Quality Assessment Of Studies Research Articles

A systematic review of parent-child communication in pediatric asthma.

Parent-child communication is integral to pediatric asthma management. This review evaluates parent-child communication among youth with asthma and their caregivers. It aims to characterize the type of communication according to a unifying framework (Murphy, L. K., Murray, C. B., & Compas, B. E., Guest Editors: Cynthia A. Gerhardt, Cynthia A. Berg, Deborah J. Wiebe and Grayson N. Holmbeck (2017). Topical review: Integrating findings on direct observation of family communication in studies comparing pediatric chronic illness and typically developing samples. Journal of Pediatric Psychology, 42, 85-94. https://doi.org/10.1093/jpepsy/jsw051), assess sociodemographic factors associated with communication, and examine the relationship between parent-child communication and youth psychosocial and health-related outcomes. A systematic literature search was conducted using PubMed, PsycINFO, CINAHL, Web of Science, Cochrane Library, and Embase databases (June 2021; updated May 2024). Included studies reported original, peer-reviewed research on the relationship between parent-child communication and youth psychosocial or health outcomes among pediatric patients (mean age <18 years) with asthma and their primary caregiver(s). Study quality was evaluated using the Study Quality Assessment Tools of the NHLBI. Sixty-six articles were included with data from 5,373 youth with asthma. Studies assessed both positive (warm and structured) and negative (hostile/intrusive and withdrawn) communication. Most studies used questionnaires and cross-sectional designs. Associations between sociodemographic and communication variables were largely nonsignificant. Greater positive and less negative communication was associated with better youth psychosocial and asthma outcomes overall. Parent-child communication may be an important target for interventions aimed at improving youth outcomes. More research is needed to develop communication-focused interventions that aim to enhance parents' and youths' communication skills (i.e., increase their use of positive communication approaches and/or reduce their use of negative communication approaches) and evaluate their impact on youth outcomes. Future research should also use more discussion tasks and longitudinal designs.

The Role of Radioiodine Therapy in Differentiated Thyroid Cancer Arising from Struma Ovarii: A Systematic Review

Background: Struma ovarii (SO) is an ovarian teratoma with the presence of ectopic thyroid tissue. Differentiated thyroid cancer (DTC) in SO is a rare finding. Management of DTC in SO is currently not clearly established. We performed a systematic review of the literature to assess the role of 131I radiometabolic therapy in the treatment of DTC in SO. Methods: a wide literature search in the Scopus, PubMed/MEDLINE, and Web of Science databases was made to find published articles regarding the treatment of patients with DTC and SO. The quality assessment of studies was performed by QUADAS-2 evaluation. Results: eleven studies were included in the systematic review. All of them were retrospective studies and/or case series, and two of them also included a review of the literature. Most of the studies describe cases of DTC in SO treated by total thyroidectomy (TT) and subsequent radioiodine (RAI) therapy, especially in patients with distant metastases and/or concomitant thyroid cancer. However, the majority of patients apparently did not require radiometabolic therapy. Conclusions: TT and subsequent RAI therapy is usually performed in metastatic disease, not recommended in patients with intraovarian disease without risk factors, and it appeared possible but not mandatory in patients with risk factors.

The Accuracy of Algorithms Used by Artificial Intelligence in Cephalometric Points Detection: A Systematic Review

The use of artificial intelligence in orthodontics is emerging as a tool for localizing cephalometric points in two-dimensional X-rays. AI systems are being evaluated for their accuracy and efficiency compared to conventional methods performed by professionals. The main objective of this study is to identify the artificial intelligence algorithms that yield the best results for cephalometric landmark localization, along with their learning system. A literature search was conducted across PubMed-MEDLINE, Cochrane, Scopus, IEEE Xplore, and Web of Science. Observational and experimental studies from 2013 to 2023 assessing the detection of at least 13 cephalometric landmarks in two-dimensional radiographs were included. Studies requiring advanced computer engineering knowledge or involving patients with anomalies, syndromes, or orthodontic appliances, were excluded. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and Newcastle–Ottawa Scale (NOS) tools. Of 385 references, 13 studies met the inclusion criteria (1 diagnostic accuracy study and 12 retrospective cohorts). Six were high-risk, and seven were low-risk. Convolutional neural networks (CNN)-based AI algorithms showed point localization accuracy ranging from 64.3 to 97.3%, with a mean error of 1.04 mm ± 0.89 to 3.40 mm ± 1.57, within the clinical range of 2 mm. YOLOv3 demonstrated improvements over its earlier version. CNN have proven to be the most effective AI system for detecting cephalometric points in radiographic images. Although CNN-based algorithms generate results very quickly and reproducibly, they still do not achieve the accuracy of orthodontists.

Human and animal brucellosis and risk factors for human infection in Ethiopia: a systematic review and meta-analysis (2015–2024)

Background and objectiveBrucellosis is a neglected zoonotic disease caused by Brucella species. Unlike most developed nations, the problem of brucellosis in Ethiopia remains a public and animal health concern. This study was conducted to determine the magnitude of brucellosis in animals (mainly cattle, sheep, goats, dogs and camels) and humans, and to identify the risk factors for human brucellosis.MethodologyThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to conduct this systematic review and meta-analysis, which was performed from May 2024 to July 2024. Academic databases such as PubMed, ScienceDirect, Scopus, PubMed Central, Web of Science, and Google Scholar were searched to identify articles focusing on brucellosis in humans and animals in Ethiopia. Data extraction was performed according to predefined inclusion and exclusion criteria. The included articles were appraised using the appraisal tool for cross-sectional studies to assess study quality. Publication bias and small study effects were examined using funnel plot observation and Egger’s test, respectively. Statistical analysis was conducted using R software version 4.4.1.ResultsThirty-nine articles published between 2015 and 2024 were included in the final analysis from a total of 1,427 identified articles. The overall pooled seroprevalence of brucellosis was 5.0% (95% CI: 3.0, 6.0). The seroprevalence of brucellosis was higher in humans at 6.9% (95% CI: 4.9, 8.8) and lower in cattle at 3.5% (95% CI: 2.2, 4.7). There was high heterogeneity in the reports of brucellosis seroprevalence between studies (τ² = 0.0038, H² = 255.9, I² = 99.61%, Q-test = 1954.99, df = 56, p ≤ 0.001). Laboratory tests and study location were identified as factors contributing to potential sources of variation in the pooled seroprevalence. Drinking raw milk from aborted animals, touching aborted materials or fetuses, and occupation were among the risk factors for human brucellosis. No publication bias or small study effects were detected.ConclusionThe findings indicate that brucellosis continues to pose a significant zoonotic threat, particularly to humans, where the seroprevalence is notably higher than in animals. These results highlight the need for targeted public health interventions and greater awareness to reduce the incidence of brucellosis, especially among high-risk populations.

The prevalence of obstructive sleep apnea-hypopnea syndrome in patients with multiple sclerosis: a systematic review and meta-analysis

ObjectiveObstructive sleep apnea-hypopnea syndrome is the most common respiratory disorder in patients with multiple sclerosis. The purpose of this meta-analysis was to evaluate the prevalence of OSAHS in MS patients and to analyze their sleep monitoring indicators of patients.MethodsOnline databases such as PubMed, EMBASE, Web of Science, CNKI, and WanFang were used to review the Chinese and English literature about OSAHS in MS patients in detail. Two researchers analyzed the Quality of included studies based on the Quality Assessment of Diagnostic Accuracy Studies. The prevalence and sleep monitoring data were analyzed using STATA 11.0 software. Based on the I2 values, pooled analyses were performed using either random (I2 &amp;gt; 50%) or fixed-effect models (I2 ≤ 50%).ResultsFourteen articles were selected for the final analysis. Our study shows that different diagnosis methods of OSAHS lead to different incidences. When the screening method was PSG, the incidence of OSAHS in MS patients was 36%; when the method was STOP-BANG, the incidence of OSAHS in MS patients was 26%; when the method was Berlin questionnaire, the incidence of OSAHS in MS patients was 30%. We performed subgroup analyses based on race, age, OSAHS severity, and BMI of patients with MS. The results suggested that the incidence of OSAHS was different in different subgroups of MS patients. In addition, we found that patients with MS generally had poorer sleep monitoring indicators.ConclusionThe current literature shows that the incidence of OSAHS is higher in MS patients. MS may affect the progression of OSAHS.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=551500, CRD42024551500.

Navigating agitation in neurodevelopmental disorders: A comparative study of pharmacotherapies via network meta-analysis in children and adults with autism spectrum disorder or intellectual disabilities.

Individuals with autism spectrum disorder (ASD) and intellectual disability often experience persistent challenges related to aggressive behaviour and agitation, highlighting the critical need for evidence-based pharmacological interventions among other strategies. Despite previous network meta-analyses (NMAs), the rapidly evolving landscape of treatment options necessitates ongoing and updated assessments. To evaluate the efficacy and tolerability of various pharmacotherapies in managing agitation in children and adults with ASD or intellectual disabilities (ID). Employing a systematic review and network meta-analysis methodology, we conducted an exhaustive search across multiple databases for double-blind, randomized controlled trials focusing on pharmacotherapies targeting agitation in these neurodevelopmental disorders. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, our assessment of study quality utilized the Cochrane Risk of Bias Tool to ensure methodological rigour and accuracy in data synthesis. Primary outcomes encompassed measures of reduced agitation, as indicated by treatment response on standardized agitation scales, alongside dropout rates, providing a comprehensive overview of treatment efficacy and tolerability. Our analysis included data from 38 eligible trials, involving 2503 participants across both pediatric and adult populations. Key pharmacological interventions, such as arbaclofen, risperidone plus buspirone, omega-3 fatty acids, risperidone plus palmitoylethanolamide, aripiprazole and risperidone, demonstrated significant efficacy in reducing agitation compared to placebo. Importantly, these treatments were generally well-tolerated, with no significant increase in all-cause dropouts compared to placebo, highlighting their suitability for clinical use in managing agitation in individuals with ASD or ID. This study underscores the efficacy and tolerability of several pharmacotherapies in managing agitation among children and adults with ASD or ID. Our findings provide robust evidence that specific treatments, such as arbaclofen, risperidone plus buspirone and omega-3 fatty acids, are both effective and well-tolerated, offering valuable therapeutic options for clinicians. The study emphasizes the need for ongoing research to ensure that treatment strategies remain aligned with the evolving clinical landscape, ultimately improving patient outcomes in this challenging population.

Association Between Parental Adverse Childhood Experiences and Offspring's Risk of Suboptimal Health: A Systematic Review and Meta-Analysis.

Previous reviews and meta-analysis have not adequately explored the impact of specific parental adverse childhood experiences (ACEs) subtypes on offspring's health. This updated systematic review and meta-analysis aimed to investigate the association between parental ACE subtypes and various offspring health outcomes. A comprehensive search was conducted in electronic databases including PubMed, Web of Science, the Cochrane Library, WANFANG, and China National Knowledge Infrastructure for studies published in English and Chinese from January 1, 1998, until July 18, 2023. Two independent reviewers screened studies, extracted data, and assessed study quality using the Newcastle-Ottawa Scale. A random-effects model was applied to generate pooled odds ratios (ORs) and 95% confidence interval (95% CI). A total of 47 eligible studies were included in the final analysis. Overall, parental ACEs were significantly associated with several offspring's health outcomes, including preterm birth (PTB), low birth weight (LBW), total developmental delay, social-emotional problems, and behavioral problems (total, externalizing and internalizing behaviors), with ORs ranging from 1.06 to 3.02. Specific subtypes of parental ACEs, such as household dysfunction, sexual abuse, and physical abuse (but not emotional abuse) were significantly associated with PTB. Household dysfunction was notably linked to delayed cognition ability in offspring. Parental sexual abuse, physical abuse, emotional abuse, and emotional neglect were significantly correlated with social-emotion problems, with the expception of household dysfunction. Regarding total behavioral problems, parental household dysfunction, physical abuse, emotional abuse, physical neglect, and peer bullying were all significantly associated with children's behavioral issues, except for emotional neglect. There is a positive correlation between parental household dysfunction, sexual abuse, physical abuse, emotional abuse, emotional neglect, physical neglect, peer bullying, and neighborhood-related adversity and their children's externalizing behavior problems. These findings underscore the significant impacts of parental ACEs on multiple adverse health outcomes in children, with specific parental ACEs subtypes exerting unique effects. This highlight the significance of comprehending the intergenerational effects of different ACE subtypes, and emphasizes the urgency of interventions to address these issues.

Barriers and facilitators in nurse prescribing practices: a protocol for qualitative meta-synthesis from nurses’ perspectives

IntroductionWith the development of the medical system and the diversification of patient needs, nurse practitioners (NPs) play an increasingly important role in medical practice, assuming more responsibilities and powers, including...

Patients' Experiences of Healthcare Professionals' Competence in Digital Counselling in Healthcare Settings-A Qualitative Systematic Review.

To critically appraise and synthesise qualitative evidence about patients' experiences of healthcare professionals' competence in digital counselling in healthcare settings. A qualitative systematic review. The review followed the Joanna Briggs Institute methodology for systematic reviews of qualitative evidence. The review included studies that focused on patient experiences of healthcare professionals' competence in digital counselling and were published in English, Finnish or Swedish, with no time limits. Study selection, quality appraisal and data extraction were performed by two independent reviewers. Findings from the studies included were pooled using the meta-aggregation method. Eight databases (Web of Science, CINAHL, Scopus, PsycArticles, Medic, Medline (Ovid), EBSCO Open Dissertations and MedNar) were systematically searched on 25 September 2023. Sixteen studies (published between 2009 and 2023) were included in the review, from which 42 findings were extracted and organised into eight categories based on their meaning. Three synthesised findings were identified: (1) Competence to provide efficient digital counselling, (2) competence to support patient self-management during digital counselling and (3) competence in establishing a reciprocal relationship in digital counselling. The evidence from the review can be used to support healthcare professionals' competence in digital counselling. It was found that competence in digital counselling includes the competence to provide digital counselling that is efficient and enables counselling to be implemented in health care, supports patients to self-manage and establishes a reciprocal counselling relationship in a digital environment. Recognising healthcare professionals' competence in digital counselling can enhance their motivation and professional growth, potentially improving the quality of services and patient outcomes. These findings can inform the development of healthcare education, fostering the training of more competent healthcare professionals and digital counsellors. The review was undertaken and reported using the PRISMA guidelines. PROSPERO CRD42024499509. No Patient or Public Contribution.

Accuracy of cell-free fetal DNA in detecting chromosomal anomalies in women experiencing miscarriage: systematic review and meta-analysis.

To report the diagnostic accuracy of cell-free fetal DNA (cfDNA) in detecting fetal chromosomal anomalies in women experiencing miscarriage. PubMed, MEDLINE, EMBASE and Cochrane databases were searched from inception to June 2024. The inclusion criteria were women experiencing miscarriage (defined as pregnancy loss before 20 weeks of gestation) who underwent cfDNA screening for trisomies 21, 18and13, other autosomal aneuploidies, sex-chromosome aneuploidies and/or copy-number variants (CNVs). The index test was cfDNA screening for each of the chromosomal anomalies listed. The reference standard was cytogenetic analysis of pregnancy tissue. The quality of the studies was assessed using the revised tool for the quality assessment of diagnostic accuracy studies. Summary estimates of sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio were computed using the hierarchical summary receiver-operating-characteristics model. Seven studies (887 women) were included in the systematic review and meta-analysis. cfDNA had a sensitivity and specificity of 100% (95% CI, 81.5-100%) and 100% (95% CI, 99.1-100%), respectively, for trisomy 21, 100% (95% CI, 54.1-100%) and 100% (95% CI, 99.0-100%), respectively, for trisomy 18, and 88.9% (95% CI, 51.8-99.7%) and 100% (95% CI, 99.1-100%), respectively, for trisomy 13. The respective values for other autosomal trisomies were 75.8% (95% CI, 65.7-84.2%) and 99.4% (95% CI, 97.9-99.9%), while those for CNVs were 60.0% (95% CI, 14.7-94.7%) and 100% (95% CI, 97.4-100%). Failure of cfDNA testing was reported in 7.3% (95% CI, 5.7-9.2%) of cases. cfDNA has high diagnostic accuracy in detecting fetal trisomies 21, 18 and 13 in women experiencing miscarriage, while its accuracy for other autosomal aneuploidies and CNVs is only moderate. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Effectiveness of non-pharmacological interventions in managing symptom clusters among lung cancer patients: a systematic review

BackgroundNon-pharmacological interventions, as complements to pharmacological treatments, are widely employed for managing symptom clusters in patients with lung cancer. Although numerous systematic reviews and meta-analyses have explored the effects of these interventions, most studies have centred on the broader cancer population and specific symptom clusters. This review aims to consolidate existing non-pharmacological interventions and assess their effectiveness in managing symptom clusters among lung cancer patients.MethodsA comprehensive literature search, encompassing eight databases from inception to October 1, 2024, was conducted. Two independent reviewers carried out the study selection, quality assessment, and data extraction. Methodological quality was evaluated using the Cochrane Risk-of-Bias 2 tool and the Risk of Bias in Non-randomized Studies of Interventions. The findings were synthesized narratively based on intervention type and supplemented by meta-analysis using RevMan 5.4 software. The study protocol was registered with PROSPERO (CRD42023467406).ResultsThis systematic review comprised 15 relevant studies involving 1,692 patients, published between 2011 and 2024. The analysis revealed the effectiveness of psychological, educational, and complementary or alternative medicine interventions in alleviating the severity of most symptom clusters. However, the efficacy of exercise-based and multimodal interventions remained inconclusive. The meta-analysis demonstrated a positive impact of non-pharmacological interventions on depression compared with the control conditions (SMD = -0.30, 95% CI [-0.46, -0.15], p < 0.01, I2 = 6%). Additionally, the educational intervention subgroup showed low heterogeneity and effectively improved fatigue (SMD = -0.50, 95% CI [-0.68, -0.33], p < 0.01, I2 = 0%).ConclusionsPsychological and educational interventions have proven effective in managing symptom clusters in lung cancer patients. However, further research is needed to explore the effects of exercise, multimodal approaches, and complementary or alternative medicine. To enhance symptom management, future research could focus on core symptom clusters.

What Is the Accuracy of 16S PCR Followed by Sanger Sequencing or Next-generation Sequencing in Native Vertebral Osteomyelitis? A Systematic Review and Meta-analysis.

Identifying a microorganism in patients with native vertebral osteomyelitis presents diagnostic challenges. Microorganism identification through culture-based methods is constrained by prolonged processing times and sensitivity limitations. Despite the availability of molecular diagnostic techniques for identifying microorganisms in native vertebral osteomyelitis, there is considerable variability in reported sensitivity and specificity across studies, leading to uncertainty in their clinical utility. What are the sensitivity, specificity, and diagnostic odds ratios for 16S broad-range PCR followed by Sanger sequencing (16S) and metagenomic next-generation sequencing (NGS) for detecting bacteria in native vertebral osteomyelitis? On June 29, 2023, we searched Cochrane, Embase, Medline, and Scopus for results from January 1970 to June 2023. Included studies involved adult patients with suspected native vertebral osteomyelitis undergoing molecular diagnostics-16S bacterial broad-range PCR followed by Sanger sequencing and shotgun or targeted metagenomic NGS-for bacteria detection. Studies involving nonnative vertebral osteomyelitis and cases of brucellar, tubercular, or fungal etiology were excluded. The reference standard for the diagnosis of native vertebral osteomyelitis was a composite clinical- and investigator-defined native vertebral osteomyelitis diagnosis. Diagnostic performance was assessed using a bivariate random-effects model. Risk of bias and diagnostic applicability were evaluated using the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. After a manual screening of 3403 studies, 10 studies (5 on 16S, 5 on NGS) were included in the present analysis, from which 391 patients were included from a total of 958 patients overall. Quality assessment via QUADAS-2 criteria showed moderate risk of bias and good applicability. 16S showed 78% (95% confidence interval [CI] 95% CI 31% to 96%) sensitivity and 94% (95% CI 73% to 99%) specificity, whereas NGS demonstrated 82% (95% CI 63% to 93%) sensitivity and 71% (95% CI 37% to 91%) specificity. In addition, the diagnostic ORs were 59 (95% CI 9 to 388) and 11 (95% CI 4 to 35) for 16S and NGS, respectively. Summary receiver operating characteristic curves showed high test performance for 16S (area under the curve for 16S 95% [95% CI 93% to 97%] and for NGS 89% [95% CI 86% to 92%]). Certainty in estimates was moderate because of sample size limitations. This meta-analysis found moderate-to-high diagnostic performance of molecular methods on direct patient specimens for the diagnosis of native vertebral osteomyelitis. When used as a complementary test to microbiological analyses, a positive 16S result rules in the diagnosis of native vertebral osteomyelitis, while further studies are needed to understand the role of NGS in the diagnosis of native vertebral osteomyelitis. When available, these tests should be used in addition to conventional microbiology, especially in complex cases with extensively negative standard microbiological test results, to detect fastidious bacteria or to confirm the causative bacteria when their isolation and pathogenicity are unclear. A large sample size is needed in future research to understand the use of these techniques as standalone tests for diagnosis. Level III, diagnostic study.

Vertical Versus Horizontal Finishing Lines for Dental Preparations: A Systematic Review With Meta-Analysis.

To evaluate the influence of horizontal and vertical dental preparation techniques on tooth-supported fixed restorations, with specific focus on survival and success rates, periodontal-related variables, and patient-reported outcome (PROs) measures. A comprehensive literature search of relevant randomized and controlled clinical trials (RCTs/CCTs), prospective/retrospective cohort studies, and case series with a minimum follow-up period of 3 years was performed across electronic databases (Medline, Embase, and Cochrane) up to January 2024. Primary outcomes included success and survival rates, and secondary outcomes included periodontal variables, both mechanical and biological complications, and PROs. Two reviewers independently conducted study selection, data extraction, and quality assessment. Of the 837 articles initially identified, 19 were included in the final analysis. A meta-analysis was conducted to compare the preparation techniques using survival and success rates as the main outcomes. Additionally, periodontal variables were analyzed. The included studies varied in design, follow-up duration, restoration type, and materials used. Survival rates showed no significant differences between vertical and horizontal techniques (risk ratio (RR) 0.96-1.04, p = 0.95). Additionally, success rates (RR 0.93-1.14, p = 0.53) and periodontal variables also showed varied results with no clear preference for either technique. Both the horizontal and vertical preparation techniques exhibited comparable survival and success rates for dental restorations. Given that there was no significant difference in outcomes between the two, the choice of technique may depend on the clinician's preference and specific clinical scenarios.

Investigating pain-related medication use and contribution to polypharmacy in adults with intellectual disabilities: a systematic review

BackgroundAdults with intellectual disability experience more pain than adults without and, despite a higher number of medications being prescribed, may be less likely to receive medication for pain. We conducted a systematic review of existing literature on medication for pain and painful conditions in adults with intellectual disability to explore if there is any association with polypharmacy, multimorbidity or demographic characteristics.MethodsThis systematic review followed PRISMA guidelines. Medline, Embase, PubMed, PsycINFO, Web of Science, CINAHL, Cochrane Library and Scopus were searched from January 2000 to 21st October 2024. We included original, peer-reviewed observational, qualitative or mixed-method studies published in English with data on medication for pain or painful conditions in adults with intellectual disability. Two independent reviewers performed study selection, data extraction, and quality assessment; disagreements were resolved by a third reviewer. Adapted Newcastle–Ottawa Scale or the Critical Appraisal Skills Programme for qualitative studies was used for quality assessment of included studies and findings were reported via narrative synthesis. PROSPERO registration: CRD42023415051.ResultsTwenty-seven of 26,170 articles met the eligibility criteria. Adults with intellectual disability were more likely to have simple analgesic medication than non-steroidal anti-inflammatory drugs, opioids or adjuvant pain medications than the general population. Psychotropic medications were more commonly prescribed in adults with intellectual disability than medication for pain or painful conditions. Adults with intellectual disability and caregivers reported under-recognition and most likely under-treatment of pain.ConclusionsAdults with intellectual disability may receive less pharmacological management of pain with analgesics and medication for painful conditions despite the high prevalence of polypharmacy, suggesting pain is under-treated. Better assessment and pharmacological treatment of pain and painful conditions is a key future research priority to address this health inequality and improve quality of life for this vulnerable group of people.

Phase angle as a marker of muscle quality: A systematic review and meta-analysis

Background & aimsPhase angle (PhA) is a biomarker derived from raw bioelectrical impedance analysis (BIA) values: resistance (R) and reactance (Xc). PhA reflects cellular membrane integrity and, as a result, has been considered a marker of fluid distribution, making it a potential prognostic indicator. A growing body of research demonstrates independent associations between PhA and muscle strength, mass, and composition. In this context, PhA has the extra potential to serve as a marker of muscle quality. However, the evidence supporting its use for this purpose is not well established. This study aimed to investigate the relationship between PhA and markers of muscle quality. MethodsThis systematic review and meta-analysis (Internal Prospective Register of Systematic Reviews – PROSPERO on a registration code: CRD42024507853) focused on observational studies assessing the relationship between PhA and markers of both concepts of muscle quality: the muscle quality index (MQI: strength by a unit of mass) and the muscle composition (i.e., skeletal muscle radiodensity [SMD], muscle echogenicity, muscle fat fraction, inter- and intramuscular adiposity). Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2), while the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Meta-analyses with a random-effects model were conducted. ResultsSeventeen studies were included in this systematic review, encompassing 2,710 participants. Meta-analyses demonstrated that PhA had a moderate positive correlation coefficient with SMD (4 studies, 924 participants; r = 0.54, 95% confidence interval (CI) 0.38 to 0.69, heterogeneity (I2) = 92%) and good accuracy (85%) for classifying low SMD (2 studies, 390 participants; Area Under the Curve – AUC pooled 0.85, 95% CI 0.78 to 0.92, I2 = 0%). PhA was inversely-moderately correlated with muscle echogenicity (8 studies, 1,401 participants; r = - 0.42, 95% CI - 0.57 to - 0.24, I2 = 82%) and positively-weakly correlated with MQI (2 studies, 191 participants; r = 0.36, 95% CI 0.21 to 0.49, I2 = 17%). All studies had a higher risk of bias. The certainty of evidence ranged from low to very low. ConclusionDespite technical challenges, this study demonstrates the potential of PhA as a surrogate marker for muscle quality, particularly expressing muscle composition (SMD). Future studies should utilize BIA with standardized protocols to potentially establish specific cutoff values for PhA, thereby enhancing its diagnostic accuracy and clinical applicability. These studies could additionally explore the mechanisms underlying the associations between PhA and muscle quality aspects. In cases where technical factors are not easily controlled, the use of standardized PhA (SPhA), which converts PhA into Z-scores, could be beneficial. Although this warrants investigation, this approach (SPhA) has the potential to account for variables such as age, sex, device differences, and health status.

Effect of aromatherapy on pruritus in people receiving hemodialysis treatment: Systematic review.

Lack of a complete understanding of the pathophysiology of pruritus directs patients to different treatments. There is little data on the effect of aromatherapy on itching in patients receiving hemodialysis treatment. However, the effect of aromatherapy on pruritus in patients receiving hemodialysis treatment remains unclear. The aim of this study is to investigate the effect of aromatherapy on pruritus in hemodialysis patients. The protocol of this systematic review study was registered with PROSPERO (CRD42024522699) and PRISMA guidelines were followed in reporting the study. The search was conducted in Pubmed, Web of Science and Scopus databases without year restriction. Inclusion and exclusion criteria were established according to the PICOS criteria. Study selection and quality assessment of the reviewed studies were performed by two independent researchers. A total of eight studies (461 participants), including two randomized controlled trials and six quasi-experimental studies, were included in the systematic review. All included studies concluded that aromatherapy reduces pruritus. The studies reported no adverse effects of aromatherapy. The studies included in this systematic review found that aromatherapy has a positive effect on reducing pruritus in hemodialysis patients. It is recommended that studies of high methodological quality be conducted to investigate the efficacy of aromatherapy on pruritus in people undergoing hemodialysis treatment.

Outcome Reporting in Prospective Studies Evaluating Neurostimulation for Obstructive Sleep Apnea.

Due to the controversy surrounding the appropriate outcomes in neurostimulation, we sought to systematically describe ways in which polysomnography and apnea-hypopnea index are reported in prospective studies involving unilateral hypoglossal nerve stimulation. MEDLINE (Ovid), Embase (Ovid), Cochrane Library, and Scopus. Following the Preferred Reporting items of Systematic Reviews and Meta-analysis (PRISMA) Statement guidelines, a systematic two-reviewer system was used for study screening and quality assessment. Articles that met inclusion criteria were included. Quality was evaluated with either the Newcastle-Ottawa Quality Assessment Scale or the Covidence risk-of-bias tool. Fifteen studies met the inclusion criteria, which included 14 prospective cohort studies and one randomized controlled trial. Titration polysomnography was the primary sleep study used to acquire data in five of the studies compared to only three studies employing exclusively non-titration polysomnography to report outcomes. Three studies compiled data from two or more sleep studies to report a single apnea-hypopnea index. Within the 15 studies, non-titration apnea-hypopnea index was the most reported type (five studies). Titration apnea-hypopnea index was used to report outcomes in one study. Five studies did not specify what type of apnea-hypopnea index was employed to report treatment effectiveness. The reported sleep studies and corresponding apnea-hypopnea indices were highly variable across the studies. Because of the high degree of heterogeneity, future research would benefit from consistent use of a standardized apnea-hypopnea index to report outcomes related to hypoglossal nerve stimulation. NA Laryngoscope, 134:4873-4881, 2024.

Prevalence and Factors Associated With Cancer-Related Fatigue Among Children and Adolescents Undergoing Cancer Treatment: A Systematic Review and Meta-Analysis.

The literature on fatigue in children and adolescents undergoing cancer treatment is highly variable, creating uncertainties about its prevalence and identifying those at higher risk. The primary purpose was to describe the prevalence of fatigue among patients (< 21 years) undergoing cancer treatment across cancer types. Secondary outcomes included the prevalence of severe fatigue and factors associated with fatigue. Systematic searches of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO were conducted from inception to May 22, 2023. Two reviewers independently identified relevant citations and extracted data. Pooled prevalence estimates were derived using an inverse variance, random-effects model. We used Joanna Briggs's critical appraisal checklist to assess study quality. (PROSPERO: CRD42020179307). We included 47 studies: 26 for prevalence and 29 for factors associated with fatigue. The pooled prevalence of fatigue was 73% (95% [Confidence Interval, CI: 66%-79%; I2 96%; 26 studies; 2699 patients], and severe fatigue was 30% [95% CI 14%-46%, I2 98%; 8 studies; 1027 patients]). Subgroup analyses based on cancer type, study design, fatigue scale, fatigue reporting personnel, sample frame, and response rate did not reveal significant differences in fatigue prevalence. Fatigue prevalence significantly differed by treatment setting (inpatient [83%] vs. outpatient [55%] vs. inpatient and outpatient [69%]; p: 0.02). Due to considerable heterogeneity among studies, data on fatigue-associated factors are presented descriptively. The prevalence of fatigue among children and adolescents undergoing cancer treatment is variable but notably high. Systematic evaluation of factors associated with fatigue is essential to understanding which children are at high risk of developing fatigue. PROSPERO: CRD42020179307.

Robot-assisted versus manually guided stereotactic biopsy for intracranial lesions - a systematic review and meta-analysis.

Stereotactic biopsies are essential for obtaining accurate histopathological analysis to guide treatment decisions for deep-seated brain lesions. Manually guided methods, while commonly used and highly precise, can be limited by potential inaccuracies and insufficient tissue sampling. The emerging robot-assisted (RA) techniques offer enhanced precision and could address these limitations for improved accuracy. We aimed to compare safety and effectiveness of RA stereotactic biopsies to traditional techniques. We conducted a systematic search of PubMed, Embase, and Web of Science using terms related to robotic biopsies and intracranial lesions. Eligible studies compared robot-assisted procedures to traditional techniques. Data extracted included diagnostic yield, complication rates, and accuracy. Quality assessment of studies was performed with the ROBINS-I tool, and a random-effects model meta-analysis was performed. Five studies were included, encompassing 913 patients (robot-assisted n = 434, traditional n = 479). Robot-assisted biopsies demonstrated higher diagnostic yield (OR 2.06, 95% CI [1.01,4.21], p = 0.04), and improved trajectory accuracy, with entry point error (EPE) reduced by 0.42mm (95% CI [-0.59,-0.26], p < 0.001) and target point error (TPE) reduced by 0.93mm (95% CI [-1.80,-0.06], p < 0.01). There were no significant differences in the incidence of complications or operative time. RA stereotactic biopsies may improve diagnostic yield and accuracy in targeting intracranial lesions without increasing complication rates or operative time. The limited number of studies and potential biases suggest a need for further high-quality, prospective research to ascertain these findings.

Can antiviral drugs address the treatment challenges of severe fever with thrombocytopenia syndrome? - a systematic meta-analysis.

Severe Fever with Thrombocytopenia Syndrome (SFTS) is an emerging infectious disease with high mortality and severity rates. However, there is no clear treatment plan, specific effective antiviral drugs, or effective vaccine for SFTS. Recent studies have shown that the therapeutic effect of Ribavirin and other commonly used antiviral drugs such as Favipiravir (T-705), on SFTS is still controversial. This meta-analysis was conducted to evaluate the therapeutic efficacy of antiviral drugs on SFTS. Relevant studies were searched from Cochrane Library, Web of Science, Embase. and PubMed from inception to June 30, 2022, and updated to 2023. The study screening, data extraction, and quality assessment were conducted by re-searchers independently. A counterpart assessment tool was used to assess methodological quality, and the Stata15 software was employed to perform meta-analysis. The meta-analysis included 8 studies consisting of 4692 patients. The results showed no significant difference in the mortality rate of SFTS patients between the antiviral drug group and the control group (HR: 0.85, 95% CI: 0.46-1.59, p = 0.618). Antiviral drugs had no noticeable effect on this disease (RR: 0.93, 95% CI: 0.58-1.48, p = 0.747). At present, antiviral drugs (Ribavirin and Favipiravir) used routinely in clinics show no positive effect on the treatment of SFTS yet and fail to reduce the mortality rate. On the other hand, clinical studies specifically evaluating viral load found that antiviral drugs were effective in the treatment of SFTS patients with low viral load, but the efficacy was not statistically significant.