Bias Assessment Research Articles

COMPARISON DIAGNOSTIC ACCURACY OF ULTRASONOGRAPHY ELASTOGRAPHY FOR DETECTING LIVER FIBROSIS COMPARED TO LIVER BIOPSY: A COMPREHENSIVE SYSTEMATIC REVIEW AND META-ANALYSIS STUDIES

Background: Liver fibrosis significantly impacts disease outcomes in chronic liver disease. While liver biopsy has long been the gold standard for assessing and staging fibrosis, non-invasive ultrasound-based methods are emerging as valuable alternatives. The aim of this study is to systematically review and conduct a meta-analysis to compare the diagnostic accuracy of ultrasound elastography with liver biopsy for detecting liver fibrosis based on literatures in the last 10 years. Method: A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines using the PICO framework. Rigorous screening, data extraction, risk of bias assessment, and statistical analysis were performed to investigate diagnostic accuracy of ultrasonography elastography for detecting liver fibrosis compared to liver biopsy. Results: A total of 32 articles were retrieved from online databases (PubMed, SagePub, Nature and Cochrane). After three rounds of screening, seven articles directly relevant to the meta-analysis were selected for full-text reading and analysis. Conclusion: Liver fibrosis significantly impacts disease outcomes in chronic liver disease. While liver biopsy has long been the gold standard for assessing and staging fibrosis, non-invasive ultrasound-based methods like shear wave elastography are emerging as valuable alternatives.

Outcomes of the effect of exercise on cognitive function in patients with depression: A meta-analysis.

Major depressive disorder is a common mental disorder, characterized by a high rate of suicide and recurrence, which is frequently accompanied by cognitive impairments, particularly in executive function, memory, attention, and information processing speed. As such, improving the cognitive function in patients with depression and enhancing their quality of life are urgent issues. To perform a systematic review and meta-analysis of the effects of exercise on cognitive function in patients with depression. The PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang Medical, VIP, and Biomedical Databases for randomized controlled trials (RCTs) databases were searched (from inception to October 19, 2023) for studies investigating improvements in cognitive function in patients with depression through exercise. Tools recommended by the Cochrane Handbook for RCT evaluation, and GRADEpro and Stata17 software, were employed for risk of bias assessment, evidence grading, forest plot construction, subgroup and sensitivity analyses, and assessment of publication bias. Seventeen RCTs (1173 patients with depression) were included. Exercise had a small but significant positive effect on attention, with an effect size of 0.21, 95%CI: 0.07-0.34, P < 0.01. Specifically, aerobic exercise regimens of 30-60 minute/session, thrice a week, at moderate intensity, and sustained over 3-12 weeks, were associated with the most pronounced benefits (P < 0.05), with effect sizes for executive function, memory, and information processing speed of 0.11, 95%CI: -0.11-0.32, P = 0.34; 0.08, 95%CI: 0.00-0.16, P = 0.05; and 0.14, 95%CI: 0.04-0.25, P = 0.01, respectively. The evidence levels for attention, information processing speed, and memory were rated as 'low,' whereas that for executive function was rated as 'very low'. Exercise could improve attention and information-processing speed in patients with depression, although improvements in executive function and memory are not significant.

Harnessing the power of adaptation: a pre-registered systematic review on executive functions and the adaptation to new technologies

ABSTRACT Given the pervasive integration of technology into everyday life and its importance in mitigating the negative consequences of global crises, an understanding of human adaptation and preceding cognitive abilities remains highly relevant. A systematic review synthesising empirical findings on the association of executive functions (EFs) and the adaptation to new technologies is currently lacking in the literature. The presented pre-registered, systematic review adheres to PRISMA 2020 guidelines and aims to extract the current state of research on this topic [Registration DOI:10.17605/OSF.IO/MKA82]. Empirical studies investigating the influence of EFs on human adaptation were eligible for inclusion, resulting in 11 studies and 3,733 participants among PubMed, Scopus, Web of Science, and PsycINFO. Results suggest an enhancing influence of EFs on the adaptation to new technologies, although findings were partially mixed. Inconsistent findings and the performed risk of bias assessment point toward a need for further high-quality research, e.g. on the influence of technological context. A model of possible covariates was proposed that provides guidance for a structured investigation of the process of human adaptation to technology. This review contributes to a better understanding of the association between EFs and human adaptation to new technologies.

Network meta-analysis evaluating the impact of diverse exercise regimens on quality of life in women post-breast cancer surgery.

This study used network meta-analysis to compare the effects of various exercise interventions, with the aim of identifying the most effective intervention measures. Data were extracted from 8 databases, comprising of PubMed, Web of Science, EBSCO, and Embase. The Cochrane risk of bias assessment tool was used to assess the quality of the research. Network meta-analysis and meta-analysis were performed using STATA15.0 and Review Manager 5.4, respectively. This analysis incorporated 58 research papers that had 4998 participants, of which 2480 were assigned to the test group and 2518 to the control group. As revealed by the data, the following is a descending order of the impact of various exercise regimens on the quality of life (QoL) of women who have undergone breast cancer surgery: For the MOS item short form health survey, the recommended sequence was as follows: aerobic + resistance exercise, football, baduanjin, walking, tai chi, yoga, resistance exercise, slow-moving qigong, aerobic exercise, and usual care; for functional assessment of cancer therapy for breast cancer, the sequence was as follows: aerobic + resistance exercise, resistance exercise, relaxation, baduanjin, square dance, aerobic exercise, tai chi, yoga, Pilates, mixer dance, aquatic sports, cycle ergometer, and usual care; and for European Organization for Research and Treatment of Cancer quality of life questionnaire, the sequence was aerobic + resistance exercise, aerobic + yoga, aerobic exercise, Pilates, yoga, muscle strengthening, resistance exercise, square dance, usual care, walking, and aerobic + edema massage. The majority of exercise interventions demonstrated a discernible impact on the QoL in women following breast cancer surgery. The effects of diverse exercise interventions on the 3 QoL outcome indicators in patients with breast cancer exhibited variability. However, irrespective of the QoL measurement technique used, aerobic and resistance exercise continue to be the most favorable choices.

Interventions for Preventing Tobacco Uptake among Adolescents within School Setting in South-East Asia region: A Systematic Review

Abstract Background Tobacco users disproportionately reside in lower-and-middle income countries, with many people beginning consumption of tobacco in adolescence. Countries employ interventions in schools as a means of providing health education thereby creating mass awareness among them. However, research has mostly restricted to developed nations. Objective To examine the impact of interventions implemented in preventing tobacco uptake among adolescents in school setting in South-East Asia region. Method The protocol was registered prospectively on PROSPERO (CRD42022337341). Systematic search was conducted on 6 databases: PubMed, Embase, Scopus, CINAHL, ProQuest and Web of Science. Randomized Control Trials (RCT) and Cluster RCT conducted in school set-up in South-East Asia among adolescents below 18 years’ age were included. Articles between timeline 2002–2022 were considered. Results From a total of 963 articles, total of 13 studies were included. Four were RCT, while nine were Cluster RCT. Most of the studies were targeted at change in prevalence, followed change in knowledge and attitude towards tobacco and impact on susceptibility to use tobacco. Nine studies had interventions based on Health Promoting School Framework, three were Peer-led Interventions and one was Counsellor-centred Intervention. Risk of Bias assessment revealed eight studies had low risk of bias, two had some concerns while three were high risk studies. Conclusion Interventions that focus on building a holistic environment and go beyond the usual classroom environment have primarily been implemented and found to be effective in this region. There is a need for strong, high-quality RCT studies with standardised evaluation techniques to combat tobacco use among adolescents.

Acupuncture combined with opioid for treatment of lung cancer-related pain: A systematic review and meta-analysis.

Many individuals diagnosed with lung cancer suffer from tremendous pain, and it is crucial to implement more effective measures to assist these patients in alleviating their pain. The present study utilizes a meta-analysis to evaluate the safety and efficacy of acupuncture combined with opioids for treating lung cancer-related pain in patients. We have searched 8 electronic databases: The Cochrane Library, PubMed, Embase, Web of Science, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Database, and SinoMed. We included all randomized controlled trials of acupuncture combined with opioids for lung cancer-related pain in adults. We observed the main outcome indicators, including pain relief rates, numeric rating scale scores, and adverse events. Two researchers independently conducted literature screening, literature data extraction, and assessment of bias risk in the literature quality. Any disagreements were resolved through discussions between the 2 researchers or consultations with a third researcher. The risk of bias in the included studies was assessed using the revised risk of bias assessment tool. The overall quality of evidence for each outcome was evaluated using Grading of Recommendations, Assessment, Development and Evaluations. We retrieved 812 lung cancer patients from 11 trials. The study showed that compared to opioids alone, the combination of acupuncture and opioids significantly reduced numeric rating scale scores, increased pain relief rates, and decreased the occurrence of side effects. The current evidence indicates that combining acupuncture with opioid analgesics is superior to using opioid analgesics alone for managing lung cancer-related pain. Additionally, this combination therapy has fewer adverse reactions.

Effectiveness of lower limb robotic rehabilitation on peak of oxygen uptake among patients with stroke: a systematic review and meta-analysis

ObjectivesTo evaluate the effectiveness of lower limb robotic rehabilitation (LLRR) on cardiovascular health among individuals with stroke undergoing rehabilitation.DesignSystematic reviews and meta-analysis.Data sourcesPubMed, Web of Science, Science Direct, Embase, China...

The association between integrating echocardiography use in the management of septic shock patients and outcomes in the intensive care unit: a systematic review and meta-analysis.

Septic shock in critically ill patients can increases morbidity and mortality. We aimed to study the effect on outcomes when integrating point of care (POC) echocardiography in the management of septic shock patients in the Intensive Care Unit (ICU) who are being treated according to the Surviving Sepsis Campaign (SSC) guidelines. An electronic search of MEDLINE through PubMed, clinical trials.gov and google scholar was conducted for the period from January 1990-January 2024 to identify studies of septic shock adult and pediatric patients in the ICU managed according to SSC guidelines with or without POC echocardiography. Three reviewers extracted data independent of each other. Cochrane collaboration tool was used for bias assessment. Random effect meta-analysis used to pool data. A total of 1701 articles identified. Seven studies included in the final report with a total of 3885 patients. POC echocardiography guided septic shock management was associated with lower in-hospital and 28-day mortality (sOR = 0.82 [95%CI: 0.71-0.95], p = 0.01), more frequent initiation of inotropic support (sOR = 2.42 [95%CI 1.92-3.03], p < 0.0001) and shorter time to achieve lactate clearance (SMD = - 0.87h [95%CI - 1.23h to - 0.51h], p < 0.0001). Summary estimates did not achieve significance for effect of POC echocardiography on 24-h fluid intake (SMD = - 2.11ml [95%CI - 5.93ml to 1.72ml], p = 0.28) on mechanical ventilation-free days (SMD = 0.03days [95%CI - 0.04 to 0.10], p = 0.94). Shock reversal time analysis was less meaningful due to the small number of studies reporting outcome. POC echocardiography guided management in septic shock patients in the ICU can lead to a decrease in mortality, increase in initiation of inotropic support, and a decrease in lactate clearance time. Larger cohort studies and data collection and analysis are needed for further understanding and optimizing standardization of protocols for POC echocardiography use in septic shock patients in the ICU.

Network Meta-Analysis of Comparing Different Dosages of Potassium-Competitive Acid Blocker With Proton-Pump Inhibitor in Acid-Related Disorders.

Potassium-competitive acid blockers have emerged as a promising treatment of acid-related disorders. However, the optimal dosage for maximizing their efficacy remains unclear. The aim of this network meta-analysis was to compare the efficacy and safety of various dosages of potassium-competitive acid blockers and proton-pump inhibitors for treating acid-related disorders. We searched PubMed, Embase, Cochrane Library, and Web of Science from inception to July 16, 2023. Data extraction was performed independently by 2 authors. The Cochrane Risk of Bias in Randomized Trials tool (RoB 2.0) was used for bias assessment. The efficacy and safety were compared using the odds ratio with 95% confidence intervals. Twelve articles were included in the present meta-analysis. For gastric/duodenal ulcers, keverprazan 30 mg (K30) exhibited the highest surface under the cumulative ranking (SUCRA) value (92.8%) for healing rate. In terms of total adverse events, lansoprazole 30 mg (L30) exhibited the lowest SUCRA value (25.3%) in the treatment of gastric/duodenal ulcers. For the healing rate in erosive esophagitis, the maximum SUCRA value of vonoprazan 40 mg (V40) was 90.7% in the first subgroup (erosive esophagitis using vonoprazan, keverprazan, and lansoprazole) and the maximum SUCRA value of T50 was 72.1% in the second subgroup (erosive esophagitis using tegoprazan, fexuprazan, and esomeprazole). For the total adverse events in erosive esophagitis, L15 exhibited the lowest SUCRA value (12.2%) in the first group and E40 exhibited the lowest SUCRA value (24.4%) in the second group. K30 may be the most effective dosage for increasing the healing rate of gastric/duodenal ulcers. For erosive esophagitis, V40 and T50 may be the preferred dosages.

Angiotensin-II and Thromboembolic Events: A Systematic Review

Objectives: To evaluate and synthesize the existing evidence for the association of angiotensin-II with thromboembolic events. Data Sources: PubMed, Scopus, and CENTRAL databases. Study Selection: This systematic review included randomized trials and comparative observational studies that reported on the occurrence of venous and/or arterial thromboembolic events in adult patients receiving treatment for shock with angiotensin-II vs. a comparator. Data Extraction: A total of 1689 records were screened by two independent investigators. Seven studies were deemed eligible for inclusion, encompassing 1461 patients. This included two randomized controlled trials and five nonrandomized studies of intervention. Data were extracted independently and in duplicate. Risk of bias assessments were performed using the Risk of Bias 2 and Risk Of Bias In Nonrandomized Studies of Interventions tools. Data Synthesis: The included studies reported on a variety of individual and composite thromboembolic events as exploratory endpoints. Overall, they demonstrated an elevated risk of bias, predominantly related to confounding, measurement of outcomes and selection of reported results, which precluded quantitative synthesis. Within these limitations, we found that thromboembolic event rates were similar between the angiotensin-II and comparator groups. Venous thromboembolic events were described in 8.8% of patients receiving angiotensin-II and 9.4% of controls, while arterial thromboembolic events were reported in 11.3% and 12.7%, respectively. Total event rates were broadly comparable when utilizing data derived from the primary publications and when adjusted for the U.S. Food and Drug Administration account of trial data. Conclusions: Published evidence does not currently support or refute an association between angiotensin-II and an increased risk of venous or arterial thromboembolic events. Given the limited quality of available data, future studies should explicitly define diagnostic and reporting criteria for such events.

Differences in Surgical Cancer Care Delivery and Outcomes Between Safety-Net and Non-Safety-Net Hospitals in the United States: A Comprehensive Systematic Review.

Studies evaluating the association of safety-net hospitals (SNHs) with outcomes of surgical care in cancer patients have demonstrated mixed results. We sought to systematically investigate the association of SNH status with measures of surgical cancer care delivery and outcomes. A comprehensive review of the literature identified from the MEDLINE/PubMed, Embase, Web of Science, and Cochrane databases was performed according to the PRISMA guidelines. Risk of bias assessment was conducted using the Joanna Briggs Institute's tool. The findings were synthesized qualitatively. Of the 1749 records identified, 33 retrospective studies were included, 79% of which investigated national databases. Risk of bias assessment revealed average score of 78%. Among studies assessing each outcome, lower likelihood of receiving appropriate surgical interventions in SNH patients was reported by 85%; longer intervals to surgery by 100%; and prolonged hospital stays by 73%. Most studies reported no differences in survival (65%) or readmission (67%). Results were mixed regarding complications and mortality. Patient characteristics and shortage of resources and interdisciplinary teams were frequently proposed factors for observed disparities. Cancer patients at SNHs may be less likely to undergo some surgical treatments and experience longer intervals to treatment but achieve largely comparable short- and long-term outcomes to non-SNH patients.

SURGICAL OUTCOMES OF TUBULAR RETRACTOR SYSTEMS IN THE MANAGEMENT OF BRAIN TUMOURS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract AIMS Retraction is a critical step in surgical removal of brain tumours, enabling visualisation and resection. Conventional retraction applies focal pressure to overlying tissue, potentially resulting in retraction-induced injury. Tubular retractors (minimally invasive parafascicular surgery) circumferentially distribute pressure to theoretically minimise injury. Whilst previous reviews have provided insight into their potential, the literature has since significantly expanded, necessitating an update. The objective was to synthesise all current evidence regarding surgical outcomes of tubular retractors in resection of brain tumours. METHOD Studies reporting on use of tubular retractors to resect brain tumours in adult patients were eligible. PRISMA guidelines were followed. MEDLINE, Embase and the Cochrane Library were searched to 18th October 2023. Duplicate title/abstract screening, data extraction and risk of bias assessments were conducted. RESULTS Of the 2453 studies screened, 49 were included in the final synthesis, involving 690 patients. Tubular retractor systems assessed were: BrainPath (n=199), VBAS (n=198), METRx (n=63) and other (n=230). Pooled estimate of gross total resection rate was 75% (95% CI 0.65-0.84; I2=83%), whilst pooled estimate of complication rate was 17% (95% CI 0.11-0.24; I2=75%). Sub-group analysis of gross total resection rate was conducted for: glioma (150 patients, pooled prevalence 47%, 95% CI 0.36-0.57; I2=29%), colloid cyst (121 patients, pooled prevalence 100%, CI 0.99-1.00; I2=0%), and metastasis (114 patients, pooled prevalence 82%, 95% CI 0.67-0.94; I2=64%). There was no significant difference between tubular retractor systems with regards to gross total resection or complication rate (p&amp;gt;0.05). CONCLUSION There is mounting evidence for the utility of tubular retractors in resection of brain tumours. However, this evidence remains largely in the form of low-quality case-series, providing proof-of-concept, but limited in its ability to draw more robust comparisons to conventional retraction. Future studies with greater sample sizes and inclusion of control groups are now needed to consolidate the position of tubular retractors in neuro-oncology.

Diagnostic Accuracy of PSMA PET-Guided Prostate Biopsy in Prostate Cancer—A Systematic Review and Meta-analysis

Purpose Early diagnosis and treatment of prostate cancer (PC) are crucial for effective management and improved patient outcomes. Newer imaging modalities like prostate-specific membrane antigen PET have shown superior diagnostic performance in detecting PC and clinically significant PC (csPC). This systematic review and meta-analysis aims to synthesize evidence on the diagnostic performance of PSMA PET-guided prostate biopsy in detecting PC and csPC. Patients and Methods The study followed the PRISMA-DTA guidelines. Using a predefined search strategy, 3 databases (PubMed, Embase, and Web of Science) were systematically searched using appropriate keywords. A meta-analysis was conducted using diagnostic accuracy parameters of the included studies. Risk of bias assessment was done using the QUADAS-2 tool. Results Out of 378 articles, 20 were assessed for full-text screening and 10 articles with 874 patients were finally included. Eight studies reported a pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of 0.90 (95%confidence interval [CI], 0.82–0.95), 0.93 (95% CI, 0.57–0.99), 12.3 (95% CI, 1.5–98.9), 0.10 (95% CI, 0.05–0.20), and 117 (95% CI, 12–1178), respectively, for detecting PC using PSMA PET-guided prostate biopsy with an area under the summary receiver operating characteristics curve of 0.94 (95% CI, 0.92–0.96). Similarly, 6 studies reported a pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of 0.89 (95% CI, 0.82–0.94), 0.65 (95% CI, 0.49–0.79), 2.6 (95% CI, 1.6–4.1), 0.17 (95% CI, 0.09–0.31), and 15 (95% CI, 6–41), respectively, for detecting csPC using PSMA PET-guided prostate biopsy with area under summary receiver operating characteristics curve of 0.86 (95% CI, 0.82–0.88). Conclusions PSMA PET-guided prostate biopsy has a high diagnostic accuracy in detecting PC and csPC in patients with clinical suspicion of PC, and provides a 1-stop solution for early diagnosis and staging of PC.

Machine learning approaches for risk prediction after percutaneous coronary intervention: a systematic review and meta-analysis

Abstract Aims Accurate prediction of clinical outcomes following percutaneous coronary intervention (PCI) is essential for mitigating risk and peri-procedural planning. Traditional risk models have demonstrated a modest predictive value. Machine learning (ML) models offer an alternative risk stratification that may provide improved predictive accuracy. Methods and results This study was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies and Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis guidelines. PubMed, EMBASE, Web of Science, and Cochrane databases were searched until 1 November 2023 for studies comparing ML models with traditional statistical methods for event prediction after PCI. The primary outcome was comparative discrimination measured by C-statistics with 95% confidence intervals (CIs) between ML models and traditional methods in estimating the risk of all-cause mortality, major bleeding, and the composite outcome major adverse cardiovascular events (MACE). Thirty-four models were included across 13 observational studies (4 105 916 patients). For all-cause mortality, the pooled C-statistic for top-performing ML models was 0.89 (95%CI, 0.84–0.91), compared with 0.86 (95% CI, 0.80–0.93) for traditional methods (P = 0.54). For major bleeding, the pooled C-statistic for ML models was 0.80 (95% CI, 0.77–0.84), compared with 0.78 (95% CI, 0.77–0.79) for traditional methods (P = 0.02). For MACE, the C-statistic for ML models was 0.83 (95% CI, 0.75–0.91), compared with 0.71 (95% CI, 0.69–0.74) for traditional methods (P = 0.007). Out of all included models, only one model was externally validated. Calibration was inconsistently reported across all models. Prediction Model Risk of Bias Assessment Tool demonstrated a high risk of bias across all studies. Conclusion Machine learning models marginally outperformed traditional risk scores in the discrimination of MACE and major bleeding following PCI. While integration of ML algorithms into electronic healthcare systems has been hypothesized to improve peri-procedural risk stratification, immediate implementation in the clinical setting remains uncertain. Further research is required to overcome methodological and validation limitations.

Effect of different electric stimulation modalities on pain and functionality of patients with pelvic pain: Systematic review with META-analysis.

Pelvic pain is located in the anterior abdominal wall, below the umbilical scar. Its treatment includes pharmacological therapy, which can cause adverse effects and is not always sufficient to control symptoms. Thus, the use of adjunct therapies such as electric stimulation has been suggested. Therefore, this review intends to appraise the literature on the effectiveness of electrostimulation in the treatment of pelvic pain. The search for studies was conducted until April 2024 in PubMed, Cochrane Library, ScienceDirect, SciELO, PEDro, CINAHL, BVS, Web of Science, Scopus, and Google Scholar databases using a combination of Mesh terms "Electric Stimulation" and "Pelvic Pain." Risk of bias assessment and meta-analysis were performed with The Cochrane Collaboration tool (RevMan 5.4). Quality of the evidence was assessed with GRADE tool. From the 3247 studies found, 19 were included. In the qualitative analysis, seven studies showed TENS, electroacupuncture, PTNS, and tDCS reduced pain intensity, one study on PTNS showed increased quality of life, and one on tDCS showed improved functional performance. However, in the meta-analysis, only TENS showed efficacy for the reduction of acute pelvic pain and primary dysmenorrhea. Our results indicate that there is moderate-quality evidence for TENS to reduce pain intensity in primary dysmenorrhea and low-quality evidence for the same outcome in acute pelvic pain. Randomized controlled clinical trials with larger sample size and with better methodological quality are needed to establish the effectiveness of other forms of electrical stimulation in pelvic pain.

A Systematic Review and Meta-Analysis of the Efficacy of Antimicrobial Chemoprophylaxis for Recurrent Acute Otitis Media in Children.

Acute otitis media (AOM) is a common childhood infection. Recurrent AOM affects a subset of children, resulting in an adverse impact on quality of life, socioeconomic disadvantage, and risk of long-term sequelae. Antimicrobial chemoprophylaxis is used in some settings but is increasingly controversial due to an awareness of adverse long-term effects and contribution to global antibiotic resistance. A comprehensive literature search was undertaken using Medline (1946-October 2023) and Embase (1974-October 2023). The primary aim was to assess the efficacy of antimicrobial chemoprophylaxis on AOM episodes in children < 18 years of age. Bias and quality assessment was performed. Dichotomous data were analysed using risk ratio with 95% confidence intervals. Meta-analysis was carried out using random-effects models for pooled analysis, independent of heterogeneity. Heterogeneity was assessed using the I2 statistic. The effect of antimicrobial chemoprophylaxis in children with rAOM on the number of individual AOM episodes. assessment of antimicrobial agents and outcomes in children with risk factors. Assessment of qualitative data was performed on 20 studies (n = 2210). No controlled trials were identified post-multivalent pneumococcal conjugate vaccine (PCV) introduction, restricting current generalisability. Quantitative meta-analysis on nine pre-PCV studies (n = 1087) demonstrated antimicrobial chemoprophylaxis reduced any episode of AOM with a risk ratio 0.59 (95% CI 0.45-0.77). Families and clinicians must balance marginal short-medium term benefit (based on pre-PCV data), and the potential for adverse effects to that individual, and the societal risk of antimicrobial resistance with prolonged antibiotic use.

Mobile applications for promoting and supporting breastfeeding: Systematic review and meta-analysis.

Breastfeeding practices require improvement. We performed a systematic review of randomised controlled trials (RCTs) and analytic observational studies to assess effects of mobile applications (apps) aiming to support and promote breastfeeding targeting pregnant women, mothers of infants or their partners, on breastfeeding outcomes. We searched MEDLINE, EMBASE, Cochrane CENTRAL and Association of Computing Machinery Digital Library from 1 July 2008 to 29 November 2022, with lack of coverage of the most recent period before publication date being a limitation of this review. We performed meta-analyses of findings from RCTs on primary outcomes, namely early breastfeeding initiation, exclusive and any breastfeeding rates. Joanna Briggs Institute tools were used for risk of bias assessment. Six RCTs, one quasi-experimental and two cohort studies, mainly from high-income countries, were included. Most studies focused on maternal app usage starting from pregnancy. One study targeted fathers as app-users. Population characteristics, such as parity or delivery mode, apps scope of content and applied active components varied between studies. Main methodological limitations of studies were baseline differences between groups and lack of blinding. Compared to controls, app usage tended to increase the odds of exclusive breastfeeding. This nonsignificant effect was most pronounced at 1-1.5 months (n = 1294, odds ratio 1.45 (95% Confidence Interval, CI 0.83, 2.54), with considerable heterogeneity between studies [I2 77%]), but less so at 3 and 6 months post-partum. The odds of early breastfeeding initiation, any breastfeeding at all time points were similar among groups. However, two cohort studies reported increased odds of exclusive and/or any breastfeeding at different time points. In conclusion, evidence is insufficient to show sustained beneficial effects of breastfeeding promotion and support through mobile apps on breastfeeding rates.

Reliability of the risk of bias assessment in randomized controlled trials for nursing: A cross-sectional study.

To evaluate the percentage and reasons for disagreements in the risk of bias (RoB) assessments for randomized controlled trials (RCTs) included in more than one Cochrane review in the field of nursing. Disagreement in RoB assessments reduces the credibility of the evidence summarized by systematic reviews (SRs). There is no study that evaluates the reliability of RoB assessments in nursing studies. Secondary data analysis based on research reports. RCTs included in more than one review in the nursing have been included. The disagreement of the assessment was analysed, and the possible reasons for disagreements were investigated. Twenty-three RCTs were included in more than one review. The agreement of assessment ranged from 36.84% for "selective reporting" to 91.30% for "random sequence generation". "Allocation concealment" showed the optimal agreement (84.21%). The items "blinding of participants and personnel", "blinding of outcome assessment" and "incomplete outcome data" showed poor agreement, with 50.00%, 58.82% and 66.67%, respectively. Most disagreements came from extracting incomplete or different RCTs' information. The level of agreement of the assessment between reviews has varied greatly in the field of nursing. More complete and accurate information of RCTs needs to be collected when conducting a SR.

Novel β-lactam antibiotics versus other antibiotics for treatment of complicated urinary tract infections: a systematic review and meta-analysis.

Novel β-lactam antibiotics as well as other kinds of antibiotics have been used to treat complicated urinary tract infections (cUTIs); however, their efficacy and safety remain controversial. We conducted a systematic review with meta-analysis to explore the efficacy and safety of novel β-lactam antibiotics versus other antibiotics against cUTIs. PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched systematically from inception through 15 March 2024 for clinical trials comparing novel β-lactam antibiotics with other antibiotics for treatment of cUTIs. Random-effects models were used to evaluate the impact of treatment on the risk ratio (RR) of clinical response, microbiologic response, adverse effects (AEs), serious adverse effects (SAEs). The quality of evidence was evaluated with the Cochrane Risk of Bias assessment tool. The review was registered in INPLASY (INPLASY202440054). Ten randomized controlled trials involving 5, 925 patients met our inclusion criteria. Our meta-analysis revealed that there was no significant difference in overall clinical response (RR = 1.02), AEs (RR = 1.07), SAEs (RR = 1.20) between novel β-lactam antibiotics groups and other antibiotics groups. However, a significant difference was found in a subgroup of clinical cure rates at the end of treatment between novel β-lactam antibiotics groups and carbapenems groups, with low heterogeneity (RR = 1.02). A significant difference was observed in microbiologic response (RR = 1.11). Subgroup analysis revealed a significant difference in microbiologic response between novel BBL/BLS groups and carbapenems groups (RR = 1.13, I2 = 21%, P = 0.005). Differences was observed between novel BBL/BLS groups and piperacillin/tazobactam sodium groups (RR = 1.21, I2 = 70%, P = 0.02). Similar results were obtained from subgroup analysis of the difference in microbiologic response between novel β-lactam antibiotics groups and ertapenem groups (RR = 0.92, I2 = 0, P = 0.01). Novel β-lactam antibiotics had similar overall clinical cure, AEs, SAE, to other antibiotics in the treatment of cUTIs. However, novel β-lactam antibiotics demonstrated superior clinical cure rates compared to carbapenems in a subgroup analysis, and exhibited better microbiologic response than other antibiotics.

Effectiveness of robotic rehabilitation for gait and balance in people with multiple sclerosis: a systematic review.

This review investigated the effectiveness of robotic-assisted gait training (RAGT) in improving gait and balance performance in adults with multiple sclerosis (MS). Databases and registers were searched from inception to December 2023 to identify randomized controlled trials (RCTs) that analyzed the effects of RAGT on gait speed, function, balance, fatigue, and adverse events. Three reviewers screened studies for eligibility and extracted key information such as participants and intervention characteristics, as well as outcomes of interest. The reviewers assessed the risk of bias of included studies using Cochrane Risk of Bias tool. From the 948 records identified, 8 RCTs were included, involving 335 participants. The studies have demonstrated significant heterogeneity in patient characteristics, intervention protocols, and outcomes measured. The risk of bias assessment revealed concerns, mainly in terms of performance and detection bias. The evidence is uncertain on the effectiveness of RAGT on balance and gait in people with MS, but a multimodal rehabilitation approach, including RAGT, should be encouraged. No serious adverse events seem to be associated with RAGT, suggesting that these interventions are generally safe for use in people with MS. Further studies of higher methodological quality should be led to confirm these positive results.