Allied And Complementary Medicine Database Research Articles

P801 Umbrella review of effectiveness of digital technologies for the management of Inflammatory Bowel Disease

Abstract Background The use of digital technology is increasing significantly world wide, with 67% of the global population (5.1 billion people) having subscribed to mobile internet services in 2018 [1]. Clinical trials assessing commercially available health tools are sparse, with limited evidence-based outcome data. Systematic reviews of the randomized clinical trials (RCTs) on digital health technology in inflammatory bowel disease (IBD) performed so far, provide mixed results from highly heterogeneous studies. This umbrella review aims to investigate the effectiveness of digital health technology for the care of patients with IBD, to identify research gaps and highlight areas where future work should focus on. Methods The following databases were searched for systematic reviews published from 2012 to August 2022: PubMed and Medline via OVID, Embase via Ovid, Cochrane Library and Prospero database of systematic reviews, CINAHL via EBSCO, PsycINFO via Ovid, AMED (Allied and Complementary Medicine database) via Ovid. Electronic search results were downloaded into the “Covidence” software and screened by two reviewers independently by titles and abstracts according to the inclusion and exclusion criteria. Standardised extraction forms were established in Microsoft EXCEL. The methodological quality assessment of the included reviews was performed using AMSTAR 2.0. [2] Results The literature search identified 65 studies that were uploaded on the “Covidence” software for title and abstract screening. Three duplicates were removed. Of the 62 papers remaining, 32 were excluded based on title and abstract screening. The full text of the remaining 30 was analysed, with a resulting selection of 8 systematic reviews (four including meta-analyses) deemed relevant to this umbrella review. The RCTs on digital health technology in IBD conducted so far have identified aspects of IBD care that appear to benefit from the use of digital technology, including the patients’ satisfaction, their quality of life and quality of care, their adherence to medications and a reduced number of hospital attendances. Existing trials have not, however, been able to prove a direct benefit of using technology to achieve or maintain clinical remission (Table 1). Conclusion Telemedicine should be regarded as an important adjuvant to routine clinical practice. Future larger trials with longer follow-up and defined interventions and outcomes have the potential to address unanswered questions in this area and to identify the patients with IBD who would most benefit from telemedicine so that these approaches can be tailored to specific groups.

The effectiveness of shockwave therapy to improve pain and symptom severity in patients with chronic patellar tendinopathy: a literature review

Background Patellar tendinopathy is a very common and debilitating condition that affects the anterior aspect of the knee. This review aimed to determine the effectiveness of shockwave therapy on pain and symptom severity for all types of patients with chronic patellar tendinopathy. Methods A search for quantitative primary studies was conducted, using the Allied and Complementary Medicine Database (AMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, SPORTDiscus, Physiotherapy Evidence Database (PEDro) and the Cochrane Database of Systematic Reviews (CDSR) databases. Investigation of grey literature sources, Google Scholar and manual citation searching also took place. All searches were completed between 1 and 8 January 2022. Papers were included if the patients' symptoms were chronic (lasting 12+ weeks); any dose, method and type of shockwave therapy were also accepted. Results A total of six articles were accepted following screening, all published after 2010. This review included a total of 270 patients, of which 145 received shockwave therapy. Overall, the methodological quality of the six papers was moderate to low. Despite this, and the variation in application of shockwave therapy, the results demonstrated improvements in both pain and symptom severity outcome measures. Conclusions Shockwave therapy was effective in improving patients' pain and symptom severity, although more high-quality research trials are needed to investigate the effects of this therapy. The clinician's first line of treatment for patellar tendinopathy should be education and exercise; however, if this fails, shockwave therapy should then be considered.

A cross-sectional study of reporting guidelines for clinical studies in Traditional Chinese Medicine

IntroductionReporting guidelines (RGs) provide the minimum information for inclusion to ensure that research reports can be understood by readers, reproduced or otherwise utilized by other researchers, or guide decisions by clinicians. The Reporting Guidelines for Clinical Studies in Traditional Chinese Medicine (RGCS-TCM) were established to guide the development of reporting standardization of clinical studies in Traditional Chinese Medicine (TCM). However, the characteristics and methodological quality of existing RGCS-TCM are yet to be investigated. We therefore performed a cross-sectional study to identify and evaluate the adequacy of RGCS-TCM and propose recommendations to optimize the development standards and future directions for RGCS-TCM. MethodsSeven databases including MEDLINE, Excerpta Medica Database (EMBASE), the Allied and Complementary Medicine Database (AMED), Chinese Biomedical Literature Service System (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Data and VIP Chinese Medical Journal Database, the EQUATOR network website, tracking references to included studies, and Google Scholar were searched up to 20th Oct 2023 for RGCS-TCM. The characteristics of included RGCS-TCM were summarized. The methodological quality of included RGCS-TCM were critically appraised. ResultsThirty published RGCS-TCM and six registered (under development) RGCS-TCM for different types of studies were included. Nine RGCS-TCM did not use a consensus method and lacked a consensus process, and fourteen RGCS-TCM failed to retrieve and use existing relevant evidence and lacked preliminary systematic reviews. Thirteen RGs had a relatively complete research and development process, which met the 3 basic criteria for determining high-quality RGs. Most RGCS-TCM reported the details of 1) rationale of TCM (10/15, 66.7 %), 2) reason for selected certain type of TCM intervention (9/15, 60.0 %), 3) diagnosis of TCM conditions (9/15, 60.0 %), 4) details about the intervention and its controls (13/15, 86.7 %), 5) dynamic changes of Pattern Differentiation and Treatment (2/15, 13.3 %), 6) outcome assessment specifically linked with TCM (8/15, 53.3 %), and 7) potential side effects related to TCM (4/15, 26.7 %). ConclusionThere are opportunities to rationalise and improve the quality of existing RGCS-TCM and reduce research waste. Further research is indicated to investigate the barriers and facilitators for optimizing the development and application of RGCS-TCM.

School-Based Interventions on Dental Trauma: A Scoping Review of Empirical Evidence.

Accidents involving sports or leisure activities, falls, blows from objects, acts of interpersonal violence, and accidents can all result in dental trauma (also known as traumatic dental injuries [TDIs]). School children are one of the population groups that are highly vulnerable to TDIs. Multiple school-based interventions have been conducted around the world on the prevention and management of TDIs; however, no known scoping review has been conducted to map the evidence. Hence, this study aimed to conduct a scoping review of existing school-based interventions on TDIs. This scoping review adopted the research design presented by Arksey and O'Malley. Eight research databases-PubMed, SCOPUS, APA PsycINFO, CINAHL Ultimate, AMED (The Allied and Complementary Medicine Database), Child Development & Adolescent Studies, Psychology and Behavioral Sciences Collection, and SPORTDiscuss-were searched to retrieve literature relevant to the scoping review question. Some of the retrieved literature existed in duplicate and was deduplicated using Rayyan software. Twenty papers that fulfilled the inclusion criteria were selected and reviewed. A total of 526 publications were retrieved from the eight databases searched in this scoping review. Ninety-seven publications were duplicates and were removed. After the two-stage screening of the deduplicated copies, only 20 peer-reviewed journal articles were relevant and included in the review. The selected studies sampled a total of 7152 participants whose ages ranged between 9 and 62 years (mean = 10.56 to 46.5; standard deviation = ±0.97 to ±8.1). The findings obtained from the reviewed journal articles revealed that pupils are at high risk of dental trauma and they are more likely to sustain these injuries during school activities. In addition, inadequate understanding, poor attitudes, and low experiential knowledge of dental trauma were found among educators, parents, and even school pupils. The evidence of long-term knowledge retention and a high knowledge score in the experimental groups buttresses the need for continuous first-aid education on dental trauma. The application of multiple educational approaches or modalities in schools will reinforce and promote good first-aid skills and management practices that are essential for preserving traumatized teeth.

Acupuncture for protracted amphetamine abstinence syndrome: study protocol for a systematic review and meta-analysis

IntroductionAmphetamine-type stimulants (ATSs) are presenting a great challenge to global public health along with its worldwide abuse in recent years. Protracted amphetamine abstinence syndrome (PAAS) is one of the primary...

Prevalence of human immunodeficiency virus (HIV) among pregnant women in Nigeria: a systematic review and meta-analysis

ObjectiveTo estimate prevalence of HIV infection in Nigeria and to examine variations by geopolitical zones and study characteristics to inform policy, practice and research.MethodsWe conducted a comprehensive search of bibliographic...

Ginseng and Ginseng Herbal Formulas for Symptomatic Management of Fatigue: A Systematic Review and Meta-Analysis.

Objectives: Ginseng has been widely used in fatigue management. However, its efficacy on fatigue remains unclear. This study aimed to assess the efficacy and safety of ginseng and ginseng herbal formulas for fatigue in randomized clinical trials (RCTs). Methods: The authors searched PubMed, Embase, Cochrane, Web of Science, and Allied and Complementary Medicine Database (AMED) databases from inception to July 6, 2022. Outcomes included fatigue severity, quality of life (QoL), and adverse events (AEs). Quality of evidence was assessed using the Cochrane Risk of Bias Tool. They pooled all included data and performed subgroup analysis by fatigue type, assessment instrument, and ginseng type. Results: The authors included 19 RCTs. Pooled analyses found no significant reduction in fatigue severity with ginseng versus controls (standardized mean difference [SMD]: -0.36, 95% confidence interval [CI]: -0.82 to 0.11, p = 0.13). In subgroup analysis, there was significant fatigue reduction with the ginseng herbal formula (SMD: -0.39, 95% CI: -0.66 to -0.13, p = 0.004) and chronic fatigue (CF) (SMD: -0.30, 95% CI: -0.56 to -0.03, p = 0.03) compared to controls. Ginseng produced significant reductions in general (i.e., non-disease-specific) fatigue compared to controls (SMD: -0.48, 95% CI: -0.71 to -0.25, p < 0.0001). Ginseng was associated with a trend toward QoL improvement (p = 0.05) and did not increase AEs compared with controls. Effect sizes were small. Conclusion: Ginseng herbal formulas improved fatigue severity compared to controls, especially among patients with CF, but with a small effect size. Rigorous RCTs as well as guidelines for standard ginseng usage are needed to further evaluate the effects of ginseng for fatigue and ensure proper use.

Intramuscular Electrical Stimulation to Trigger Points: Insights into Mechanisms and Clinical Applications-A Scoping Review.

Intramuscular electrical stimulation (IMES) is a modality used by clinicians to treat myofascial pain. Recent studies have shown positive results for the use of IMES on pain outcomes, yet studies investigating the potential mechanisms of IMES directly to trigger points (TrPs) are lacking. We performed a scoping review of the literature to summarize the current evidence from human and animal studies on the mechanisms of IMES to the TrP location, and to identify gaps in the existing literature. Electronic literature searches were conducted across five databases from inception to 15 August 2022, including PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED), Scopus and Cochrane Register of Controlled Trials. Four studies met our full criteria for inclusion in this review. Three studies assessed the effects of IMES to TrPs on human subjects with MPS, and only one study used an animal model with experimentally generated TrPs. Based on the results of the included studies, IMES within a TrP region was reported to normalize muscle blood flow, decrease endplate noise of the TrP and elicit antinociceptive effects, at least partially, through engaging supraspinal descending pain inhibitory systems. At present, no clinical implications can be determined on the use of IMES to TrPs due to the limited amount and quality of the available evidence. Further studies investigating the clinical effectiveness and also underlying mechanisms of IMES to TrPs are clearly needed.

Impact of osteopathic manipulative techniques onthe management of dizziness caused by neuro-otologic disorders: systematic review andmeta-analysis.

Osteopathic manipulative treatment (OMT) has been utilized by osteopathic clinicians as primary or adjunctive management for dizziness caused by neuro-otologic disorders. To our knowledge, no current systematic reviews provide pooled estimates that evaluate the impact of OMT on dizziness. We aimed to systematically evaluate the effectiveness and safety of OMT and analogous techniques in the treatment of dizziness. We performed a literature search in CINAHL, Embase, MEDLINE, Allied and Complementary Medicine Database (AMED), EMCare, Physiotherapy Evidence Database (PEDro), PubMed, PsycINFO, Osteopathic Medicine Digital Library (OSTMED.DR), and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to March 2021 for randomized controlled trials (RCTs) and prospective or retrospective observational studies of adult patients experiencing dizziness from neuro-otological disorders. Eligible studies compared the effectiveness of OMT or OMT analogous techniques with a comparator intervention, such as a sham manipulation, a different manual technique, standard of care, or a nonpharmacological intervention like exercise or behavioral therapy. Assessed outcomes included disability associated with dizziness, dizziness severity, dizziness frequency, risk of fall, improvement in quality oflife (QOL), and return to work (RTW). Assessed harm outcomes included all-cause dropout (ACD) rates, dropouts due to inefficacy, and adverse events. The meta-analysis was based on the similarities between the OMT or OMT analogous technique and the comparator interventions. The risk of bias (ROB) was assessed utilizing a modified version of the Cochrane Risk of Bias Tool for RCTs and the Cochrane Risk of Bias in Non-randomized Studies- of Interventions (ROBINS-I) for observational studies. The quality of evidence was determined utilizing the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. There were 3,375 studies identified and screened, and the full text of 47 of them were reviewed. Among those, 12 (11 RCTs, 1 observational study, n=367 participants) met the inclusion criteria for data extraction. Moderate-quality evidence showed that articular OMT techniques were associated with decreases (all p<0.01) in disability associated with dizziness (n=141, mean difference [MD]=-11, 95% confidence interval [CI]=-16.2 to-5.9), dizziness severity (n=158, MD=-1.6, 95% CI=-2.4 to-0.7), and dizziness frequency (n=136, MD=-0.6, 95% CI=-1.1 to-0.2). Low-quality evidence showed that articular OMT was not associated with ACD rates (odds ratio [OR]=2.2, 95% CI=0.5 to 10.2, p=0.31). When data were pooled for any type of OMT technique, findings were similar; however, disability associated with dizziness and ACD rates had high heterogeneity (I2=59 and 46%). No studies metall of the criteria for ROB. The current review found moderate-quality evidence that treatment with articular OMT techniques was significantly associated with decreased disability associated with dizziness, dizziness severity, and dizziness frequency. However, our findings should be interpreted cautiously because of the high ROB and small sample sizes in the eligible studies.

The Effectiveness and Safety of Abelmoschus manihot in Treating IgA Nephropathy: A Systematic Review and Meta-Analysis.

Introduction IgA nephropathy (IgAN) is a common issue. In China, Abelmoschus manihot (AM) is widely used in the treatment of IgAN. However, their combined effectiveness and safety for this purpose have not yet been explored. AM is an effective medicine for treating IgAN. This meta-analysis aimed to evaluate the effectiveness of AM for IgAN. Materials and Methods The Cochrane Library, PubMed, EMBASE, Allied and Complementary Medicine Database (AMED), Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure Database (CNKI), Chinese Science and Technique Journals Database (VIP), and the Wanfang Database were searched from their inceptions to June 2021. Random clinical trials (RCTs) comparing the effects of AM treatment in patients with IgAN were included. The study evaluated the efficacy or effectiveness of AM for IgAN and had clear outcome data, such as total effectiveness rate or proteinuria. Results A total of 11 RCTs with 850 participants were included in this meta-analysis. The results of the meta-analysis showed that, compared with that of the conventional therapy alone, being combined with conventional treatment was significantly more effective for the total efficacy rate (OR = 4.33; 95% CI = 2.66, 7.04; P < 0.00001) and proteinuria (MD = −0.41 g/24 h; 95% CI = −0.44, −0.38; P < 0.00001) but had no effect on serum creatinine (Scr) (MD = −2.23 μmol/L; 95% CI = −5.90, 1.45; P=0.24), eGFR (MD = −0.45 mL/min·1.73 m2; 95% CI = −1.24, 2.13; P=0.60), Bun (MD = −0.22 mmol/L; 95% CI = −0.59, 0.14; P=0.23), systolic blood pressure (MD = −0.04 mmHg; 95% CI = −2.59, 2.51; P=0.98), diastolic blood pressure (MD = −0.34 mmHg, 95% CI = −1.65, 2.33; P=0.74), systolic blood pressure (MD = −0.04 mmHg, 95% CI = −2.59, 2.51; P=0.98), or serum albumin (MD = 1.70 g/L, 95% CI = −1.06, 4.45; P=0.23). Conclusions AM provided additional benefits to proteinuria individuals with IgAN. However, due to the high clinical heterogeneity and small sample size of the included trials, future studies should conduct more rigorous RCTs on the clinical efficacy and safety of AM and RCTs with a larger sample size involving multicenters.

Repetitive peripheral magnetic stimulation for impairment and disability in people after stroke.

Repetitive peripheral magnetic stimulation (rPMS) is a non-invasive treatment method that can penetrate to deeper structures with painless stimulation to improve motor function in people with physical impairment due to brain or nerve disorders. rPMS for people after stroke has proved to be a feasible approach to improving activities of daily living and functional ability. However, the effectiveness and safety of this intervention for people after stroke remain uncertain. This is an update of the review published in 2019. To assess the effects of rPMS for improving activities of daily living and functional ability in people after stroke. We searched the Cochrane Stroke Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; MEDLINE; Embase; the Cumulative Index to Nursing and Allied Health Literature (CINAHL); PsycINFO; the Allied and Complementary Medicine Database (AMED); OTseeker: Occupational Therapy Systematic Evaluation of Evidence; the Physiotherapy Evidence Database (PEDro); Ichushi-Web; and six ongoing trial registries on 5 October 2021. We screened reference lists and contacted experts in the field. We placed no restrictions on the language or date of publication when searching the electronic databases. We included randomised controlled trials (RCTs) conducted to assess the therapeutic effect of rPMS for people after stroke. The following comparisons were eligible for inclusion: 1) active rPMS only compared with 'sham' rPMS (a very weak form of stimulation or a sound only); 2) active rPMS only compared with no intervention; 3) active rPMS plus rehabilitation compared with sham rPMS plus rehabilitation; and 4) active rPMS plus rehabilitation compared with rehabilitation only. Two review authors independently assessed studies for inclusion in the review. The same review authors assessed methods and risk of bias, undertook data extraction, and evaluated the certainty of the evidence using the GRADE approach. We contacted trial authors to request unpublished information if necessary. Any disagreements were resolved through discussion. We included four trials (three parallel-group RCTs and one cross-over trial) involving a total of 139 participants. This result was unchanged from the review published in 2019. Blinding of participants and physicians was well reported in three trials, with no information on whether personnel were blinded in one trial. We judged the overall risk of bias across trials as low. Only two trials (with 63 and 18 participants, respectively) provided sufficient information to be included in the meta-analysis. We found no clear effect of rPMS on activities of daily living at the end of treatment (mean difference (MD) -3.00, 95% confidence interval (CI) -16.35 to 10.35; P = 0.66; 1 trial; 63 participants; low-certainty evidence) and at the end of follow-up (MD -2.00, 95% CI -14.86 to 10.86; P = 0.76; 1 trial; 63 participants; low-certainty evidence) when comparing rPMS plus rehabilitation versus sham rPMS plus rehabilitation. We found no statistical difference in improvement of upper limb function at the end of treatment (MD 2.00, 95% CI -4.91 to 8.91; P = 0.57; 1 trial; 63 participants; low-certainty evidence) and at the end of follow-up (MD 4.00, 95% CI -2.92 to 10.92; P = 0.26; 1 trial; 63 participants; low-certainty evidence) when comparing rPMS plus rehabilitation versus sham rPMS plus rehabilitation. We observed a decrease in spasticity of the elbow at the end of follow-up (MD -0.41, 95% CI -0.89 to 0.07; 1 trial; 63 participants; low-certainty evidence) when comparing rPMS plus rehabilitation versus sham rPMS plus rehabilitation. In terms of muscle strength, rPMS treatment was not associated with improved muscle strength of the ankle dorsiflexors at the end of treatment (MD 3.00, 95% CI -2.44 to 8.44; P = 0.28; 1 trial; 18 participants; low-certainty evidence) when compared with sham rPMS. No studies provided information on lower limb function or adverse events, including death. Based on the GRADE approach, we judged the certainty of evidence related to the primary outcome as low, owing to the small sample size of the studies. There is insufficient evidence to permit the drawing of any conclusions about routine use of rPMS for people after stroke. Additional trials with large sample sizes are needed to provide robust evidence for rPMS after stroke.

Efficacious interventions for improving the transition readiness of adolescents and young adult patients with chronic illness: A narrative review of randomized control trials assessed with the transition readiness assessment questionnaire.

ObjectiveWe inspected efficacious interventions to improve the transition readiness of adolescent and young adult patients with childhood-onset chronic illnesses using the Transition Readiness Assessment Questionnaire (TRAQ).MethodsOur narrative review was conducted on randomized control studies assessed with TRAQ for outcome measurement before and after the interventions. We included all patients with chronic diseases. We searched eight electronic database(s): Allied and Complementary Medicine Database (AMED) Allied and Complementary Medicine, BioSciences Information Service of Biological s (BIOSIS) Previews, Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, Embase, Ichu-shi, Medline, and Web of Science. The text words for the search of data sources were as follows: “(“transition readiness assessment questionnaire” OR TRAQ) AND 2011/01:2022/06[DP] AND (clinical AND trial OR clinical trials OR clinical trial OR random* OR random allocation).” More studies were identified from the references in our reported study. This data set was independently cross-checked by two reviewers.ResultsWe identified 261 reports and collected three articles. The target diseases were type-1 diabetes, congenital heart disease, cystic fibrosis, and inflammatory bowel disease. All the studies excluded patients with intellectual disabilities. The age of the participants was distributed between 12 and 20 years. Nurse-provided web-based intervention of transition readiness was constructed using digital resources in two studies. The intervention ranged from 6 to 18 months. All the interventions were efficacious in improving transition readiness assessed with TRAQ scores, except for the self-advocacy score.ConclusionsWe obtained three randomized control studies with TRAQ for outcome measurement. In two studies, web-based and nurse-led organized interventions were shown to improve transition readiness.

Acupuncture for treating overactive bladder in adults.

Overactive bladder is a common, long-term symptom complex, which includes frequency of micturition, urgency with or without associated incontinence and nocturia. Around 11% of the population have symptoms, with this figure increasing with age. Symptoms can be linked to social anxiety and adaptive behavioural change. The cost of treating overactive bladder is considerable, with current treatments varying in effectiveness and being associated with side effects. Acupuncture has been suggested as an alternative treatment. To assess the effects of acupuncture for treating overactive bladder in adults, and to summarise the principal findings of relevant economic evaluations. We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (including In-Process, Epub Ahead of Print, Daily), ClinicalTrials.gov and WHO ICTRP (searched 14 May 2022).We also searched the Allied and Complementary Medicine database (AMED) and bibliographic databases where knowledge of the Chinese language was necessary: China National Knowledge Infrastructure (CNKI); Chinese Science and Technology Periodical Database (VIP) andWANFANG (China Online Journals), as well as the reference lists of relevant articles. SELECTION CRITERIA: We included randomised controlled trials (RCTs), quasi-RCTs and cross-over RCTs assessing the effects of acupuncture for treating overactive bladder in adults. Four review authors formed pairs to assess study eligibility and extract data. Both pairs used Covidence software to perform screening and data extraction. We assessed risk of bias using Cochrane's risk of bias tool and assessed heterogeneity using the Chi2 testand I2 statistic generated within the meta-analyses. We used a fixed-effect model within the meta-analyses unless there was a moderate or high level of heterogeneity, where we employed a random-effects model. We used the GRADE approach to assess the certainty of evidence. We included 15 studies involving 1395 participants in this review (14 RCTsand one quasi-RCT). All included studies raised some concerns regarding risk of bias. Blinding of participants to treatment group was only achieved in 20% of studies, we considered blinding of outcome assessors and allocation concealment to be low risk in only 25% of the studies, and random sequence generation to be either unclear or high risk in more than 50% of the studies. Acupuncture versus no treatment One study compared acupuncture to no treatment. The evidence is very uncertain regarding the effect of acupuncture compared to no treatment in curing or improving overactive bladder symptoms and on the number of minor adverse events (both very low-certainty evidence). The study report explicitly stated that no major adverse events occurred. The study did not report on the presence or absence of urinary urgency, episodes of urinary incontinence, daytime urinary frequency or episodes of nocturia. Acupuncture versus sham acupuncture Five studies compared acupuncture with sham acupuncture.The evidence is very uncertain about the effect of acupuncture on curing or improving overactive bladder symptoms compared to sham acupuncture (standardised mean difference (SMD) -0.36, 95% confidence interval (CI) -1.03 to 0.31; 3 studies; 151 participants; I2 = 65%; very low-certainty evidence). All five studies explicitly stated that there were no major adverse events observed during the study. Moderate-certainty evidence suggests that acupuncture probably makes no difference to the incidence of minor adverse events compared to sham acupuncture (risk ratio (RR) 1.28, 95% CI 0.30 to 5.36; 4 studies; 222 participants; I² = 0%). Only one small study reported data for the presence or absence of urgency and for episodes of nocturia. The evidence is of very low certainty for both of these outcomes and in both cases the lower confidence interval is implausible. Moderate-certainty evidence suggests there is probably little or no difference in episodes of urinary incontinence between acupuncture and sham acupuncture (mean difference (MD) 0.55, 95% CI -1.51 to 2.60; 2 studies; 121 participants; I2 = 57%). Two studies recorded data regarding daytime urinary frequency but we could not combine them in a meta-analysis due to differences in methodologies (very low-certainty evidence). Acupuncture versus medication Eleven studies compared acupuncture with medication. Low-certainty evidence suggests that acupuncture may slightly increase how many people's overactive bladder symptoms are cured or improved compared to medication (RR 1.25, 95% CI 1.10 to 1.43; 5 studies; 258 participants; I2 = 19%). Low-certainty evidence suggests that acupuncture may reduce the incidence of minor adverse events when compared to medication (RR 0.34, 95% CI 0.26 to 0.45; 8 studies; 1004 participants; I² = 51%). The evidence is uncertain regarding the effect of acupuncture on the presence or absence of urinary urgency (MD -0.40, 95% CI -0.56 to -0.24; 2 studies; 80 participants; I2 = 0%; very low-certainty evidence)and episodes of urinary incontinence (MD -0.33, 95% CI -2.75 to 2.09; 1 study; 20 participants; very low-certainty evidence) compared to medication. Low-certainty evidence suggests there may be little to no effect of acupuncture compared to medication in terms of daytime urinary frequency (MD 0.73, 95% CI -0.39 to 1.85; 4 studies; 360 participants; I2 = 28%). Acupuncture may slightly reduce the number of nocturia episodes compared to medication (MD -0.50, 95% CI -0.65 to -0.36; 2 studies; 80 participants; I2 = 0%, low-certainty evidence). There were no incidences of major adverse events in any of the included studies. However, major adverse events are rare in acupuncture trials and the numbers included in this review may be insufficient to detect these events. The evidence is very uncertain about the effect acupuncture has on cure or improvement of overactive bladder symptoms compared to no treatment. It is uncertain if there is any difference between acupuncture and sham acupuncture in cure or improvement of overactive bladder symptoms. This review provides low-certainty evidence that acupuncture may result in a slight increase in cure or improvement of overactive bladder symptoms when compared with medication and may reduce the incidence of minor adverse events. These conclusions must remain tentative until the completion of larger, higher-quality studies that use relevant, comparable outcomes. Timing and frequency of treatment, point selection, application and long-term follow-up are other areas relevant for research.

Comparison of short and long-acting testosterone replacement therapy for better sperm production and testosterone levels in male late-onset hypogonadism

Introduction: Testosterone Replacement Therapy (TRT) is the standard treatment for male late-onset hypogonadism.  Short-acting and long-acting testosterone are currently available treatments and have been approved by the Food and Drug Administration (FDA). The administration of exogenous testosterone is known to increase sperm production and T levels in men suffering from late-onset hypogonadism. However, limited research compares the efficacy of these two types of TRT. Objective: This study aims to compare the efficacy of short-acting and long-acting testosterone replacement therapy on sperm production and T levels in men suffering from late-onset hypogonadism. Methods: We searched for electronic databases including PubMed, Cochrane Library, EMBASE, Scopus, Web of Science, Allied and Complementary Medicine Database (AMED), and Google using keywords. All studies were evaluated by three independent reviewers who resolved differences by consensus. Results: We identified 21 studies that met our inclusion criteria. After applying the inclusion criteria, only 21 database sources remain for further analysis. Conclusion: Long-acting formulas affect blood more. RCTs show TU boosts libido and testosterone. Male infertility may result from long-acting TU blocking LH and FSH. TRP improves erections by increasing motile sperm and libido. Peanut allergy-related short-acting TRT causes nausea, itching, and injection-site pain.

Sex Differences in Physical Activity Among Individuals With Type 2 Diabetes Across the Life Span: A Systematic Review and Meta-analysis.

Physical activity (PA) is a cornerstone of type 2 diabetes mellitus (T2DM) treatment. Sex differences in PA behavior or barriers/facilitators to PA among individuals with T2DM are unclear. To summarize the evidence related to sex differences in participation in PA and barriers/facilitators to PA among individuals with T2DM across the life span. Systematic searches (CRD42021254246) were conducted with Ovid MEDLINE, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED), APA PsychInfo, and SPORTDiscus. We included studies with assessment of PA, sedentary behaviors (SB), or barriers/facilitators to PA among individuals with T2DM by sex or gender. Participant characteristics, meeting PA guidelines, participation in PA and SB, and barriers/facilitators to PA were extracted by two independent reviewers. A total of 53 articles (65,344 participants) were included in the systematic review and 21 articles in the meta-analysis. Sex differences were not observed in meeting of PA guidelines among adolescents (odds ratio 0.70 [95% CI 0.31, 1.59]), but males were more likely than females to meet PA guidelines among adults (1.65 [1.36, 2.01]) and older adults (1.63 [1.27, 2.09]). Males performed more moderate-to-vigorous PA (MVPA) than females across all age-groups. Common barriers to PA were lack of time (men) and lack of social support and motivation (women). Limitations include heterogeneity of measures used to assess PA and lack of stratification of data by sex. Sex differences in meeting PA guidelines were not observed among adolescents but were apparent among adults and older adults with T2DM. Females consistently engaged in less MVPA than males across the life span.

Nurses' intention to stay in the work environment in acute healthcare: a systematic review.

BackgroundWith staffing shortages affecting increasing numbers of health services globally, and predictions that shortages will worsen in the future, there is broad consensus that leaders at all levels must do more to support and develop current employees. However, the wide range of attributes of a healthy work environment identified in the literature and the financial implications of creating healthy work environments make it challenging to determine which elements of the nursing work environment are the most important in terms of workforce sustainability. This is a significant gap in our knowledge, and there is no consensus in the literature regarding definition and explanation of work environment factors in a way that facilitates prioritisation.ObjectivesThe aim of this review was to synthesise and evaluate the evidence of the factors which may have an effect on intention to stay and role of the work environment in enhancing nurses’ intention to stay in the work environment in acute healthcare.Design and methodsThis systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. A comprehensive search was performed for relevant articles published between 1990 and December 2017 using the following electronic databases: Allied and Complementary Medicine Database (AMED), Excerpta Medica dataBASE (EMBASE), ProQuest Nursing & Allied Health Source, ProQuest theses and dissertations, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, MEDLINE (Ovid) and PsycINFO. The reviewers independently screened the abstracts and full texts, extracted data, and assessed the methodological quality of the included papers using appropriate tools.ResultsA total of 4968 studies were screened by title, abstract, and full-text review, and 29 studies were included in this review. The identified determinants of nurses’ intention to stay were grouped into four main categories: individual indicators (personal and professional), organisation/profile, work environment, and patient-related. Several working environment variables identified in this review were significantly associated with the nurses’ intention to stay.ConclusionDespite the limitations of this review, the evidence indicates that attention to meso-level variables such as organisational characteristics and work environment is vital if the working environment is to improve and nurses’ intention to stay is to increase. The multifaceted nature of the concept of intention to stay makes it difficult to present definitive conclusions based on the findings of this review. However, the identified theoretical models were instrumental in differentiating intention to stay from other concepts such as intention to leave, turnover and retention, theoretically, and operationally.

Educational interventions for health professionals managing chronic obstructive pulmonary disease in primary care.

Chronic obstructive pulmonary disease (COPD) is a common, preventable and treatable health condition. COPD is associated with substantial burden on morbidity, mortality and healthcare resources. To review existing evidence for educational interventions delivered to health professionals managing COPD in the primary care setting. We searched the Cochrane Airways Trials Register from inception to May 2021. The Register includes records from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED) and PsycINFO. We also searched online trial registries and reference lists of included studies. We included randomised controlled trials (RCTs) and cluster-RCTs. Eligible studies tested educational interventions aimed at any health professionals involved in the management of COPD in primary care. Educational interventions were defined as interventions aimed at upskilling, improving or refreshing existing knowledge of health professionals in the diagnosis and management of COPD. Two review authors independently reviewed abstracts and full texts of eligible studies, extracted data and assessed the risk of bias of included studies. We conducted meta-analyses where possible and used random-effects models to yield summary estimates of effect (mean differences (MDs) with 95% confidence intervals (CIs)). We performed narrative synthesis when meta-analysis was not possible. We assessed the overall certainty of evidence for each outcome using Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Primary outcomes were: 1) proportion of COPD diagnoses confirmed with spirometry; 2) proportion of patients with COPD referred to, participating in or completing pulmonary rehabilitation; and 3) proportion of patients with COPD prescribed respiratory medication consistent with guideline recommendations. We identified 38 studies(22 cluster-RCTs and 16 RCTs) involving 4936 health professionals (reported in 19/38 studies) and 71,085 patient participants (reported in 25/38 studies). Thirty-six included studies evaluated interventions versus usual care; seven studies also reported a comparison between two or more interventions as part of a three- to five-arm RCT design. A range of simple to complex interventions were used across the studies, with common intervention features including education provided to health professionals via training sessions, workshops or online modules (31 studies), provision of practice support tools, tool kits and/or algorithms (10 studies), provision of guidelines (nine studies) and training on spirometry (five studies). Health professionals targeted by the interventions were most commonly general practitioners alone (20 studies) or in combination with nurses or allied health professionals (eight studies), and the majority of studies were conducted in general practice clinics. We identified performance bias as high risk for 33 studies. We also noted risk of selection, detection, attrition and reporting biases, although to a varying extent across studies. The evidence of efficacy was equivocal for all the three primary endpoints evaluated: 1) proportion of COPD diagnoses confirmed with spirometry (of the four studies that reported this outcome, two supported the intervention); 2) proportion of patients with COPD who are referred to, participate in or complete pulmonary rehabilitation (of the four studies that reported this outcome, two supported the intervention); and 3) proportion of patients with COPD prescribed respiratory medications consistent with guideline recommendations (12 studies reported this outcome, the majority evaluated multiple drug classes and reported a mixed effect). Additionally, the low quality of evidence and potential risk of bias make the interpretation more difficult. Moderate-quality evidence (downgraded due to risk of bias concerns) suggests that educational interventions for health professionals probably improve the proportion of patients with COPD vaccinated against influenza (three studies) and probably have little impact on the proportion of patients vaccinated against pneumococcal infection (two studies). Low-quality evidence suggests that educational interventions for health professionals may have little or no impact on the frequency of COPD exacerbations (10 studies). There was a high degree of heterogeneity in the reporting of health-related quality of life (HRQoL). Low-quality evidence suggests that educational interventions for health professionals may have little or no impact on HRQoL overall, and when using the COPD-specific HRQoL instrument, the St George's Respiratory Questionnaire (at six months MD 0.87, 95% CI -2.51 to 4.26; 2 studies, 406 participants, and at 12 months MD -0.43, 95% CI -1.52 to 0.67, 4 studies, 1646 participants; reduction in score indicates better health). Moderate-quality evidence suggests that educational interventions for health professionals may improve patient satisfaction with care (one study). We identified no studies that reported adverse outcomes. The evidence of efficacy was equivocal for educational interventions for health professionals in primary care on the proportion of COPD diagnoses confirmed with spirometry, the proportion of patients with COPD who participate in pulmonary rehabilitation, and the proportion of patients prescribed guideline-recommended COPD respiratory medications. Educational interventions for health professionals may improve influenza vaccination rates among patients with COPD and patient satisfaction with care. The quality of evidence for most outcomes was low or very low due to heterogeneity and methodological limitations of the studies included in the review, which means that there is uncertainty about the benefits of any currently published educational interventions for healthcare professionals to improve COPD management in primary care. Further well-designed RCTs are needed to investigate the effects of educational interventions delivered to health professionals managing COPD in the primary care setting.

Quality-of-life improvement, psychosocial benefits, and patient satisfaction of patients undergoing orthognathic surgery: a summary of systematic reviews.

Function, aesthetics, and social and psychological well-being are all important aspects for patients undergoing orthognathic surgery. To evaluate the impact of orthognathic surgery on patient perception and quality of life before, during and after treatment. All relevant systematic reviews published up to 31st July 2020 have been searched via MEDLINE via OVID, Scopus, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, PsycINFO, AMED (Allied and Complementary Medicine Database), and PubMed.Ongoing systematic reviews and grey literature were eliminated. A manual search was also undertaken, and no restrictions were applied to language or publication date. Systematic reviews involving dentofacial deformities related to systemic disorders, cleft lip and palate, facial trauma, and syndromes affecting cranial and dentofacial structures were excluded. Identification, screening, eligibility, and quality assessment [using the AMSTAR 2 tool (A Measurement Tool to Assess Systematic Reviews)] were performed by two authors independently. Data were synthesized qualitatively using thematic analysis. A total of 662 eligible studies were obtained of which 24 studies were selected for full-text evaluation, resulting in 12 eligible systematic reviews. Due to heterogeneity of data, quantitative analysis was not possible. Aesthetics and function are the main motives for seeking orthognathic surgery. Patient assessment before, during, and after orthognathic surgery is necessary for a thorough evaluation of self-perception and satisfaction throughout treatment. While psychological and social domains improved after orthognathic surgery treatment, the quality of life can deteriorate transiently during the pre-surgical orthodontic phase of treatment. A standardized assessment tool needs to be developed to assess quality-of-life changes consistently and provide comparable results. CRD42020199091.

Exercise in the Aquatic Environment for People With Primary Hip Osteoarthritis: A Systematic Review and Meta-analyses

Background and Purpose: More than 31 million Americans experience activity limitations related to hip osteoarthritis (OA), and aquatic exercise is one management option. To guide aquatic-based exercise practice, the available evidence-based data (quantity and quality) of aquatic environment exercise for people with primary hip OA was evaluated. Methods: A systematic search was conducted from 2004 to 2020 using 8 databases: PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Library, EMBASE, Allied and Complementary Medicine Database (AMED), Science Citation Index Expanded, ISI Proceedings (Web of Science), and REHABDATA. The extracted data included information related to authors, study design, participant characteristics (demographics, time since diagnosis, comorbidity), intervention details (setting, type, water temperature and depth, and dosage parameters such as frequency, intensity, duration and length), outcome measures, and adverse events. Results: There were 196 studies identified, with 136 studies screened at the abstract level with 48 resultant studies, reviewed at the full-text level with 9 resultant publications included in this quantitative analyses (7 randomized controlled trials [RCTs] and 2 non-RCTs). Individuals with hip OA who participated in prescribed aquatic exercise experienced improved overall lower extremity function including range of motion, strength, balance, gait, function performance (p = .00; standardized mean difference [SMD] = 0.30; SE = 0.07; I 2 = 0), and pain (p = .00; SMD = 0.34; SE = 0.12; I 2 = 45) but no change in quality of life (p = .07; SMD = 0.15; SE = 0.08; I 2 = 0). Discussion and Conclusion: For individuals with primary hip OA, prescribed exercise in an aquatic environment improved lower extremity function, balance, and pain outcomes. To improve consistent, evidence-driven aquatic intervention for individuals experiencing limitations secondary to hip OA, these researchers recommend that schedule individual or staff time to review these systematic review results, establish a user-friendly dosage rubric including these minimum intensity and aquatic environment parameters, and discuss the evidence-driven suggested outcomes and include other specific standardized outcomes for their facility, as well as a means to efficiently document these outcomes.

The effect of anger expression and perceived injustice on the formation of a beneficial therapeutic alliance in chronic pain management: A systematic review

Aims: The negative role of anger expression in chronic pain has been described. However, there is a poor understanding of the impact of anger and perceived injustice in the therapeutic alliance in this setting. The aim was to review the current literature examining anger and perceived injustice and its impact on the therapeutic alliance in the context of chronic pain. Methods: In July 2020 a search was carried out of electronic databases [Academic Search Complete, Allied and Complementary Medicine Database (AMED), Biomedical Reference Collection, General Science, Medline, PsycArticles, PsycInfo, Social Sciences Full Text and SPORTDiscus]. Further results were obtained from reference lists. Inclusion and exclusion criteria were applied using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews. Results: The initial search yielded 255 results, and after duplicates were removed and inclusion and exclusion criteria applied, the final result was three papers to be reviewed. In total 225 patients were analyzed. Of the papers reviewed, all showed a negative correlation between perceived injustice and patient rating of the therapeutic alliance. Anger expression is the mediator of the proposed perceived injustice and therapeutic alliance relationship. Conclusion: The review addresses the potential role of anger expression in the modulation of the therapeutic alliance. The assessment of anger expression in chronic pain patients may be beneficial. Clinicians should be aware of its implications on the therapeutic alliance. The review highlights the need for further research which could lead to potential therapeutic interventions for such patient groups.