Cochrane Library Research Articles

Efficacy and safety of transhepatic arterial chemoembolization with drug-loaded microspheres in unresectable primary liver cancer

BACKGROUND Transhepatic arterial chemoembolization (TACE), as a local treatment, has been widely used in the treatment of unresectable liver cancer. The introduction of drug carrier microspheres has brought new hope for the therapeutic effect of TACE. Microspheres can realize the slow release and directional delivery of drugs, reduce systemic toxicity and improve local curative effect. AIM To compare the effectiveness of traditional transcatheter arterial chemoembolization against microsphere-assisted transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma that is incurable. METHODS We searched the PubMed, Embase, Cochrane Library, and CNKI databases for clinical trials of drug-luting beads TACE (DEB-TACE) vs conventional TACE (cTACE) for the treatment of unresectable liver cancer. We screened references based on inclusion and exclusion criteria and then selected valid data for meta-analysis using RevMan 53 software. The complete response (CR) rate, partial response (PR) rate, postoperative stable disease (SD) rate, and 6-month and 12-month survival rates were compared. RESULTS A total of 12 articles were included, including 1177 patients, 519 of whom received DEB-TACE and 658 of whom received cTACE. The CR rate in the DEB-TACE group was much greater than that in the cTACE group [relative risk (RR) = 1.42, 95%CI: 1.18–1.72, P = 0.0002]. The 12-month survival rate significantly increased (RR = 1.09; 95%CI: 1.01- 1.17, P = 0.03); the PR rate (RR = 1.13; 95%CI: 0.97-1.30, P = 0.12); the SD rate (RR = 0.82; 95%CI: 0.64-1.05, P = 0.12); and the 6-month survival rate (RR = 1.05; 95%CI: 1.00-1.10, P = 0.07). There was no significant difference (P < 0.05). CONCLUSION Compared with those of iodized oil TACE, the drug-loaded microspheres tended to have therapeutic advantages.

Global strategies to reduce elective surgery waiting times for sustainable health outcomes: a systematic review

ABSTRACT Objective Long waiting times for elective surgery reflect not just backlog issues but systemic inefficiencies that disrupt the smooth flow of patients through the surgical care pathway. This systematic review adopts a holistic approach to summarize global policies, strategies, and interventions aimed at reducing elective surgery wait times. Method A comprehensive electronic search was performed in PubMed, EMBASE, SCOPUS, Web of Science, and Cochrane Library from December 2019 to January 2020 and updated in April 2022. Eligible studies, published after 2013, focused on waiting lists for major elective surgeries in adults, excluding cancer-related surgeries. Both randomized and non-randomized studies and systematic reviews were included. Study quality was assessed using ROBINS-I, AMSTAR 2, and CASP tools, as appropriate. The review was registered in PROSPERO (CRD42019158455) and reported using a PRISMA flow diagram. Results From 7543 records, 92 articles met the inclusion criteria. Evidence was categorized into seven strategic areas: referral management, patient prioritization, preventing scheduled surgery cancellations, perioperative time management, quality improvement methods for surgical care pathways, and waiting time targets for hospitals. Strategies such as referral management, patient prioritization, and preventing cancellations had the most significant impact on reducing waiting times, while perioperative time management and waiting time targets proved less effective. Conclusion The review highlights that targeted interventions at different stages of the surgical care pathway yield variable impacts on overall waiting times. While individual measures had limited effects, combining multiple short-term strategies may be more beneficial, particularly for health systems recovering from the COVID-19 pandemic.

Segmental versus extended colectomy for colorectal cancer in patients with lynch syndrome: A systematic review and meta-analysis.

The decision to perform segmental or extended colectomy in Lynch syndrome (LS) patients with colorectal cancer (CRC) is still controversial. Therefore, this systematic review and meta-analysis aims to provide updated evidence for segmental versus extended colectomy in LS carriers with CRC. PubMed, Embase, and Cochrane Library were systematically searched for studies published until January 2024 comparing segmental and extended colectomies for CRC in patients with LS. Risk ratio (RR) was used to evaluate binary endpoints with 95% confidence intervals (CIs). Heterogeneity was assessed with the Cochran's Q test and I2 statistics. Statistical analysis was performed using the R Software, version 4.2.3. A total of 14 studies comprising 2303 LS carriers with CRC, of whom 1724 (74.9%) patients underwent segmental colectomy and 579 (25.1%) patients underwent extended colectomy. Segmental colectomy significantly increased metachronous CRC (mCRC) (RR 2.87; 95% CI 2.03-4.07; and p<0.01). There were no significant differences between groups for 5-year overall survival (OS) (RR 0.92; 95% CI 0.82-1.03; and p=0.14), 10-year OS (RR 0.99; 95% CI 0.96-1.04; and p=0.80), and mortality (RR 1.63; 95% CI 0.90-2.97; and p=0.11). There were no significant linear associations between the outcome of mCRC and age at the time of primary CRC, sex, primary CRC location, and pathogenic LS variant. In this meta-analysis, segmental colectomy significantly increased mCRC compared with extended colectomy after the first surgery for CRC in patients with LS. However, there were no significant differences between groups for 5- and 10-year OS and mortality.

Piperacillin/tazobactam vs. cefepime or carbapenems for the treatment of bloodstream infections due to bacteria producing chromosomal AmpC beta-lactamase: a systematic review and meta-analysis.

The best treatment for bloodstream infections (BSI) due to chromosomal AmpC (c-AmpC) producing Enterobacterales is not clearly defined. To describe the clinical and microbiological outcomes of patients treated with piperacillin/tazobactam, cefepime or carbapenems for bloodstream infections (BSIs) due to c-AmpC beta-lactamase-producing strains. We searched MEDLINE, the Cochrane Library and EMBASE to screen original reports published up to January 2024. RCTs and observational studies investigating all-cause mortality, clinical failure, microbiological failure or rate of ADRs of patients treated with piperacillin/tazobactam, cefepime or carbapenems. Patients with bloodstream infections due to c-AmpC producing bacteria. Piperacillin/tazobactam, cefepime or carbapenems as targeted treatment. We used the Cochrane Risk of Bias Tool for RCTs, and the Newcastle Ottawa scale for observational studies. We conducted a meta-analysis pooling Risk ratios (RRs) through random effect models. We screened 1,720 original reports, and 20 studies (1 RCTs, 1 case-control study, 18 cohort studies) were included in the analysis, for a total of 2,834 patients. When comparing piperacillin/tazobactam with alternative treatments (cefepime or carbapenems), no significant difference in mortality rate was observed between the treatment groups (RR: 1.1; 95% CI: 0.76-1.58, p = 0.61), while an higher rate of microbiological failure (RR: 1.80; 95% CI: 1.15-2.82, p = 0.01) and clinical failure (RR: 1.54; 95% CI: 1.00-2.40, p = 0.05) was observed among patients receiving piperacillin/tazobactam. No difference was observed in microbiological and clinical failure rate among patients treated with cefepime or carbapenems, with a lower mortality rate in those receiving cefepime (RR: 0.74; 95% CI: 0.59-0.94, p = 0.014). Cefepime represents an excellent alternative to carbapenems for BSI due to AmpC-producing strains, whereas piperacillin/tazobactam is associated with a higher rate of clinical and microbiological failure. There is an urgent need for randomized clinical trials that aim to define the best carbapenem-sparing strategy in these infections.

The efficacy and safety of radiofrequency ablation for allergic rhinitis: a systematic review and meta-analysis.

This systematic review aims to synthesise findings from randomised, controlled trials and assess the efficacy and safety of radiofrequency ablation in treating allergic rhinitis. A thorough search was conducted across PubMed, the Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, WanFang, Chinese Scientific Journal, and Chinese Biomedical Literature databases from their inception until October 2023. The primary outcome measure was the total effective rate, with secondary outcomes including adverse events. This review included 15 randomised, controlled trials involving 1430 patients. The pooled analysis revealed a statistically significant effect on the total effective rate (odds ratio = 3.27, 95 per cent confidence interval = 2.37 to ~4.51). However, no statistical significance was observed in adverse events (odds ratio = 1.18, 95 per cent confidence interval = 0.67 to ~2.08). Based on the analytical results, radiofrequency ablation emerges as an efficacious and safe treatment modality for allergic rhinitis. Given the constraints posed by a limited sample size, it is imperative that forthcoming clinical trials adhere rigorously to the gold standard of randomised, controlled trials for the purpose of corroborating these conclusions.

Non-Pharmacological Sleep Interventions after Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

To synthesise up-to-date research evidence for non-pharmacological interventions to improve various sleep outcomes (e.g., sleep quality, duration) in postsurgical cardiac patients. Sleep disturbances are common amongst postsurgical cardiac patients, yet the effectiveness of non-pharmacological interventions in improving various sleep outcomes has not been comprehensively reviewed. A systematic review and meta-analysis guided by the PRISMA protocol. CINAHL, PubMed, PsycINFO, Embase, Web of Science, and Cochrane Library were searched for relevant research in May 2023. Included studies used a randomised controlled trial design that applied a non-pharmacological intervention for postsurgical cardiac patients and reported sleep as an outcome. For the meta-analysis, mean effect sizes were separately calculated for studies with regular and reverse-scored scales. Of 37 studies included, the most common cardiac surgery was coronary artery bypass graft. Most interventions were performed within the first postoperative week and assessed sleep quality outcomes using the Pittsburgh Sleep Quality Index. The interventions are categorised into five types. Human resource-based strategies emerged as the most effective. The meta-analysis of 27 eligible studies showed a mean effect size of 0.76 for studies with regular scoring scales and - 1.04 for those with reverse-scored scales, indicating medium to large effect sizes. Our findings provide strong evidence that non-pharmacological interventions, particularly human resource-based strategies, significantly improve sleep quality in postsurgical cardiac patients. The medium to large effect sizes underscore the clinical significance of these findings. Healthcare professionals should consider incorporating non-pharmacological interventions, especially human resource-based strategies, in care plans for postsurgical cardiac patients to improve sleep outcomes and promote recovery. These interventions should be tailored to individual physical and cultural differences for maximum effectiveness. Future research should evaluate the long-term effects of these interventions on various sleep outcomes, using both objective and subjective measures to provide a comprehensive assessment of their efficacy. This study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Patient and public contributions were not required for this review.

Describing randomization in trials included in systematic reviews in orthopaedic surgery.

Systematic reviews of randomized controlled trials (RCTs) are the highest level of evidence used to inform patient care. However, it has been suggested that the quality of randomization in RCTs in orthopaedic surgery may be low. This study aims to describe the quality of randomization in trials included in systematic reviews in orthopaedic surgery. Systematic reviews of RCTs testing orthopaedic procedures published in 2022 were extracted from PubMed, Embase, and the Cochrane Library. A random sample of 100 systematic reviews was selected, and all included RCTs were retrieved. To be eligible for inclusion, systematic reviews must have tested an orthopaedic procedure as the primary intervention, included at least one study identified as a RCT, been published in 2022 in English, and included human clinical trials. The Cochrane Risk of Bias-2 Tool was used to assess random sequence generation as 'adequate', 'inadequate', or 'no information'; we then calculated the proportion of trials in each category. We also collected data to test the association between these categories and characteristics of the RCTs and systematic reviews. We included 917 unique RCTs. We found that 374 RCTs (40.8%) reported adequate sequence generation, 61 (6.7%) were inadequate, 410 (44.7%) lacked information, and 72 (7.9%) were observational studies incorrectly included as RCTs within the systematic review. Publication year, an author with statistical or epidemiological qualifications, and journal impact factor were each associated with adequate randomization. We found that 45 systematic reviews (45%) included at least one inadequately randomized RCT or an observational study incorrectly treated as a RCT. There is evidence of a lack of random allocation in RCTs included in systematic reviews in orthopaedic surgery. The conduct of RCTs and systematic reviews should be improved to minimize the risk of bias from inadequate randomization in RCTs and mislabelling of non-randomized studies as RCTs.

Effectiveness of advance care planning programmes in improving end-of-life outcomes for individuals with dementia and their caregivers in nursing homes: protocol for a systematic review and meta-analysis

IntroductionWith advances in medicine and the resultant increased ageing population, dementia, including Alzheimer’s disease, has become a leading cause of death in individuals aged over 65 years in nursing homes....

Telehealth and Telemedicine in the Management of Adult Patients after Liver Transplantation: A Scoping Review.

Introduction: Telemedicine can support home-based self-care for liver transplant recipients after discharge from the hospital. This study aimed to (1) provide an overview of the forms of home care for liver transplant patients; (2) identify the content elements of telemedicine in the home care of liver transplant patients; and (3) summarize the effect and outcome indexes of using telemedicine in liver transplantation patients. Methods: A search was performed in the electronic databases of PubMed, CINAHL, Web of Science, Cochrane Library, Embase, Google Scholar, CNKI, Wan Fang data and Wei Pu database through March 1, 2024. Subject heading and keywords were used to reflect the concepts of telemedicine, hepatic transplantation. Studies of tele-home care after transplantation in liver transplant recipients over 18 years of age and the form, content elements, and outcome assessments of telemedicine were included. Results: A total of 16 articles met the inclusion criteria, and from this, the application form of telemedicine in liver transplantation patients, intervention elements and evaluation outcome indexes were identified. The forms of application include internet platform, applications, network communication software, and portable devices; and the elements of intervention include telemonitoring, remote health guidance, telerecordings, teleconsultation, and telerehabilitation; and the outcome indicators include physiological indicators, psychological status, Quality of life, self-management ability, compliance, satisfactory degree, complication rate, readmission rate, and feasibility. Conclusion: Telemedicine is active and feasible in the home-based self-care of patients after liver transplantation, but its application is immature and there are still some problems.

Adjunctive Midodrine Therapy for Vasopressor-Dependent Shock in the ICU: A Systematic Review and Meta-Analysis.

To summarize the efficacy of midodrine as an adjunctive therapy in critically ill patients. Safety of midodrine was assessed as a secondary outcome. We performed a systematic review and meta-analysis using a peer-reviewed search strategy combining the themes of vasopressor-dependent shock, critical care, and midodrine and including MEDLINE, Ovid Embase, CINAHL, and Cochrane library databases until September 14, 2023. We included studies if they: 1) included patients with vasopressor-dependent shock, 2) were performed in the ICU, 3) evaluated oral midodrine therapy compared with placebo or usual care, and 4) evaluated one of the outcomes of interest. We extracted data independently in duplicate using standardized data abstraction forms, which included the following specific variables: patient characteristics, age, sex, type of ICU, etiology of shock, number of patients, study inclusion and exclusion criteria, and geographical location. We also captured the type, dose, and duration of IV vasopressors, any cointervention used, and outcome data. We identified seven randomized controlled trials (six included in the pooled analysis) and ten observational studies (four included in the pooled analysis) that met eligibility criteria. Adjunctive midodrine may decrease ICU length of stay (LOS) and there is low certainty of effect on hospital LOS. Midodrine may decrease IV vasopressor support duration, ICU mortality, and hospital mortality. Pooled observational data was based on very low certainty data for all outcomes of interest. The trial sequential analysis-informed required sample size was not met for ICU LOS or IV vasopressor duration and this contributed to Grading of Recommendations, Assessment, Development, and Evaluations assessments of imprecision for both outcomes. Adjunctive midodrine may decrease ICU LOS, duration of IV vasopressor therapy, and mortality in critically ill patients. However, required sample sizes was not met to determine our outcomes of interest. Midodrine may increase risk of bradycardia. While midodrine may provide benefit for patient-centered outcomes, due to increased risk of adverse events, further large-scale studies are needed to inform and guide its routine use in the ICU.

Comparative effectiveness of kilo- and megavoltage energies in low-dose radiotherapy for painful degenerative musculoskeletal diseases: asystematic review and meta-analysis.

This study aimed to assess the impact of different energy levels on the effectiveness of low-dose radiotherapy (LDRT) for treating painful degenerative musculoskeletal diseases, as comparative efficacy data are currently lacking. Asystematic review was conducted in PubMed, Embase, and the Cochrane Library databases to identify studies with response information on the energy used (kilovoltage [kV] vs. megavoltage [MV]). The primary endpoint was the overall response rate (ORR), and the secondary endpoint was the complete response rate (CRR). Exploratory subgroup analyses included treatment site, study period, study design, country, and dose per fraction. Atotal of 33studies involving 12,143patients were analyzed. Short-term follow-up (up to 6months) showed apooled ORR of 64% (95% CI 46-78%) for kV and of 62% (95% CI 54-70%) for MV. Long-term follow-up (at least 12months) revealed apooled ORR of 85% (95% CI 65-95%) for kV and of 69% (95% CI 62-75%) for MV. Subgroup analysis indicated no significant differences in ORR for energy level stratified by treatment site and other factors. Regarding dose per fraction (0.5 Gy vs.1.0 Gy), comparable ORRs were demonstrated between the two energies. No clinical side effects were noted. This meta-analysis suggests that the known effectiveness of LDRT in painful degenerative musculoskeletal disease may not depend on the energy used. Additional studies using standardized evaluation methods are warranted to establish consistency and enhance the comprehensiveness of research. Further research is also needed to explore treatment modality selection considering disease-specific biology.

Safety and efficacy of resmetirom in metabolic dysfunction-associated steatohepatitis (MASH): a systemic review and meta-analysis

Metabolic dysfunction-associated steatohepatitis (MASH) affects nearly 38% of the population, potentially progressing to cirrhosis and cancer. Lifestyle changes remain the cornerstone of management, but adherence is challenging, prompting the exploration of therapeutic options. Resmetirom, targeting thyroid hormone receptors, regulates liver enzymes and fat metabolism, showing potential as a treatment for MASH. This systematic review and meta-analysis evaluates the safety of resmetirom in MASH patients. Three randomized controlled trials with adult participants were analyzed, sourced from PubMed and the Cochrane Library until April 2024. Participants received either resmetirom or placebo, and data on adverse effects and efficacy outcomes were extracted. Statistical analyses, including risk ratios (RRs) and confidence intervals (CI), were performed using Review Manager (version 5.4.1) with a random-effects model. The pooled RR for serious adverse events was 0.85 (95% CI: 0.63–1.14; P = 0.28), indicating no significant difference. However, diarrhea (RR = 1.82, 95% CI: 1.41–2.35; P &lt; 0.001) and nausea (RR = 1.73, 95% CI: 1.31–2.28; P &lt; 0.001) showed higher incidence. No significant differences were found for fatigue (RR = 1.19, 95% CI: 0.77–1.84; P = 0.43) or urinary tract infections (RR = 1.07, 95% CI: 0.76–1.52; P = 0.69). Liver fat content, lipid profiles, and liver enzymes also showed significant improvement in the resmetirom group. Low heterogeneity across most outcomes indicated consistent findings among the studies. While resmetirom demonstrates efficacy in improving lipid and liver profiles, its increased risk of diarrhea and nausea should be considered in therapeutic decisions.

Robotic-Assisted Medial Unicompartmental Knee Arthroplasty Provides Better FJS-12 Score and Lower Mid-Term Complication Rates Compared to Conventional Implantation: A Systematic Review and Meta-Analysis

Background: Robotic-assisted unicompartmental arthroplasty (rUKA) is gradually gaining more popularity than its conventional counterpart (cUKA). Current studies are highly heterogenic in terms of methodology and the reported results; therefore, establishing the optimal recommendation for patients becomes less straightforward. For this reason, this meta-analysis aims to provide an up-to-date evidence-based analysis on current evidence regarding clinical outcomes and complication rates following rUKA and cUKA. Methods: A meta-analysis was conducted following PRISMA guidelines. Five databases were searched, PubMed via MEDLINE, Epistemonikos, Cochrane Library, Web of Science, and Scopus. The relevant inclusion criteria were as follows: comparative clinical studies in which medial rUKA was compared to medial cUKA (prospective or retrospective designs), (2) human studies, (3) meta-analyses for cross-referencing, and (4) English language. The relevant extracted data were patient demographics, patient-reported outcome measures (PROMs), range of motion, and complications. A random-effects meta-analysis and subgroup analysis were conducted. The results include mean differences (MDs) and odds ratios (ORs), along with 95% confidence intervals (CIs) for continuous and binary variables, respectively. Results: rUKA showed a higher overall FJS-12 score compared to cUKA, with MD = 6.02 (95%CI: −0.07 to 12.1), p = 0.05. At 6 months postoperatively, the MD increased to 10.31 (95%CI: 5.14 to 15.49), p &lt; 0.01. At a minimum 36-month follow-up, cUKA had a higher all-cause revision rate, with OR = 3.31 (95%CI: 1.25 to 8.8), p = 0.02, and at a minimum 60-month follow-up, a higher aseptic loosening rate, with OR = 3.86 (95%CI: 1.51 to 9.91), p &lt; 0.01, compared to rUKA. Conclusions: rUKA provides better FJS-12 results compared to cUKA, as well as lower all-cause revision and aseptic loosening rates at 36- and 60-month follow-up, respectively. However, long-term follow-up is still pending.

Management of twin-reversed arterial perfusion (TRAP) sequence: a systematic review and meta-analysis.

Twin reversed arterial perfusion (TRAP) sequence is a rare complication of monochorionic twin pregnancies characterized by placental anastomoses between a normally developed twin and an acardiac mass. Though several treatment modalities exist, the optimal management strategy is unclear. This study aims to compare the various treatment strategies for TRAP sequence. A systematic review of the literature was performed using PRISMA guidelines including PubMed, Scopus, Web of Science and the Cochrane Library. Studies were imported into Covidence, where they were independently screened by two authors. Studies included described interventions for TRAP sequence. Those excluded were unavailable in English and lacked differentiation between intervention strategies for TRAP and other monochorionic twin pregnancies. Fisher's exact test and random effects modeling were used for statistical analysis. 2340 abstracts were screened, of which 218 articles progressed to full review and 120 qualified for data extraction. 757 twin pregnancies were described. Most were treated with radiofrequency ablation (RFA) (n=363, 47.95%) and laser ablation (n=220, 29.06%). Statistically significant differences amongst the modalities were seen in technical success (p = 0.005), gestational age at presentation (p < 0.01), intervention (p = 0.01), and delivery (p = 0.01), respectively, and time between treatment and delivery (p < 0.01). Notably, pump twin survival did not differ based on treatment modality used (p = 0.196). Overall, complication rates were low with no differences in preterm premature rupture of membranes (PPROM) (p = 0.66), preterm labor (p = 0.58) or maternal hemorrhage between modalities (p = 0.28). Suture cord ligation, however, had a greater hemorrhage rate than RFA (p = 0.03). This embodies the first meta-analysis comparing treatment modalities for TRAP sequence with outcomes and complications. RFA is the most technically successful strategy. Prospective data is required to further understand the optimal modality and gestational age at treatment to ensure best overall outcomes. .

Prevalence and determinants of hyperemesis gravidarum among pregnant women in Ethiopia: A systematic review and meta-analysis.

Studies focusing on the occurrence and correlates of hyperemesis gravidarum in Ethiopia have reported varied values in different regions of the country. Additionally, there is no systematic review and meta-analysis summarizing the prevalence of hyperemesis gravidarum and its determinants in Ethiopia. Hence, this systematic review and meta-analysis aimed to estimate the overall prevalence of hyperemesis gravidarum and explore its determinants in Ethiopia. Cross-sectional or case-control studies conducted in Ethiopia, written in English, and reporting the prevalence or the determinant of hyperemesis gravidarum among pregnant women were included in the review. International databases (PubMed, Scopus, Cochrane Library, Google Scholar, Science Direct, African Journal Online, Directory of Open Access Journal, and African Index Medicus) and Ethiopian university repositories (Jimma, Addis Ababa, Haramaya, Hawassa, and Gondar Universities) were searched from September 4-15, 2023, to identify articles published on the topic. The pooled prevalence of hyperemesis gravidarum with a 95% confidence interval was presented using the forest plots. The heterogeneity of the studies was checked by I2 with its corresponding p-values and the Galbraith plot. Subgroup analysis and meta-regression were performed to identify sources of heterogeneity. Funnel plot, Egger, and Begg's tests were used to assess publication bias. A total of 11 articles with a 3510-sample size were included in this systematic review and meta-analysis. The pooled prevalence of hyperemesis gravidarum among pregnant women in Ethiopia was 7.12% with a 95% CI (4.09-10.15) and a high level of heterogeneity (I2 = 86.5%, p<0.001). Subgroup analyses revealed the overall prevalence of hyperemesis gravidarum was highest in the Amhara region with 11.30%, 95% CI (8.20-14.40), and lowest in Oromia with 3.40%, 95% CI (1.94-4.85). Having a previous history of hyperemesis gravidarum (POR = 3.828, 95% CI: 1.673-5.983), being in the first trimester of pregnancy (POR = 8.476, 95% CI: 5.047-11.905), and Helicobacter pylori infection (POR = 3.924, 95% CI: 2.027-5.821) were found to be significantly associated with hyperemesis gravidarum in Ethiopia. The prevalence of hyperemesis gravidarum among pregnant women in Ethiopia is high. Targeting pregnant women in the first trimester, with a previous history of hyperemesis gravidarum, and those with Helicobacter pylori infection during prenatal counseling on how to manage and reduce hyperemesis gravidarum is very helpful to avert related complications. The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number "CRD42023461808", on September 19, 2023.

A meta-analysis of the efficacy and safety of genicular artery embolization for the treatment of pain secondary to knee osteoarthritis

Objective: To assess the efficacy and safety of genicular artery embolization (GAE) in the management of pain secondary to knee osteoarthritis (KOA). Methods: Literature search was conducted on PubMed, Web of Science, Cochrane Library, Embase, and Wanfang databases to collect literatures related to KOA, GAE and therapeutic effects. The search period was from the inception of the databases to July 2024. Literature screening and data extraction were carried out independently by two researchers according to the inclusion and exclusion criteria, and the quality of the included literature was assessed using the methodological index for non-randomized studies. Data extracted included visual analog scale (VAS) scores, total western ontario and mcmaster universities osteoarthritis index (WOMAC) scores, and the incidence of adverse events, followed by a meta-analysis using STATA 15.1 software. Results: A total of 11 papers involving 332 patients (419 knees) from 11 studies were included according to the Na-row criteria. The technical success rate was 100%. The standardized mean differences of VAS scores at 1, 3, 6, and 12 months postoperatively were -2.42(95%CI:-2.89--1.95), -2.44(95%CI:-2.94--1.93), -2.57(95%CI:-3.13--2.01), and -2.60(95%CI:-3.37--1.84), respectively, all showing decreases (all P<0.001); the weighted mean difference of WOMAC total score at 1, 3, 6, and 12 months after surgery were -24.44(95%CI:-29.13--19.75), -28.30(95%CI:-31.47--25.12), -30.66(95%CI:-32.94--28.37), and -34.23(95%CI:-44.39--24.07), all showing decreases (all P<0.001). The incidence of adverse events mainly included skin color changes of 16.4%(95%CI: 5.5%-31.0%, P<0.001) and hematoma at the puncture site 3.8%(95%CI: 1.1%-7.6%, P<0.001), with the majority being mild and self-resolving. Conclusions: GAE treatment for KOA secondary pain has good efficacy and safety, providing a new treatment option for KOA patients as a minimally invasive procedure.

Electroacupuncture for abdominal obesity: protocol for a systematic review and meta-analysis of randomised controlled trials

IntroductionThe prevalence of obesity is rising, significantly impacting health and quality of life. Effective treatment is crucial, particularly for abdominal obesity (AO). Electroacupuncture (EA), which combines acupuncture and moxibustion with...

Effect of Physical Activity Interventions on Health Parameters in Children and Adolescents with Intellectual Disabilities: A Systematic Review

Intellectual disability (ID) encompasses diverse challenges that affect daily life and health. Sedentary behaviors, prevalent in this population, contribute to alarming health concerns, notably obesity and musculoskeletal issues. This review examines the role of physical activity (PA) interventions in addressing these health challenges among children and adolescents with ID. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was conducted in the Cochrane Library, PubMed, Scopus, and SPORTDiscus databases, using specific keywords aligned with the PICO framework (population, intervention, comparison, and outcome). From January 2013 to October 2024, a total of 5236 studies were identified, of which 17 met the inclusion criteria for this review according to PRISMA procedures. Randomized controlled trials (RCTs) focusing on the impact of PA on body composition, physical fitness, bone health, metabolic indicators, and overall quality of life were included. The study cohort consisted of individuals aged 13–24 diagnosed with ID. The findings consistently highlight the positive relationship between PA interventions and improved health markers in individuals with ID. Diverse PA interventions, ranging from strength training to high-intensity exercises, demonstrated significant improvements in body composition, physical fitness, and bone mineral density. Notably, higher-frequency PA programs (minimum three sessions per week) yielded more substantial benefits. This review underscores the potential of adapted PA interventions to address health concerns and enhance the quality of life for individuals with ID. Further comprehensive research is needed to establish standardized guidelines for effective PA interventions in this population

The Role of Smartwatch Technology in the Provision of Care for Type 1 or 2 Diabetes Mellitus or Gestational Diabetes: Systematic Review

Abstract Background The use of smart technology in the management of all forms of diabetes mellitus has grown significantly in the past 10 years. Technologies such as the smartwatch have been proposed as a method of assisting in the monitoring of blood glucose levels as well as other alert prompts such as medication adherence and daily physical activity targets. These important outcomes reach across all forms of diabetes and have the potential to increase compliance of self-monitoring with the aim of improving long-term outcomes such as hemoglobin A1c (HbA1c). Objective This systematic review aims to explore the literature for evidence of smartwatch technology in type 1, 2, and gestational diabetes. Methods A systematic review was undertaken by searching Ovid MEDLINE and CINAHL databases. A second search using all identified keywords and index terms was performed on Ovid MEDLINE (January 1966 to August 2023), Embase (January 1980 to August 2023), Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library, latest issue), CINAHL (from 1982), IEEE Xplore, ACM Digital Libraries, and Web of Science databases. Type 1, type 2, and gestational diabetes were eligible for inclusion. Quantitative studies such as prospective cohort or randomized clinical trials that explored the feasibility, usability, or effect of smartwatch technology in people with diabetes were eligible. Outcomes of interest were changes in blood glucose or HbA1c, physical activity levels, medication adherence, and feasibility or usability scores. Results Of the 8558 titles and abstracts screened, 5 studies were included for qualitative synthesis in this review. A total of 322 participants with either type 1 or type 2 diabetes mellitus were included in the review. A total of 4 studies focused on the feasibility and usability of smartwatch technology in diabetes management. One study conducted a proof-of-concept randomized clinical trial including smartwatch technology for exercise time prescriptions for participants with type 2 diabetes mellitus. Adherence of participants to smartwatch technology varied between included studies, with one reporting input submissions of 58% and another reporting that participants logged 50% more entries than they were required to. One study reported significantly improved glycemic control with integrated smartwatch technology, with increased exercise prescriptions; however, this study was not powered and required a longer observational period. Conclusions This systematic review has highlighted the lack of robust randomized clinical trials that explore the efficacy of smartwatch technology in the management of patients with type 1, type 2, and gestational diabetes. Further research is required to establish the role of integrated smartwatch technology in important outcomes such as glycemic control, exercise participation, drug adherence, and diet monitoring in people with all forms of diabetes mellitus.

A systematic review and meta-analysis comparing robotic-assisted percutaneous screw fixation and conventional surgical techniques for acetabular fractures.

The objective of this comprehensive review and meta-analysis was to evaluate the effectiveness of robot-aided percutaneous screw fixation versus traditional surgical techniques in managing acetabular fractures. We plan to carry out an exhaustive exploration of certain databases (PubMed, CNKI, Embase, and Cochrane Library) to find studies that have been published since the beginning of these databases until August 2024, focusing on patients with acetabular fractures. These studies will compare the efficacy of robot-assisted percutaneous screw fixation with conventional surgical methods. Both English and Chinese literature will be included. We will adhere strictly to the predefined inclusion and exclusion criteria, with a focus on randomized controlled trials and cohort studies. Review Manager 5.4.1 will be utilized for the execution of data analysis. The ROBINS-I instrument will be used to evaluate the bias risk in Not-RCTs. The final analysis included 6 retrospective cohort studies, encompassing a total of 168 patients, with 83 undergoing robot-assisted percutaneous screw fixation and 85 receiving conventional surgery. The results indicated that patients treated with robot-assisted percutaneous screw fixation had shorter OT, fewer intraoperative fluoroscopy instances, and fewer adjustments of guide pins compared to those receiving conventional surgery. However, no significant differences were observed between the two treatment methods in terms of Modified Postel Merle D'Aubigne scores and EBL. The use of robots in percutaneous screw fixation has been demonstrated to be a secure and efficient method for managing acetabular fractures. Compared to conventional ORIF or free-hand screw fixation, this robotic-assisted technique offers significant advantages, including reduced operation time, lower IFF, and fewer guide wire adjustments.