Certainty Of Evidence Research Articles

The effect of probiotic, prebiotic, and synbiotic supplements on anthropometric measures and respiratory infections in malnourished children: a systematic review and meta-analysis of randomized controlled trials

BackgroundMalnutrition remains a significant concern in many societies. This study systematically reviewed the effects of probiotics, prebiotics, and synbiotics on anthropometric measures in malnourished children, focusing on changes in weight, height, and respiratory infections (primary outcomes), and head circumference, hemoglobin, hematocrit, and body mass index (BMI) as secondary outcomes.MethodsThis systematic review and meta-analysis involved searching various databases in both Persian and English, including Scopus, Web of Science Core Collection, Cochrane Library, Science Direct, and PubMed up to October 5, 2024. Non-randomized controlled trials (RCTs) were excluded. The Cochrane Handbook Risk of Bias Version 2 tool was used to assess risk of bias, and RevMan 5.3 software was employed for analysis. Subgroup analyses were conducted based on the type of supplement received. Meta-regression was applied to identify factors influencing results, and the GRADE approach was used to evaluate evidence certainty.ResultsTwelve studies with a total of 3,086 children (aged up to 6 years, equally distributed between boys and girls) were included. All children were malnourished without underlying illnesses. Limitations of the study included variations in intervention type, dose, duration, and timing of outcome measurement. Meta-analysis revealed that probiotics, prebiotics, and synbiotics may increase weight (6 trials, mean difference: 0.33 kg, 95% CI: 0.15 to 0.50, low certainty of evidence), while probiotics and synbiotics may increase height compared to control groups (5 trials, mean difference: 0.44 cm, 95% CI: 0.02 to 0.85, low certainty of evidence). However, probiotics and synbiotics did not show a statistically significant effect on lower respiratory tract infections (5 trials, risk ratio: 0.84, 95% CI: 0.68 to 1.04, moderate certainty of evidence). Meta-regression indicated that intervention type, sample size, and follow-up duration were not significant moderators for outcomes related to weight, height, or respiratory infections.ConclusionThe current evidence suggests that probiotics, prebiotics, and synbiotics supplements may help manage malnutrition-related outcomes in malnourished children, but further research with stronger study designs is needed to confirm these findings due to the low certainty of evidence.

Nutritional interventions in patients with burn injury: an umbrella review of systematic reviews and meta-analyses of randomised clinical trials.

Multiple reviews have examined the impact of nutritional interventions in patients with burn injuries; however, discrepancies among results cast doubt about their validity. We implemented this review to assess the impact of various nutritional interventions in adult patients with burn injuries. We conducted a thorough search of PubMed, Scopus and Web of Science databases until 1 August 2024, to identify relevant meta-analyses of intervention trials, examining the impact of nutritional interventions on burn patients. We adopted the random-effect models to determine the pooled effect sizes while employing the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to examine evidence certainty. Thirty-three original intervention trials from eleven meta-analyses were entered in our review. Early enteral nutrition could substantially reduce overall mortality (relative risk (RR): 0·36, 95 % CI: 0·19, 0·68, GRADE = moderate certainty), hospital stay (mean difference (MD): -15·3, 95 % CI: -20·4, -10·2, GRADE = moderate certainty) and sepsis risk (RR: 0·23, 95 % CI: 0·11, 0·45, GRADE = moderate certainty). Glutamine showed a notable decrease in the length of hospital stay (MD: -6·23, 95 % CI: -9·53, -2·94, GRADE = low certainty). However, other nutritional interventions, including combined immunonutrition, branched-chain amino acids, fish oil, ornithine α-ketoglutarate and trace elements, did not significantly affect the assessed clinical outcomes. Early enteral nutrition might impose a beneficial effect on mortality, hospital stay length and incidence of sepsis with moderate evidence. Lower length of hospital stay was also seen in burn patients supplemented with glutamine, although the evidence was weak.

Comparative effects of tea and coffee drinking on body weight in adults: a systematic review and network meta-analysis of randomised trials.

We aimed at quantifying the effects of different tea and coffee on weight loss in adults. We searched PubMed, Scopus, CENTRAL and grey literature sources to July 2024. The study excluded cross-over trials without washout period, those in critically ill patients, pregnant or breast-feeding women, multicomponent interventions and active control groups with tea or coffee. A random-effects network meta-analysis with a Bayesian framework was performed to calculate the mean difference (MD) and 95 % credible intervals (CrIs). The certainty of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation approach, and risk of bias was assessed using Cochrane tool. Twenty-two randomised controlled trials with 1710 participants (average intervention duration = 10 weeks) were included. Green tea was effective for weight loss compared with placebo (MD: −1·23 kg, 95 % CrI: −2·45, −0·02; low certainty evidence) or water (MD: −1·61 kg, 95 % CrI: −2·90, −0·35; very low certainty evidence), while other beverages (coffee, decaffeinated coffee, green coffee, black tea and sour tea) were not. Green tea was effective for weight loss compared with water in sensitivity analysis of healthy individuals (MD: −3·31 kg, 95 % CrI: −5·83, −1·04). Based on very low to low certainty evidence, green tea drinking may result in a small weight loss in adults. This study mainly focused on weight loss effects of green tea and coffee, with limited data on other teas. Only five trials had longer intervention durations, suggesting future research on long-term effects. Most trials had high bias risk and low certainty, requiring more high-quality trials.

E-Health Interventions for Managing Spine Pain—Benefits for Pain, Quality of Life, Catastrophizing and Fear Avoidance Beliefs: An Overview of Systematic Reviews With Meta-Analysis

OBJECTIVE: To summarize the effectiveness of eHealth interventions for improving pain, physical disability, psychological factors, and the quality of life for people with spine pain. DESIGN: Overview of systematic reviews. LITERATURE SEARCH: CINAHL, Embase, PubMed, and SPORTDiscus e-databases were searched. STUDY SELECTION CRITERIA: Systematic reviews with meta-analysis of randomized clinical trials evaluating any type of eHealth were included. DATA SYNTHESIS: AMSTAR 2 was used to assess the methodological quality of included reviews. The degree of overlap between reviews was calculated. RESULTS: Sixteen systematic reviews were included. Of them, thirteen reviews were exclusively focused on back pain or low back pain. Exercise and psychological interventions were the primary contents of eHealth interventions. In general, eHealth interventions based on physical exercise may improve the quality of life of people with low back pain. eHealth interventions based on cognitive behavioral therapy may reduce pain catastrophizing and fear-avoidance beliefs for physical activity for people with low back pain. eHealth interventions based on multidisciplinary approaches including physical exercise may reduce low back pain. Few systematic reviews used the GRADE system to evaluate the certainty of evidence, and few specified the content of eHealth interventions. CONCLUSION: eHealth interventions may improve the quality of life, pain catastrophizing, fear-avoidance beliefs, for people with low back pain. It is unclear, based on available systematic reviews, how clinicians should deliver eHealth interventions for people with spine pain (e.g., neck pain or low back pain).

Novel tuberculosis skin tests for detecting latent tuberculosis infection.

Dear Editor, We are impressed by the article titled "Latent tuberculosis diagnostics: current scenario and review" by Gupta et al. published in your journal. The authors have reviewed the tests used for diagnosis of latent tuberculosis infection and have given a detailed overview of the purified protein derivative-based tuberculin skin test and interferon γ release assays. We would like to draw attention to the fact that in 2022, the World Health Organization has also recommended the use of Mycobacterium tuberculosis antigen-based skin tests for the diagnosis of latent tuberculosis (conditional recommendation, very low certainty of evidence).

Diagnostic accuracy of the point-of-care standard G6PD test™ (SD Biosensor) for glucose-6-phosphate dehydrogenase deficiency: a systematic review and meta-analysis

BackgroundGlucose-6-Phosphate Dehydrogenase deficiency (G6PDd) is a common genetic enzymopathy that can induce haemolysis triggered by various factors, including some anti-malarial drugs. Although many Point-of-Care (PoC) tests, such as Standard G6PD™ are available to detect G6PDd, its pooled diagnostic test accuracy (DTA) remains unknown.MethodsTo estimate the DTA of StandG6PD-BS at various thresholds of G6PDd, a systematic review with a DTA meta-analysis were conducted, searching EMBASE, MEDLINE, and SciELO databases up to April 4, 2024.The included studies were those that measured G6PD activity using StandG6PD-BS (reference test) and spectrophotometry (gold standard) in patients suspected of having G6PDd. The risk of bias (RoB) of the studies was assessed using the QUADAS-2 tool and the certainty of evidence (CoE) with the GRADE approach. For the estimation of within-study DTA, a random-effect bivariate meta-analysis was performed to determine the pooled sensitivity and specificity for 30%, 70%, and 80% enzyme levels’ thresholds, and a graphical analysis of the heterogeneity using crosshair and Confidence Regions on receiver operating characteristic (ROC) space plots.ResultsAfter screening 2496 reports, four studies were included with 7864 participants covering all thresholds. Two studies had high RoB in QUADAS-2 domains 2 and 3, and the others had low RoB, with low, moderate, and high heterogeneity at the 30%, 70%, and 80% thresholds, respectively. The pooled sensitivity was 99.1%, 95.7%, and 90% for 30%, 70%, and 80% thresholds, respectively. The pooled specificity was 97.4%; 92.9%; and 89.0% for 30%, 70%, and 80% thresholds, respectively.ConclusionStandG6PD-BS is a PoC test with high sensitivity and specificity to detect G6PDd at different thresholds.

The effect of health education on symptom severity in patients with fibromyalgia: a systematic review and meta-analysis.

Fibromyalgia (FM) is a complex chronic disorder characterized by widespread pain as the primary symptom. To evaluate the effect of health education on the severity of various symptoms in patients with FM, seven databases were searched from inception to August 2024 to identify randomized controlled trials evaluating the effects of health education for FM. The primary outcome was overall symptom severity, and the secondary outcomes were pain, depression, anxiety, sleep quality, fatigue, physical function and self-efficacy. The Cochrane Risk-of-Bias tool for randomized trials and the Grading of Recommendations, Assessment, Development, and Evaluations were used to assess the quality of the included studies and the certainty of evidence, respectively. Treatment effects were estimated by calculating Hedges' g and the corresponding 95% confidence intervals. Meta-analysis included a total of 13 trials. The results revealed that health education significantly reduced overall symptom severity, depression and anxiety and increased sleep quality and physical function among patients with FM (all P values < 0.05). However, no significant effects were observed on pain, fatigue and self-efficacy. Health education may be a beneficial intervention for FM patients, particularly for mitigating symptom severity. Health-care providers should implement health education interventions to empower patients to effectively manage their symptoms.

Subtype prevalence and treatment implication in adolescents and adults with mild-to-moderate asthma: A systematic review and meta-analysis

BackgroundInhaled corticosteroid (ICS) containing regimens are the mainstay for treating asthma despite usually being ineffective in non-eosinophilic asthma (NEA). Data on the prevalence of NEA versus eosinophilic asthma (EA) in mild-to-moderate asthmatics is limited. ObjectiveTo systematically review the subtype prevalence of mild-to-moderate asthma in adolescents and adults using sputum inflammatory cell analysis and their responses to ICS. MethodsWe searched electronic databases (PubMed, Scopus, EMBASE, Cochrane) for studies in adolescents and adults with mild-to-moderate asthma. The primary outcome was the prevalence of asthma subtypes based on sputum inflammatory cell analysis, categorized into EA and NEA. The secondary outcome involved comparing asthma outcomes between different subtypes following ICS therapy. Certainty of evidence was reported for each pooled analysis. ResultsEighteen studies involving 3,533 adolescents and adults with mild-to-moderate asthmatics were reviewed. The pooled prevalence (95% confidence interval, CI) of NEA was estimated at 40.39% (27.54, 53.93) in patients with ICS naïve with very low certainty of evidence. Upon reevaluating sputum cytology, approximately 20% to 30% of patients initially classified as having NEA transitioned to the EA subtype. EA patients showed significant improvements in asthma symptoms, FEV1 [standardized mean difference (95% CI): 0.79 (0.30, 1.27)], and airway hyperresponsiveness [1.34 (0.29, 2.40)] following ICS therapy, while NEA patients exhibited limited response. ConclusionA high proportion of adolescents and adults with mild-to-moderate asthma were identified as having the NEA subtype, which exhibited a poor response to ICS. A thorough diagnostic evaluation before initiating treatment should be integrated into clinical practice.

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.

Does preprocedural ultrasound prior to lumbar neuraxial anesthesia or analgesia increase first-pass success in adults with obesity? A systematic review.

Preprocedural ultrasound (PPU) reduces the risk of technical failure in non-obese patients and when technical difficulty is predicted. We conducted this review to determine if PPU improves first-pass needle insertion success for neuraxial anesthesia in patients with obesity. We conducted a systematic review without meta-analysis, due to the small number of included studies. The study protocol was registered (PROSPERO: CRD42022368271). We conducted searches in MEDLINE, Embase, PubMed, and Cochrane Library from January 1, 1980 to October 1, 2022 for peer-reviewed randomized controlled or observational studies comparing PPU versus landmark techniques in patients with body mass index >30 kg/m2. The quality of evidence was assessed using the revised Cochrane risk-of-bias tool for randomized trials and Grading of Recommendations Assessment, Development, and Evaluation approach. There were nine randomized controlled studies, comprising 866 patients having lumbo-sacral neuraxial techniques. Three studies utilized a small handheld ultrasound device called Accuro™ and six utilized non-handheld ultrasound devices. Certainty of evidence was low for improving the first-pass success rate. There was evidence (moderate certainty) that PPU decreased number of passes, increased first insertion attempt success, and reduced number of insertion attempts. There was no evidence that PPU affected identifying time, needling time, or overall procedural time. There was no evidence that PPU influenced procedural failure rate (very low certainty evidence) and insufficient evidence to suggest that artificial intelligence-supported handheld devices were superior to conventional ultrasound devices. In patients with obesity, there is evidence of very-low to moderate certainty that PPU improves markers of insertion success, with no indication of increased adverse effects. PPU should be used to reduce attempts. Further studies adhering to standardized outcome definitions are required for definitive recommendations. The study protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42022368271).

Peripheral versus central cannulation of VA-ECMO for primary graft dysfunction after heart transplantation: a systematic review and meta-analysis

Severe primary graft dysfunction (PGD) after heart transplantation (HT) is a major cause of death and requires veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Given the wide between-center variability in cannula configuration, we conducted a systematic review and metanalysis including studies of adult HT recipients who required VA-ECMO for PGD to determine whether a peripheral or central configuration was associated with higher mortality. The primary endpoints were short-term and one-year mortality. Secondary endpoints were VA-ECMO-related complications. Overall, we included 16 studies comprising 874 patients from 33 centers. Using a random effects model, peripheral cannulation was associated with a non-significant reduction in short-term mortality (OR=0.73, 95%CI=0.41–1.28, I2=55.8%) and a significant reduction in one-year mortality (OR=0.60, 95%CI=0.37–0.97, I2=35.9%). Peripheral cannulation decreased risk of bleeding but increased risk of limb ischemia and infection, with similar rates of stroke and need for renal replacement therapy. Overall, certainty of evidence was low.

Clinical effect and contributing factors of acupuncture for knee osteoarthritis: a systematic review and pairwise and exploratory network meta-analysis

ObjectivesThis study aims to evaluate (1) the effect and safety of acupuncture in patients with knee osteoarthritis (KOA) and explore (2) whether the effect of acupuncture differed according to acupuncture...

Traditional, complementary and integrative medicine therapies for the treatment of mild/moderate acute COVID-19: protocol for a systematic review and network meta-analysis

BackgroundIncreasing evidence has emerged for traditional, complementary and integrative medicine (TCIM) to treat COVID-19 which requires systematic summaries of the net benefits of interventions against standard care and one another....

Effect of Sodium Hypochlorite Concentration on the Outcome of Full Pulpotomy in Mature Permanent Teeth with Irreversible Pulpitis - A Systematic Review.

To determine the outcome of full pulpotomy in management of mature permanent teeth with irreversible pulpitis when 2.5% versus other concentrations of sodium hypochlorite (NaOCl) were used to achieve haemostasis. Electronic searches were performed in PubMed, Embase, Web of Science, International Clinical Trials Registry Platform, and ClinicalTrials.gov for English language articles until July 2021. Randomised clinical trials and cohort, cross-sectional, and case-control studies where full pulpotomy was performed to manage mature permanent molar teeth with irreversible pulpitis and no periapical radiolucency were included. Newcastle Ottawa Scale and the Cochrane risk of bias tool were used for quality assessment. The success rate for full pulpotomy was documented. The protocol was registered in PROSPERO database (CRD42020177214). Out of 861 studies, four were considered for data analysis. Three studies were single-arm prospective trials on pulpotomy, while one was a randomised control trial comparing pulpotomy and root canal treatment. A combined success rate of 93% from 117 teeth was reported from three studies using 2.5% NaOCl as a haemostatic agent. One study used 5% NaOCl and reported a success rate of 100% (n = 6 teeth). The certainty of evidence substantiated by the GRADE approach was of low quality. Overall quality assessment revealed a considerable risk of bias in three studies. Irrespective of the NaOCl concentration, the success rate of pulpotomy in mature permanent teeth with irreversible pulpitis was high. No study compared the different concentrations of NaOCl as a haemostatic agent. Further, randomised controlled trials are required to investigate the effect of NaOCl concentration for haemostasis on the outcome of pulpotomy.

Operationalizing shared decision making in clinical practice

Shared decision-making (SDM) requires a clear-eyed view of evidence certainty, context, and equipoise in clinical care. This paradigm of care builds on the foundational ethical principle of patient autonomy, further leveraging beneficence, nonmaleficence, and justice to provide bespoke care in the appropriate clinical setting. When evidence is carefully evaluated together with acceptability and feasibility, equity, cost-effectiveness, resources, and patient preferences, an individualized assessment of the trade-off between possible benefits and harms can optimize patient management. In the setting of a conditional recommendation, it is appropriate to engage in SDM with patient partners, to the extent each patient is willing and able to engage in the SDM process. Three conversations inform SDM and include team talk, option talk, and decision talk with discussion of the plan of care. During these conversations, clear communication strategies that are specific, measurable, achievable, realistic, time sensitive, and provide assessment of absolute (not just relative) risk are important to provide necessary education to patient partners. Follow-up is key to ensure that decisions lead to effective treatment. Through this process, it is necessary to minimize cognitive overload and promote a minimally disruptive medicine approach. The acronym “HOW” promotes a holistic appraisal of evidence in context, open-minded teamwork with patients and families, and willingness to be a listening presence while serving as a partner and guide and appreciating the multidimensional and unique nature of each individual. SDM is and will continue to remain a cornerstone of appropriate medical care in settings of clinical equipoise.

Curcumin on Human Health: A Comprehensive SystematicReview and Meta-Analysis of 103 RandomizedControlled Trials.

The aim of this meta-analysis was to determine the effect of curcumin on a range of health outcomes. PubMed, EMBASE, Scopus, and Web of Science were searched from inception until September 2023. Randomized clinical trials (RCTs) that compared the effect of Curcuma longa L. with placebo were considered eligible. The risk of bias and overall certainty of evidence were assessed using the Newcastle-Ottawa Scale and Grading of Recommendations Assessment, Development, and Evaluation (GRADE), respectively. We meta-analyzed the effect sizes across eligible studies using the random-effects model. In total, 103 RCTs on 42 outcomes were included, incorporating a total population of 7216 participants. Overall, 23 out of 42 (55%) outcomes reported statistically significant effect sizes. The credibility of the evidence was rated as high for fasting blood sugar (FBS), C-reactive protein (CRP), high-density lipoprotein (HDL), and weight. The remaining outcomes presented moderate (waist circumference [WC], hip circumference [HC], body mass index [BMI], insulin, Homeostatic Model Assessment for Insulin Resistance [HOMA-IR], quantitative insulin-sensitivity check index [QUICKI], leptin, gamma-glutamyl transferase [GGT], glutathione [GSH], and superoxide dismutase [SOD]), low (14 outcomes), or very low (14 outcomes) evidence. In conclusion, curcumin supplementation can modify FBS and some glycemic indices, lipid parameters, as well as inflammatory and oxidative parameters. This updated summary of the accumulated evidence may help inform clinicians and future guidelines regarding medical and scientific interest in curcumin. However, due to limitations in the methodological quality of the included studies, well-designed and long-term RCTs with large sample sizes are needed. Trial registration: PROSPERO: CRD42021251969.

Foot Reflexology for Managing Menopausal Symptoms in Women: A Systematic Review and Meta-Analysis

Background: Menopause can cause a variety of unpleasant symptoms, such as hot flashes, night sweats, mood swings, and sleep disturbances. Although hormone replacement therapy is frequently utilized to help manage these issues, long-term use of this treatment approach carries certain potential risks. Objective: This study aims to examine the effects of foot reflexology, a type of massage therapy that focuses on applying pressure to specific reflex points on the feet, on menopausal symptoms (primary outcome) and anxiety, fatigue, and depression (secondary outcomes). Methods: A systematic electronic search for relevant studies was conducted in PubMed, Scopus, Web of Science, the Cochrane Library, SID, Magiran, and Google Scholar until September 21, 2023. In addition to the electronic database searches, manual searches were also performed. This manual search process included scanning the reference lists of the included studies and handsearching key journals in the topic area. The risk of bias was assessed via the RoB 2.0 and ROBIN-I tools. Heterogeneity was evaluated via the I² statistic, and in cases of high heterogeneity, a random effects model was used instead of a fixed effects model. Subgroup analyses were performed for the primary outcome on the basis of menopausal symptoms (vasomotor/psychosocial/physical/sexual). The certainty of evidence was assessed via the GRADE approach. Results: A total of 186 articles were retrieved from database searches, and an additional 9 articles were identified through manual searches. Ultimately, 8 studies were included in the systematic review, and 6 studies were included in the meta-analysis. The meta-analysis revealed that foot reflexology had a significant effect on menopausal symptoms, with an average reduction of 3.41 points on the associated measurement scale (95% confidence interval (CI): -4.81 to -2.01; low-certainty evidence). It also significantly reduced fatigue, with an average reduction of 5.84 points (95% CI: - 11.61 to -0.06; very low-certainty evidence). However, there was no significant impact on anxiety (SMD: -0.89, 95% CI: -1.96--0.18; very low-certainty evidence) or depression (SMD: -0.73, 95% CI: -1.80--0.34; very low-certainty evidence) compared with the control group. Conclusion: The present study demonstrated that the use of foot reflexology as a nonhormonal and noninvasive intervention led to a significant reduction in menopausal symptoms and fatigue among women. Given the limited number of studies available in this area and the low to very low-level certainty of the evidence for the desired outcomes, further research with appropriate methodologies to ensure accurate conclusions in this field is strongly recommended.

Individuals with patellofemoral pain have impaired self-reported and performance-based function: Systematic review with meta-analysis and meta-regression.

To determine impairments on self-reported/performance-based function in individuals with patellofemoral pain (PFP) as well as physical and non-physical factors potentially related with these impairments. We searched MEDLINE, Embase, CINAHL, Web of Science, and SPORTDiscus databases from inception until January 2024. We included studies comparing self-reported/performance-based measures of function between individuals with PFP and their pain-free limbs or pain-free individuals. Two independent researchers extracted the key information from each study. We performed meta-analyses for each self-reported/performance-based measure of function and meta-regressions to identify factors that might explain meta-analyses outcomes. We assessed the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). We included 83 studies (2807 individuals with PFP and 2518 pain-free individuals). We identified very low to high certainty evidence that individuals with PFP have reduced self-reported (large effect sizes, standardized mean difference [SMD], -1.99; 95% confidence interval [CI]:-2.41,-1.57 to SMD, -4.87; 95% CI:-6.97,-2.77) and performance-based (small to large effect sizes: SMD, -.30; 95% CI:-.58, -.02 to SMD, -1.21; 95% CI:-2.71, -.29) measures of function compared to pain-free individuals, but there are no differences between limbs in individuals with unilateral PFP for the most of performance-based measures of function (small to moderate effect sizes, SMD, -.20; 95% CI:-.68, .27 to SMD, -.49; 95% CI:-1.02, .03). Age, body mass index, duration of symptoms and self-reported pain did not significantly explain self-reported function, whereas age did not significantly explain performance-based function (R2 25 <.01 to .02, p =.145 to .914). Our results highlight the negative impact of PFP on self-reported and performance- based function, which seems to also affect the pain-free limb. Self-reported and performance- based measures of function should be considered when assessing individuals with PFP. None of the factors investigated explained impaired self-reported and performance-based function.

Survival and Toxicity Outcomes with Radiotherapy Technique and Timing in the Management of Wilms Tumor: a Systematic Review to Inform a National Clinical Practice Guideline Development

Purpose: Wilms tumor (WT) management has evolved into a multimodality paradigm that includes radiotherapy (RT), usually as an adjuvant or consolidative modality. Protocols are refined to maximize cure and compliance while minimizing acute toxicity and long-term effects. RT technique and timing are two factors that could improve these outcomes. We reviewed the evidence on survival and toxicity outcomes among WT patients with conventional versus advanced RT techniques and early versus delayed RT to inform a Department of Health (DOH) commissioned guideline. Materials and Methods: We systematically searched PubMed, EuropePMC, EBSCOHost, HERDIN, systematic review and clinical trial registries and official websites of scientific societies for relevant publications and grey literature. Eligibility screening, risk-of-bias assessment and data extraction were performed using a single-reviewer approach. Given the study and data heterogeneity, only a qualitative synthesis was performed. Certainty of evidence assessment was done using the GRADE approach. Results: We screened 314 studies and included seven in the review, including a phase 1/2 trial and six retrospective studies, all from first-world countries (US, France, Netherlands), except one from a newly industrialized country (Brazil). The certainty of evidence on the survival and toxicity outcomes with advanced RT techniques was very low. Moderate-certainty evidence supports that giving RT &gt;14 days after surgery leads to increased mortality. Conclusion: Current evidence does not support the routine use of advanced RT techniques; proper contextualization is necessary. Tertiary centers managing WT should strive to administer RT within 14 days after surgery whenever possible. Keywords: Wilms tumor, nephroblastoma, radiotherapy, intensity-modulated radiotherapy, survival, toxicity

A guideline on biomarkers in the diagnosis and evaluation in axial spondyloarthritis

ObjectiveTo develop a guideline for selecting biomarkers in the diagnosis and assessment in patients with axial spondyloarthritis (axSpA).MethodA joint effort was carried out by the core team, the literature review team and the multidisciplinary voting panel to formulate recommendations regarding biomarkers in axSpA, using an evidence-based and consensus-based strategy. Certainty of evidence and strength of recommendation were determined, and levels of agreement within the voting panel were calculated.ResultsA total of 20 recommendations were formulated in this guideline, with levels of agreement ranging from 6.48 to 9.71. The two strong recommendations, HLA-B27 testing in patients suspected of axSpA and regular-interval monitoring of CRP/ESR represent the status quo of axSpA evaluation, while the 13 conditional recommendations represent the promising biomarkers with clinical utility in diagnosis, disease activity assessment, prediction of radiographic progression and therapeutic responses. This guideline does not dictate clinical choices of tests on axSpA, and decisions should be made based on comprehensive consideration of costs, accessibility, patients’ values and willingness as well as the objective of testing in the local context.ConclusionThis guideline addresses the interpretation of the clinical significance of biomarkers in axSpA, and the biomarkers endorsed in this guideline composed a clinical toolkit for healthcare professionals to choose from.