on inflammatory biomarkers in OSA? Electronic and manual literature searches were conducted on databases: PubMed/MEDLINE, Web of Science, and Cochrane Library for studies published until September 2021 to collect information about the effect of mandibular advancement therapy, a non-continuous positive airway pressure alternative measurement of OSA. A systematic literature review was performed following the PRISMA guidelines to identify studies evaluating the effect of MAT in patients suffering from OSA. Randomized clinical trials were included, and case reports, retrospective studies, literature reviews, in-vitro studies, observational studies, authors’ opinions, letters to the editor, and engineering articles were excluded. Fifty-nine articles published before September 2021 were identified. Fifty-four articles met the inclusion criteria. After assessing inclusion criteria, three clinical trials were included with 148 patients suffering from OSA and treated with mandibular advancement therapy. The follow-up period ranged from two to three months, with the average follow-up being 1.66 months. The mean age of the patients was observed to be 53.11 ± 2.65 years. The mean Epworth Sleepiness Scale observed in patients in all three clinical trials was 9.75 ± 0.89. MAT in patients with moderate or severe OSA reduced apnea-hypopnea index but has less effect on inflammatory and metabolic biomarkers.
... We assessed the risk of bias in the studies using the Cochrane risk-of-bias tool (Higgins & Altman, 2008;Higgins & Green, 2008). For each study, each criterion was scored as low risk, unclear risk, or high risk of bias. ...
Objetivo: Se necesitan con urgencia nuevos enfoques para mitigar la vacilación ante las vacunas (VH, por sus siglas en inglés) y mejorar la aceptación de la vacuna. La teoría del empujón ha mostrado resultados efectivos en varias áreas de la salud. Sin embargo, la eficacia de las intervenciones que implican la teoría del empujón para aumentar la vacunación contra la COVID-19 sigue sin estar clara. Métodos: Se buscaron en PubMed, Web of Science y Scopus ensayos controlados aleatorios (RCT, por sus siglas en inglés) publicados antes del 31 de diciembre de 2022 para determinar si las intervenciones que involucraban la teoría del empujón mejoraron el comportamiento y la intención de la vacunación contra la COVID-19. Se utilizaron el índice de riesgos (RR, por sus siglas en inglés) y un intervalo de confianza (CI, por sus siglas en inglés) del 95% como medidas agrupadas para evaluar el comportamiento de vacunación. La intención de vacunar se informó en una síntesis narrativa. Resultados: Se incluyeron dieciséis RCT con 176,125 participantes. Las intervenciones que involucraron la teoría del empujón aumentaron débilmente la tasa de vacunación contra la COVID-19 (RR: 1.21; CI del 95% [1.07; 1.36], p < .01). El análisis de subgrupos mostró un efecto positivo débil de las normas sociales (RR: 2.04, CI del 95% [1.61, 2.57]), los valores predeterminados (RR: 1.32, CI del 95% [1.03, 1.69]) y los recordatorios destacados (RR: 1.19, 95% CI [1.04, 1.36]). Las intervenciones de empujón que integran múltiples componentes fueron más eficaces para aumentar las tasas de vacunación en comparación con el empujón solo. El efecto de las intervenciones de empujón se debilitó con el tiempo (p < .001). La mayoría de los estudios (10 de 11) que involucraron resultados de intención de vacunación mostraron resultados positivos o parcialmente positivos. Conclusiones: Las intervenciones que involucran la teoría del empujón pueden promover el comportamiento y las intenciones de vacunación COVID-19.
... The evaluation includes the following aspects: (1) random sequence generation; (2) Distribution hiding; (3) Implement blind method for the implementers and participants; (4) Implement blind method for results evaluators; (5) Integrity of data results; (6) Selective reporting of research results; (7) Other sources of bias. A detailed description of those criteria can be found elsewhere (Higgins and Altman, 2008). The evaluation was completed by two researchers, and if there was any disagreement, the third researcher would discuss and decide together. ...
Objective
To explore the intervention effect of mindfulness training on athletes’ performance using meta-analysis method.
Methods
A total of 11 articles and 23 effect sizes were included through retrieval of Chinese and English databases, with a total sample size of 582.
Result
Mindfulness training improves the level of mindfulness [SMD =1.08, 95%CI (0.30, 1.86), p < 0.01], fluency (The optimal competitive psychological state of the athlete, the athlete’s attention is all focused on the task, and other things no longer attract their attention) [SMD =1.47, 95%CI (0.87, 2.08), p < 0.001] and performance [SMD =0.92, 95% CI (0.40, 1.43), p < 0.01], reduced psychological anxiety [SMD = -0.87, 95% CI (−1.54, −0.20), p < 0.05], and all reached the level of large effect size.
Conclusion
The effect of mindfulness training on athletes’ sports performance is effective, and it can be used as an effective psychological skill intervention method to improve athletes’ sports performance. In the future, we should further expand the sample size, strengthen the comparative study of different sports and intervention modes, and pay attention to the difference between the time effect and trait mindfulness level in fluency state.
... Systematic reviews play important roles in many fields including in education. They consolidate and summarize research findings in a transparent and unbiased manner, provide the basis for evidence-based practices and interventions such as via subsequent meta-analysis, and can highlight current gaps and conflicts as well as future research directions (Hattie, 2009;Higgins et al., 2011;Shaheen et al., 2023). However, systematic reviews can be very time-consuming, estimated to take thousands of hours spanning over a year (Allen & Olkin, 1999;Borah et al., 2017). ...
Systematic reviews play important roles, but manual efforts can be time-consuming given a growing literature. There is a need to use and evaluate automated strategies to accelerate systematic reviews. Here, we comprehensively tested classical machine learning (ML) and deep learning model families. We also assessed the performance of prompt engineering via few-shot learning of GPT-3.5 and GPT-4 large language models. We further attempted to understand when ML models can help automate screening. These ML models were applied to actual datasets of systematic reviews in education. Results showed that the performance of classical and deep ML models varied widely across datasets, ranging from 1.2% to 75.6% of work saved at 95% recall. LLM prompt engineering produced similarly wide performance variation. We searched for various indicators of whether and how ML screening can help. We discovered that the separability of clusters of relevant versus irrelevant articles in high-dimensional embedding space can strongly predict whether ML screening can help (overall R = 0.81). This simple and generalizable heuristic applied well across datasets and different ML model families. In conclusion, ML screening performance varies tremendously but researchers can consider using our embedding heuristic in various ways to aid ML screening efforts. AI FOR SYSTEMATIC REVIEWS 3
... We assessed the risk of bias in the included RCT using the Cochrane "risk of bias" tool and the criteria specified in Chapter 8 of the Cochrane Handbook for Systematic Reviews of Interventions [29]. This includes assessment of bias arising from the randomization process, bias due to deviations from intended interventions, bias due to missing outcome data, bias in measurement of the outcome, and bias in selection of the reported result [30]. ...
Background: Lymph node metastasis in vulvar cancer is a critical prognostic factor associated with higher recurrence and decreased survival. A survival benefit is reported with adjuvant radiotherapy but with potential significant morbidity. We aim to clarify whether there is high-quality evidence to support the use of adjuvant radiotherapy in this setting.
Objectives: The aim of the study was to assess the effectiveness and safety of adjuvant radiotherapy to locoregional metastatic nodal areas.
Search Methods: We conducted a comprehensive and systematic literature search of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Google Scholar, ClinicalTrials.gov , and the National Cancer Institute. We considered only randomized controlled trials (RCTs).
Main Results: We identified 1,760 records and finally retrieved only one eligible RCT (114 participants with positive inguinofemoral lymph nodes). All women had undergone radical vulvectomy and bilateral inguinal lymphadenectomy and had been randomized to adjuvant radiotherapy or to intraoperative ipsilateral pelvic lymphadenectomy without adjuvant radiotherapy. At 6 years, the overall survival (OS) was 51% versus 41% in favor of radiotherapy (HR 0.61; 95% CI 0.30–1.3) without significance and with very low certainty of evidence. At 6 year, the cumulative incidence of cancer-related deaths was 29% versus 51% in favor of adjuvant radiotherapy (HR 0.49; 95% CI 0.28–0.87). Recurrence-free survival at 6 years was 59% after adjuvant radiotherapy versus 48% after pelvic lymphadenectomy (HR 0.39; 95% CI 0.17–0.88). Three (5.3%) versus 13 (24.1%) groin recurrences were noted, respectively, in the adjuvant radiotherapy and pelvic lymphadenectomy groups. There was no significant difference in acute toxicities for pelvic lymphadenectomy compared to radiotherapy. In women with positive pelvic lymph nodes (20%), the OS at 6 year was 36% compared with 13% in favor of adjuvant radiotherapy. Late cutaneous toxicity rate appeared to be greater after radiotherapy (19% vs. 15%) but with less chronic lymphedema (16% vs. 22%).
Conclusion: There is only very low-quality evidence on administering adjuvant radiotherapy for inguinal lymph node metastases. Although the identified study was a multicenter RCT, there was a reasonable imprecision and inconsistency because of small study numbers, wide confidence intervals in the data, and early trial closure, resulting in downgrading of the evidence.
... Assessment items included selection bias, performance bias, detection bias, attrition bias and reporting bias. Each assessment item was scored as '+' (representing a low risk of bias), '?' (representing an unclear risk of bias), or '-' (representing a high risk of bias) (Higgins et al., 2017). If the assessment did not reach a consensus on each item, other members of the research team would be invited to resolve the conflict. ...
Aims: To evaluate the effect of earplugs and eye masks on the sleep quality of patients in intensive care unit (ICU). Design: Systematic review and meta-analysis. Data Sources: Randomized controlled trial studies conducted before May 5, 2020 were searched for in Embase, MEDLINE, Cochrane Library, CINAHL and Index to Taiwan Periodical Literature System databases. Review Methods: Analyses in this study were according to the PRISMA statement. The heterogeneity of the data was investigated through subgroup analysis while a meta-analysis was performed using the Review Manager 5.3 software. Results: A total of 797 patients from 13 studies were included in this study. Without considering alone or combined use of earplugs and eye masks, the meta-analysis supported that there was a significant effect on self-reported sleep quality. The overall standardized mean difference of the effect size was 1.44 (95% confidence interval [CI]: [0.80, 2.09]). Subgroup analysis indicated that the use of earplugs alone had no significant effect on sleep quality (effect size: 0.07, 95% [CI]: [−0.50, 0.64]). The use of eye masks alone had a significant effect on sleep quality (effect size: 1.56, 95% [CI]: [1.08, 2.05]). The use of both earplugs and eye masks proved to have the largest effect size on sleep quality (effect size: 2.08, 95% [CI]: [0.95, 3.21]). Conclusion: The combined use of earplugs and eye masks or the standalone use of eye masks is a non-invasive, economical and effective way to promote sleep quality in adult ICU patients. Impact: Clinical nurses could use this meta-analysis as it recommends that nurses provide adult ICU patients with either one or both earplugs and eye masks to improve the patients' sleep quality. Study Registration: The review protocol was registered a priori and published on-line in the PROSPERO database of systematic reviews (www.crd.York.ac.uk/Prospero with the registration number # CRD42021221185). K E Y W O R D S earplugs, eye masks, intensive care, meta-analysis, nursing, sleep quality, systematic review
Background
Research waste is present in all study designs and can have significant consequences for science, including reducing the reliability of research findings and contributing to the inefficient use of resources. Estimates suggest that as much as 85% of all biomedical research is wasted. However, it is uncertain how avoidable research waste is assessed in specific types of study designs and what methods could be used to examine different aspects of research waste. We aimed to investigate which methods, systematic reviews, scoping reviews, and overviews of reviews discussing research waste, have used to assess avoidable research waste.
Materials and Methods
We published a protocol in the Open Science Framework prospectively ( https://osf.io/2fbp4 ). We searched PubMed and Embase with a 30-year limit (January 1993–August 2023). The concept examined was how research waste and related synonyms ( e.g. , unnecessary, redundant, duplicate, etc .) were assessed in reviews with a systematic search: systematic, scoping, or overviews of reviews. We extracted data on the method used in the review to examine for research waste and for which study design this method was applied.
Results
The search identified 4,285 records of which 93 reviews with systematic searches were included. The reviews examined a median of 90 (range 10–6,781) studies, where the study designs most commonly included were randomized controlled trials (48%) and systematic reviews (33%). In the last ten years, the number of reports assessing research waste has increased. More than 50% of examined reviews reported evaluating methodological research waste among included studies, typically using tools such as one of Cochrane Risk of Bias tools ( n = 8) for randomized controlled trials or AMSTAR 1 or 2 ( n = 12) for systematic reviews. One fourth of reviews assessed reporting guideline adherence to e.g. , CONSORT ( n = 4) for randomized controlled trials or PRISMA ( n = 6) for systematic reviews.
Conclusion
Reviews with systematic searches focus on methodological quality and reporting guideline adherence when examining research waste. However, this scoping review revealed that a wide range of tools are used, which may pose difficulties in comparing examinations and performing meta-research. This review aids researchers in selecting methodologies and contributes to the ongoing discourse on optimizing research efficiency.
BACKGROUND: Multiple System Atrophy (MSA) is a rapidly progressive and fatal neurodegenerative disease, with no effective treatment. Estimating the placebo and nocebo responses will help better design and interpret clinical trials.
Objective: To estimate the placebo and nocebo responses in MSA and explore their determinants.
METHODS: Electronic databases were searched up to November 2020. Randomized, blinded, placebo- or sham-controlled trials of patients with MSA were included if quantitative data were extractable on the placebo arm. The primary outcomes were: placebo response, defined as the within-group change from baseline, using any scale measuring motor outcomes; and nocebo response, defined as the proportion of patients experiencing adverse effects in the placebo arm. Random-effects meta-analyses were used to pool data. Several predetermined subgroup analyses and metaregressions were performed. PROSPERO registration number: CRD42021222915.
RESULTS: We included 21 randomized controlled trials (614 participants). Pooled placebo response was an increase in the Unified MSA Rating Scale (UMSARS) parts I and II of 9.09 points (95% CI 7.78 to 10.31, I2=94.00%, 9 studies, 304 participants). Pooled nocebo response was 63,88% (CI 95% 41.15 to 84.05, I2 =93.03%, 13 studies, 331 participants). Both placebo and nocebo responses were greater in trials with longer duration, whereas nocebo response was also higher in studies testing pharmacological interventions when compared with non-pharmacological interventions.
CONCLUSIONS: There may be a favorable response associated with the placebo, but this data needs to be compared with a 'no treatment group' in order to validate its real impact. The nocebo response is high and should be considered in future clinical trial design and interpretation.
Traumatic brain injury (TBI) is widely recognized as a major cause of death and disability. Optimizing recovery from coma is a priority for improving patient prognosis. Recently, an increasing number of studies have demonstrated that median nerve electrical stimulation (MNES) may be a potential approach for comatose patients awakening with TBI, although the results of these studies are not consistent. The aim of this study was to evaluate the effects of the MNES on recovery from coma in patients with TBI based on data from randomized controlled trials. The PubMed, Embase, Ovid MEDLINE, Cochrane Library, and China National Knowledge Infrastructure electronic databases were systematically searched from their inception to July 2023 using specific keywords. The χ2 test and I2 test were used to evaluate the heterogeneity across these studies. The mean differences with 95% confidence intervals (CIs) and relative risk (RR) with 95% CIs were adopted to analyze the continuous outcomes and binary outcomes, respectively. A total of 1831 patients from 18 studies were included in this meta-analysis. There were significant differences in the proportions of patients who regained consciousness between the MNES group and the control group after treatment (RR 1.36, 95% CI 1.18–1.56; P < 0.001) and at 6 months after injury (RR 1.31, 95% CI 1.16–1.47; P < 0.001). MNES significantly improved the Glasgow Coma Scale score (mean difference 2.38, 95% CI 1.78–2.98; P < 0.001). Furthermore, no significant differences in complications between the two groups of patients were observed, including pneumonitis (RR 0.86, 95% CI 0.72–1.03; P = 0.107), seizures (RR 1.24, 95% CI 0.49–3.10; P = 0.651), or gastric hemorrhage (RR 1.08, 95% CI 0.60–1.93; P = 0.795).The results of the present study indicate that patients with TBI in the MNES group recovered from coma more rapidly after treatment and at 6 months after injury. These results suggest that MNES is an effective approach for coma awakening after TBI.
Obesity has become a global epidemic, affecting both developed and developing nations. Despite extensive efforts, historical outcomes of medical interventions for obesity have been unsatisfactory. Bariatric surgeries, including sleeve gastrectomy (SG) and laparoscopic Roux-en-Y gastric bypass (RYGB), are now recognized as the primary treatment for severe obesity. However, laparoscopic one-anastomosis gastric bypass (OAGB) has emerged as a promising alternative, offering simplified procedures compared to RYGB. While OAGB's initial outcomes are optimistic, concerns about biliary reflux persist. Our systematic review aims to compare the safety and efficacy outcomes of RYGB and OAGB to inform clinical decision-making in managing obesity. We searched five databases up to February 2024. We included randomized controlled trials (RCTs) comparing RYGB and OAGB in obese patients, focusing on safety and efficacy outcomes. Data extraction covered study details, participant demographics, interventions, and outcomes related to operative details, complications, follow-up results, and weight changes. The risk of bias was assessed using the Cochrane tool. The analysis involved risk ratios for dichotomous data and mean differences for continuous data, using fixed or random effects models based on heterogeneity. Analyses were performed with Review Manager software v5.4. A total of 1057 patients were included in the analysis, sourced from 12 distinct RCTs. The analysis indicated OAGB outperformed RYGB in BMI reduction (MD = -0.69, p = 0.005), whereas RYGB was more effective in excess weight loss (MD = 6.51, p < 0.0001) and excess BMI loss (MD = 3.91, p < 0.0001). OAGB led to shorter operation times (MD = -34.89 minutes, p < 0.0001) and shorter periods of hospital stays (MD = -0.27 days, p = 0.01), along with fewer overall complications (RR = 0.58, p = 0.02) and lower incidence of upper gastrointestinal endoscopy complications (RR = 2.98, p = 0.0001). On the other hand, RYGB showed higher remission rates for dyslipidemia (RR = 0.60, p = 0.0003) and higher remissions of hypertension (RR = 0.83, p = 0.04). The majority of results were homogenous. Both OAGB and RYGB have their respective advantages and limitations. OAGB appears to offer benefits in terms of operation efficiency and early postoperative recovery, making it a potentially preferable option for patients and surgeons focused on these aspects. On the other hand, RYGB might be more suitable for patients prioritizing long-term weight loss and remission of certain comorbidities like hypertension. Ultimately, the choice between OAGB and RYGB should be made on an individual basis, considering the specific needs, conditions, and goals of each patient.
Pasteurella spp. can cause fatal zoonotic infections in humans. We performed a multicenter study to investigate the prevalence and clinical features of Pasteurella infections in South Korea during 2018‒2022. We also conducted a collaborative systematic review and meta-analysis of the global burden of Pasteurella bacteremia. The study included 283 cases found an increasing trend in Pasteurella infections. Blood cultures were positive in 8/35 (22.9%) cases sampled, for overall bacteremia-associated rate of 2.8% (8/283). Aging was a significant risk factor for bacteremia (odds ratio 1.05 [95% CI 1.01-1.10]), according to multivariate analyses. For the meta-analysis, we included a total of 2,012 cases from 10 studies. The pooled prevalence of bacteremia was 12.4% (95% CI 7.3%-18.6%) and of mortality 8.4% (95% CI 2.7%-16.5%). Our findings reflect the need for greater understanding of the increase in Pasteurella infections and the global burden of Pasteurella bacteremia to determine appropriate case management.
Background
The purpose of this systematic review was to assess the efficiency of allogenic bone block grafts for maxillary alveolar ridge reconstruction.
Materials and Methods
An electronic literature search was conducted using the PubMed, Cochrane Library, and Google Scholar databases. In addition, manual searching was done. Randomized controlled trials (RCTs) and prospective clinical trials (non-RCTs) up to December 2022, presenting the outcomes of allogenic bone blocks in maxillary alveolar ridge reconstruction, were identified. The rate of resorption, survival rate of implants, and formation of new bone following ridge augmentation were the outcome parameters. The quality assessment of the studies included was done using Joanna Briggs Institute Critical Appraisal Tool.
Results
A total of 13 studies that matched the inclusion criteria were included. The average rate of bone resorption ranged from 0.2 to 29.2 mm, with an implant survival rate of 96.87% across the included investigations. On an average, 25.83 mm (18.6–33/mm) of new mature compact osseous tissue was discovered, including viable osteocytes in close contact with the remnant cancellous bone.
Conclusion
According to the results of the current systematic review, using allogenic bone block graft for reconstruction of atrophic maxillae appears to be an effective and reliable bone substitute for reconstruction of atrophic maxillae.
Background
Ultrasound therapy is a non-invasive technique used to address a variety of health issues.
Objectives
This systematic review and meta-analysis aim to assess the effectiveness of ultrasound therapy in alleviating pain associated with musculoskeletal diseases.
Design
This study was conducted following PRISMA guidelines, with relevant articles identified through comprehensive searches in electronic databases.
Data sources and methods
We conducted searches across multiple databases, including Scopus, PubMed, MEDLINE, ProQuest, Science Direct, CINAHL, AIM, and ELDIS. Two independent reviewers screened the titles and abstracts of the retrieved articles. We included randomized controlled trials (RCTs) and observational cohort studies published between 2010 and 2023 that evaluated ultrasound therapy for knee and shoulder skeletal disorders. The selected data were analyzed qualitatively and synthesized, with the risk of bias assessed using the RoB2 tool.
Results
Initially, 117 articles were reviewed using the search strategy, and 10 trials that met the inclusion criteria were identified. In seven of these studies, the primary musculoskeletal disorder was osteoarthritis, while three studies focused on shoulder pain and impingement. Most studies indicated that ultrasound therapy significantly reduced pain. The meta-analysis showed that ultrasound therapy was significantly more effective than other interventions for knee disorders (I² = 51%, Z = 2.65, p = 0.008). However, for shoulder disorders, both ultrasound and other intervention methods were found to be ineffective (I² = 93%, Z = 0.73, p = 0.46).
Conclusion
The current evidence supports the effectiveness of ultrasound therapy in reducing pain and aiding rehabilitation for knee conditions. However, there are mixed results regarding its efficacy for shoulder conditions, highlighting the need for further research in this area.
Background
Multiple sclerosis (MS) is the most common non-traumatic disabling disease affecting young adults. A definitive curative treatment is currently unavailable. Many randomized controlled trials (RCTs) have reported the efficacy of Chinese herbal medicine (CHM) on MS. Because of the uncertain quality of these RCTs, the recommendations for routine use of CHM for MS remain inconclusive. The comprehensive evaluation of the quality of RCTs of CHM for MS is urgent.
Methods
Nine databases, namely, PubMed, Embase, Web of Science, Cochrane Library, EBSCO, Sinomed, Wanfang Database, China National Knowledge Infrastructure, and VIP Database, were searched from inception to September 2023. RCTs comparing CHM with placebo or pharmacological interventions for MS were considered eligible. The Consolidated Standards of Reporting Trials (CONSORT) and its extension for CHM formulas (CONSORT-CHM Formulas) checklists were used to evaluate the reporting quality of RCTs. The risk of bias was assessed using the Cochrane Risk of Bias tool. The selection criteria of high-frequency herbs for MS were those with cumulative frequency over 50% among the top-ranked herbs.
Results
A total of 25 RCTs were included. In the included RCTs, 33% of the CONSORT items and 21% of the CONSORT-CHM Formulas items were reported. Eligibility title, sample size calculation, allocation concealment, randomized implementation, and blinded description in CONSORT core items were reported by less than 5% of trials. For the CONSORT-CHM Formulas, the source and authentication method of each CHM ingredient was particularly poorly reported. Most studies classified the risk of bias as “unclear” due to insufficient information. The top five most frequently used herbs were, in order, Radix Rehmanniae Preparata, Radix Rehmanniae Recens, Herba Epimedii, Scorpio, and Poria. No serious adverse effect had been reported.
Conclusions
The low reporting of CONSORT items and the unclear risk of bias indicate the inadequate quality of RCTs in terms of reporting completeness and result validity. The CONSORT-CHM Formulas appropriately consider the unique characteristics of CHM, including principles, formulas, and Chinese medicinal substances. To improve the quality of RCTs on CHM for MS, researchers should adhere more closely to CONSORT-CHM Formulas guidelines and ensure comprehensive disclosure of all study design elements.
An increasing number of cross-sectional studies suggests that diet may impact memory and cognition in healthy older adults. However, randomized controlled trials investigating the effects of whole-diet interventions on memory and cognition in healthy older adults are rather rare, and conflicting results are often reported. Therefore, a systematic review was conducted to compile the current evidence regarding the potential effects of whole-diet interventions on 1) memory and 2) other cognitive outcomes in older adults. Studies that reported on randomized controlled trials with dietary interventions in healthy older adults (≥60 y) were included. Studies utilizing supplements, single food items, or trials in specific patient groups (i.e., neurodegenerative diagnoses) were excluded. For the 23 included articles, the main outcomes examined fell into 1 or more of the following categories: cognitive task-based outcomes related to memory, other cognitive task-based outcomes, and additional outcomes related to cognitive function or disease risk. Three of the studies that investigated dietary interventions alone and 2 multidomain studies showed positive effects on memory function, whereas 5 multidomain interventions and 1 intervention that focused on diet alone showed positive effects on other cognitive outcomes. The effect of randomized, controlled whole-diet interventions on memory and cognitive function in healthy older adults is modest and inconclusive, highlighting the need for more well-designed, sufficiently powered studies. Furthermore, the potential mechanisms by which diet impacts cognition in healthy aging need to be elucidated.
This systematic review is registered in PROSPERO as CRD42022329759.
Objective
This study aimed to establish which anesthetic agents are associated with minimized adverse outcomes during laryngeal mask airway (LMA) insertion.
Methods
Databases were searched for randomized controlled trials (RCTs) with American Society of Anesthesiologists I or II adult patients (≥15 years of age) receiving general anesthesia (GA) with an LMA. Propofol only was the comparator to other anesthetics used during LMA insertion. The primary outcome was prolonged apnea, and secondary outcomes were adverse airway events, LMA insertion failure, inadequate depth of anesthesia, and hemodynamic events. A network meta-analysis was conducted to estimate the treatment effects (odds ratios, 95% credible intervals, and surface under the cumulative ranking curve [SUCRA]).
Results
A total of 28 anesthetic combinations used on 4695 patients for GA induction and LMA insertion were examined across 53 RCTs. Overall, there was an apnea incidence rate of 33.3% (849 of 2548) with a mean time of 3.74 ± 3.56 minutes (n = 3091). Propofol + dexmedetomidine had the highest overall summed score of SUCRA ranks in reducing adverse outcomes (apnea incidence: SUCRA = 37%, apnea time: SUCRA = 66%, airway adverse event: SUCRA = 67%, insertion failure: SUCRA = 73%, inadequate depth of anesthesia: SUCRA = 84%). In comparison among all propofol combinations, propofol alone ranked lowest for overall summed score of SUCRA in reducing adverse outcomes (apnea incidence: SUCRA = 47%, apnea time: SUCRA = 71%, airway adverse event: SUCRA = 9%, insertion failure: SUCRA = 20%, inadequate depth of anesthesia: SUCRA = 9%).
Conclusion
All anesthetic combinations, other than those with thiopental, reduced adverse outcomes as compared with propofol alone. The combination of propofol and dexmedetomidine infused over 10 minutes ranked as the most effective for reducing adverse outcomes during LMA insertion.
Background and objective
Despite its acknowledged benefits, the selection of an optimal regional block for analgesia pediatric hernia surgery remains a subject of debate. This study endeavored to conduct a network meta-analysis and systematic review of randomized clinical trials, aiming to amalgamate insights from both direct and indirect comparisons concerning the analgesic effectiveness and safety of various regional blocks post-inguinal hernia repair in children.
Method
A comprehensive literature search was performed across PubMed, EMBASE, Web of Science, and the Cochrane Library up to 12 November 2022 by two independent reviewers, employing a standardized protocol. The inclusion criteria encompassed randomized trials focusing on children undergoing inguinal hernia repair utilizing either local infiltration analgesia or regional analgesia. The primary outcomes assessed were pain scores at 2, 6, and 24 h post-operation.
Results
The initial search yielded 281 records relating to 1,137 patients. The analysis of ranking probability indicated that Paravertebral Block (PVB) holds the highest likelihood (88% and 48%) of being the most effective in alleviating pain at 2 h and 6 h post-surgery. Trans vs. Abdominis Plane Block (TAPB) emerged as the superior choice for mitigating pain (83%) and decreasing morphine consumption (93%) at 24 h following the operation. Local Anesthetic Infiltration (LAI) was identified as the most effective in shortening the hospital stay, with a 90% probability.
Conclusions
Regional anesthesia significantly enhances postoperative pain management in pediatric inguinal hernia repair surgery. For short-term postoperative pain relief, PVB emerges as the most effective technique. Meanwhile, TAPB provides more prolonged analgesia. Although TAPB does not exhibit a pronounced advantage in short-term analgesia, its simplicity and the absence of a need for a special position render it a viable option. However, the interpretation of these results should be approached with caution due to the presence of limited data and heterogeneity.
Systematic Review Registration
PROSPERO (CRD42022376435; www.crd.york.ac.uk/prospero).
Topical dapsone is an alternative medication for acne treatment. However, which topical dapsone formulation is superior remains uncertain. Furthermore, data on the efficacy of dapsone compared with other topical acne treatments are lacking. We aimed to review the efficacy and safety of topical dapsone at different concentrations and to compare it with other topical acne treatments. We systematically reviewed literature related to the use of topical dapsone in treating acne published from January 2005 to September 2022. We searched databases from selected research studies for inclusion criteria and performed a network meta-analysis to compare the efficacy of using dapsone at different concentrations. Nine eligible studies were identified; among these, two studies with 7,350 patients were analyzed using network meta-analysis. At 12 weeks, the percentage of achieving a Global Acne Assessment Score and the mean percentage reduction in inflammatory acne were higher with 7.5% than with 5% dapsone, but the difference was not statistically significant. However, the mean percentage reduction in noninflammatory acne and total acne lesion-count at 12 weeks was lower with 7.5% than with 5% dapsone, but the difference was not statistically significant. Both concentrations of dapsone were more effective in treating inflammatory than comedonal acne and particularly effective in female patients and those aged ≥18 years. The side effects of dapsone were mild. Thus, topical dapsone is an effective alternative treatment for acne. Both concentrations of topical dapsone are effective in treating acne with no significant difference in efficacy and minimal side effects.
Importance
Sodium glucose cotransporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor analogues (GLP1ra) and dipeptidyl peptidase-4 inhibitors (DPP4i) improve hyperglycaemia and, in the case of SGLT2i and GLP1ra, reduce the risk of major adverse cardiovascular events (MACE) in type 2 diabetes. It is not clear whether efficacy varies by age or sex.
Objective
Assess whether age or sex are associated with differences in efficacy of SGL2i, GLP1ra and DPP4i.
Data sources
Medline, Embase and clinical trial registries.
Study selection
Two independent reviewers screened for randomised controlled trials of SGLT2i/GLP1ra/DPP4i, compared to placebo/active comparator, in adults with type 2 diabetes.
Data extraction and synthesis
We sought individual participant data (IPD) all eligible studies. Where IPD were available, we modelled age- and sex-treatment interactions for each trial. Otherwise, we assessed age-sex distributions along with results from aggregate trial data. IPD and aggregate findings were combined in a Bayesian network meta-analysis.
Main outcome measures
HbA1c and MACE.
Results
We identified 616 eligible trials (604 reporting HbA1c, 23 reporting MACE) and obtained IPD for 75 trials (6 reporting MACE). Mean age was 59.0 (10.7) years and 64.0 (8.6) in HbA1c and MACE trials, respectively. Proportions of female were 43.1% and 44.0% in HbA1c and MACE trials, respectively. SGLT2i reduced HbA1c by 0.5-1.0% overall compared to placebo. This reduction versus placebo was attenuated in older participants (change in HbA1c 0.25 percentage-points less for 75-year-olds compared to 45-year-olds). SGLT2i showed greater relative efficacy in MACE risk reduction among older than younger people. This finding was sensitive to the exclusion of one of the IPD MACE trials, however, in all sensitivity analyses, SGLT2i were either as efficacious or more efficacious in older participants. There was no consistently significant difference in efficacy by age for GLP1ra or DPP4i for HbA1c or MACE, nor were there consistent significant sex differences for any class.
Conclusion
Newer glucose-lowering drugs are efficacious across age and sex groups. SGLT2i are more cardioprotective in older than younger people despite smaller HbA1c reductions. Age alone should not be a barrier to treatments with proven cardiovascular benefit providing they are well tolerated align with patient priorities.
Background
Achieving full revascularization via percutaneous coronary intervention (PCI) may enhance the prognosis of individuals diagnosed with acute coronary syndrome (ACS) and multivessel coronary disease (MVD). The present work focused on investigating whether PCI should be performed during staged or index procedures for non-culprit lesions.
Methods
Electronic databases, such as PubMed, EMBASE, the Cochrane Library, and Web of Science, were systematically explored to locate studies contrasting immediate revascularization with staged complete revascularization for patients who experienced ACS and MVD without cardiac shock. The outcome measures comprised major adverse cardiovascular events (MACEs), all-cause mortality, cardiovascular mortality, myocardial infarction (MI), stroke, and unplanned ischemia-driven revascularization (UIDR).
Results
Nine randomized controlled trials involving 3550 patients, including 1780 who received immediate complete revascularization (ICR) and 1770 who received staged complete revascularization (SCR), were included in the analysis. The ICR group had lower MACEs (RR: 0.73, 95% CI: 0.61~0.87, P = 0.0004), MI (RR: 0.53, 95% CI: 0.37~0.77, P = 0.0008), and UIDR (RR: 0.64, 95% CI: 0.50~0.81, P = 0.0003) than did the SCR group. All-cause mortality, CVD incidence, and stroke incidence did not significantly differ between the two groups. According to our subgroup analyses based on the time window of the SCR, the ICR group had significantly fewer MACEs (RR: 0.70, 95% CI: 0.56~0.88, P = 0.003), MI (RR: 0.53, 95% CI: 0.37~0.77, P = 0.0002), and UIDR (RR: 0.56, 95% CI: 0.40~0.77, P = 0.0004) than did the subgroup of patients who were between discharge and 45 days.
Conclusion
Compared with patients in the SCR group, patients in the ICR group had decreased MACEs, MI, and UIDR, especially between discharge and 45 days. All-cause mortality and CVD incidence were not significantly different between the two groups.
Introduction
Lay advisor interventions improve hypertension outcomes; however, the added benefits and relevant factors for their widespread implementation into health systems are unknown. We performed a systematic review to: (1) summarize the benefits of adding lay advisors to interventions on hypertension outcomes, and (2) summarize factors associated with successful implementation in health systems using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework.
Methods
We systematically searched several databases, including Ovid MEDLINE, CINAHL, PsycINFO from January 1981 to May 2023. All study designs of interventions delivered solely by lay advisors for adults with hypertension were eligible. If both arms received the lay advisor intervention, the study arm with lower intensity was assigned as the low-intensity intervention.
Results
We included 41 articles, of which 22 were RCTs, from 7,267 screened citations. Studies predominantly included socially disadvantaged populations. Meta-analysis (9 RCTs; n = 4,220) of eligible lay advisor interventions reporting outcomes showed improved systolic blood pressure (BP) [−3.72 mm Hg (CI –6.1 to −1.3; I² 88%)], and diastolic BP [−1.7 mm Hg (CI −1 to −0.9; I² 7%)] compared to control group. Pooled effect from six RCTs (n = 3,277) comparing high-intensity with low-intensity lay advisor interventions showed improved systolic BP of −3.6 mm Hg (CI –6.7 to −0.5; I² 82.7%) and improved diastolic BP of −2.1 mm Hg (CI –3.7 to −0.4; I² 70.9%) with high-intensity interventions. No significant difference in pooled odds of hypertension control was noted between lay advisor intervention and control groups, or between high-intensity and low-intensity intervention groups. Most studies used multicomponent interventions with no stepped care elements or reporting of efficacious components. Indicators of external validity (adoption, implementation, maintenance) were infrequently reported.
Discussion
Lay advisor interventions improve hypertension outcomes, with high intensity interventions having a greater impact. Further studies need to identify successful intervention and implementation factors of multicomponent interventions for stepped upscaling within healthcare system settings as well as factors used to help sustain interventions.
Background
Evidence indicates that the addition of ezetimibe to statin therapy reduces cardiovascular events. However, the impact of ezetimibe–statin combination therapy on coronary plaque regression, plaque stabilization, and diameter stenosis remains a matter of controversy.
Methods
We performed electronic searches in PubMed, Web of Knowledge, and the Cochrane Central Register of Controlled Trials to identify eligible trials assessing the effects of ezetimibe–statin combination therapy versus statin monotherapy reporting at least one outcome among total atheroma volume (TAV), minimum fibrous cap thickness (FCT), lumen volume (LV), and lumen area (LA) derived from intravascular imaging modalities of intravascular ultrasound (IVUS) and optical coherence tomography (OCT). We used the random-effects model and performed trial sequential analysis (TSA) during this meta-analysis.
Results
Eleven articles with a total of 926 individuals (460 in the dual-lipid-lowering therapy group and 466 in the statin monotherapy group) were included in the final meta-analysis. Compared to statin monotherapy, ezetimibe–statin combination therapy was associated with significantly decreased TAV [WMD = −3.17, 95% CI (−5.42 to −0.92), and p = 0.006], with no effect on the LV of the coronary artery [WMD = −0.52, 95% CI (−2.24 to 1.21), and p = 0.56], the LA of the coronary artery [WMD = 0.16, 95% CI (−0.10–0.42), and p = 0.22], or minimum FCT thickness [WMD = 19.11, 95%CI (−12.76–50.97)].
Conclusion
In patients with coronary artery disease, ezetimibe–statin combination therapy resulted in a significant regression in TAV compared to statin monotherapy, whereas no overall improvements of minimum FCT or lumenal stenosis were observed.
Background
Almost half of the global population face significant challenges from long-term conditions (LTCs) resulting in substantive health and socioeconomic burden. Exercise is a potentially key intervention in effective LTC management.
Methods
In this overview of systematic reviews (SRs), we searched six electronic databases from January 2000 to October 2023 for SRs assessing health outcomes (mortality, hospitalisation, exercise capacity, disability, frailty, health-related quality of life (HRQoL), and physical activity) related to exercise-based interventions in adults (aged >18 years) diagnosed with one of 45 LTCs. Methodological quality was assessed using AMSTAR-2. International Prospective Resister of Systematic Reviews (PROSPERO) ID: CRD42022319214.
Findings
Forty-two SRs plus three supplementary RCTs were included, providing 990 RCTs in 936,825 people across 39 LTCs. No evidence was identified for six LTCs. Predominant outcome domains were HRQoL (82% of SRs/RCTs) and exercise capacity (66%); whereas disability, mortality, physical activity, and hospitalisation were less frequently reported (≤25%). Evidence supporting exercise-based interventions was identified in 25 LTCs, was unclear for 13 LTCs, and for one LTC suggested no effect. No SRs considered multimorbidity in the delivery of exercise. Methodological quality varied: critically-low (33%), low (26%), moderate (26%), and high (12%).
Interpretation
Exercise-based interventions improve HRQoL and exercise capacity across numerous LTCs. Key evidence gaps included limited mortality and hospitalisation data and consideration of multimorbidity impact on exercise-based interventions.
Funding
This study was funded by the 10.13039/501100000272National Institute for Health and Care Research (NIHR; Personalised Exercise-Rehabilitation FOR people with Multiple long-term conditions (multimorbidity)—NIHR202020).
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