Cochrane Review Research Articles

A review of health equity considerations in Cochrane reviews of lifestyle interventions for cardiovascular health in adults

ObjectiveCardiovascular disease (CVD) is the leading cause of global disease burden and rising healthcare costs. Systematic reviews (SRs) rigorously evaluate evidence on health interventions' effects and guide personal, clinical, and policy decision-making. Health equity is the absence of avoidable and unfair differences in health between groups within a population. Assessing equity in lifestyle interventions for cardiovascular health is important due to persisting health inequities in CVD burden and access to interventions. We aim to explore how health equity considerations are addressed in Cochrane SRs of lifestyle interventions for cardiovascular health. Study Design and SettingThis is a methodological review of Cochrane SRs of lifestyle interventions for cardiovascular health using the PROGRESS-Plus framework. PROGRESS-Plus stands for Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status, and Social capital, while “Plus” stands for additional factors associated with discrimination and exclusion such as age, disability, and comorbidity. Using predefined selection criteria, two authors independently screened all Cochrane reviews published in the Cochrane Database of Systematic Reviews between August 2017 and December 2022. PROGRESS-Plus factors in the SRs were sought in the Summary of Findings (SoF) table, Methods/Inclusion criteria, Methods/Subgroup analyses, Results/Included studies, Results/Subgroup analyses, and Discussion/Overall completeness and applicability of evidence. ResultsWe included 36 SRs published by 10 Cochrane groups, addressing 11 health conditions with mostly dietary and exercise interventions. The most common PROGRESS-Plus factors assessed were gender/sex, age, and comorbidity. PROGRESS-Plus factors were most addressed in the inclusion criteria (64%), the discussion (75%), and the included studies (92%) sections of the SRs. Only 33% of SoF tables referenced PROGRESS-Plus. Sixty-nine percent of the included SRs planned for subgroup analyses across one or more PROGRESS-Plus factors, but only 43% of SRs conducted subgroup analyses, suggesting limited reporting of PROGRESS-Plus factors in primary studies. ConclusionsEquity factors are not sufficiently addressed in Cochrane reviews of lifestyle interventions for cardiovascular health. Low reporting of PROGRESS-Plus factors in implications for practice and research sections of Cochrane SRs limit equity focused guidance for current clinical practice, public health interventions and future research.

Optimal timing of oral anticoagulation initiation in patients with acute ischaemic stroke and atrial fibrillation: a comprehensive meta-analysis and systematic review

The optimal timing for initiating direct oral anticoagulants (DOACs) for secondary stroke prevention in patients with atrial fibrillation and acute ischaemic stroke remains controversial due to concerns about haemorrhagic transformation....

Psychotherapeutic treatments for depression in older adults.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of psychotherapeutic interventions in the treatment of older adults with depression and whether the effects of different types of psychotherapeutic treatments vary for older adults with depression.

Prevalence and determinants of scabies: A global systematic review and meta-analysis.

Scabies is a neglected skin disease that disproportionately affects people from resource poor and overcrowded countries. Global data on prevalence and risk factors are limited. This article aims to estimate the global burden of scabies and identifies the risks associated with it. Databases (PubMed, Scopus and Cochrane Reviews) were accessed to identify studies of scabies prevalence published between 2000 and 2024. Results were pooled to estimate prevalence and identify factors, which explained between-study heterogeneity. Odds ratios (ORs), risk of bias, subgroup analyses and meta-regression were used to describe variation in effect size and heterogeneity based on country-level demographic and economic variables. Seventy studies yielded a pooled prevalence of 11.9% (95% confidence interval [CI]: 9.60-14.7) with substantial heterogeneity . Prevalence was highest in Oceania (17.9%; 95% CI: 13.9-22.8) compared to other regions. Pooled risk factors for scabies showed significant associations for demographic and behavioural factors including contact history with household members with itch (OR 11.3; 95% CI 4.82-26.51; ; n = 7), lack of soap use (OR 3.41; 95% CI: 2.56-4.54; ; n = 7), bed-sharing (OR 2.64; 95% CI: 1.50-4.63; ; n = 7), sharing of clothes (OR 2.52; 95% CI: 1.58-4.03; ; n = 7), infrequent bathing (OR 2.13; 95% CI: 1.41-3.22; ; n = 6), presence of pets (OR 1.76; 95% CI: 1.08-2.87; ; n = 4) and being a male (OR = 1.19; 95% CI: 1.04-1.37; ; n = 22). Socioeconomic factors were not convincingly associated with scabies prevalence. Prevalence of scabies is associated with geographic location and behavioural factors, but not between-country socioeconomic status. In addition to mass drug administration, risk factors are identified which may be included in health promotion programmes to reduce scabies prevalence and its sequelae in the long term.

Glucocorticoid facet joint injection for chronic back or neck pain.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: The primary objective is to assess the benefits and harms of glucocorticoid facet joint injections in adults with chronic back or neck pain that is presumed to be facet joint-mediated. The secondary objective is to assess whether the effects differ by diagnostic method for facet joint-mediated pain.

Artificial intelligence in respiratory pandemics-ready for disease X? A scoping review.

This study aims to identify repeated previous shortcomings in medical imaging data collection, curation, and AI-based analysis during the early phase of respiratory pandemics. Based on the results, it seeks to highlight essential steps for improving future pandemic preparedness. We searched PubMed/MEDLINE, Scopus, and Cochrane Reviews for articles published from January 1, 2000, to December 31, 2021, using the terms "imaging" or "radiology" or "radiography" or "CT" or "x-ray" combined with "SARS," "MERS," "H1N1," or "COVID-19." WHO and CDC Databases were searched for case definitions. Over the last 20 years, the world faced several international health emergencies caused by respiratory diseases such as SARS, MERS, H1N1, and COVID-19. During the same period, major technological advances enabled the analysis of vast amounts of imaging data and the continual development of artificial intelligence algorithms to support radiological diagnosis and prognosis. Timely availability of data proved critical, but so far, data collection attempts were initialized only as individual responses to each outbreak, leading to long delays and hampering unified guidelines and data-driven technology to support the management of pandemic outbreaks. Our findings highlight the multifaceted role of imaging in the early stages of SARS, MERS, H1N1, and COVID-19, and outline possible actions for advancing future pandemic preparedness. Advancing international cooperation and action on these topics is essential to create a functional, effective, and rapid counteraction system to future respiratory pandemics exploiting state of the art imaging and artificial intelligence. Question What has been the role of radiological data for diagnosis and prognosis in early respiratory pandemics and what challenges were present? Findings International cooperation is essential to developing an effective rapid response system for future respiratory pandemics using advanced imaging and artificial intelligence. Clinical relevance Strengthening global collaboration and leveraging cutting-edge imaging and artificial intelligence are crucial for developing rapid and effective response systems. This approach is essential for improving patient outcomes and managing future respiratory pandemics more effectively.

Methylxanthines for the prevention or treatment of intermittent hypoxemia or respiratory insufficiency in late preterm infants.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of methylxanthines in preventing or treating intermittent hypoxemia or respiratory insufficiency in late preterm infants.

Minimizing blood sampling in preterm infants.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of different strategies to minimize blood sampling in preterm infants.

Virtual reality technology for pain management in advanced cancer.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Primarily, to determine the effectiveness of a virtual reality (VR) intervention compared to an alternative or no intervention for people living with advanced cancer: on pain intensity, adverse events (AEs) and serious adverse events (SAEs); and secondarily, on additional pain properties (e.g. type, frequency), psychological well-being, other physical symptoms (e.g. anxiety) and quality of life. We will also report on the context in which the VR was implemented (setting, type and dose of VR).

Adherence to secondary antibiotic prophylaxis among patients with acute rheumatic fever and/or rheumatic heart disease: a systematic review and meta-analysis

ObjectivesWorldwide, a number of studies have been conducted to assess the prevalence of adherence to secondary antibiotic prophylaxis and to identify the associated factors (reasons) for poor adherence among patients...

Support for parents and families after stillbirth and neonatal death.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To identify and assess the effect of support interventions focused on psychological, social, and emotional outcomes for bereaved parents (including birth and non-birthing mothers, fathers, partners) and family members of parents (e.g. grandparents; siblings) who have experienced stillbirth or neonatal death.

International models of accreditation and certification for hospitals with a focus on nursing: a scoping review

BackgroundQuality assurance in hospitals is essential for ensuring patient safety, quality of care and efficiency. The nursing profession is a key contributor to healthcare quality, yet, a comprehensive overview and comparison of the role and scope of nursing as part of accreditation and certification schemes has been lacking. The aim was to identify if and to what extent international accreditation or certification schemes focus on nursing, and to compare their conceptual models and outcome indicators.MethodsA scoping review was conducted. A search strategy was developed together with a librarian and carried out in January 2024 in Medline, CINAHL, Web of Science Core Collection, Cochrane Reviews and Google Scholar. Additionally, authoritative websites of accreditation/certification holders were searched. Inclusion criteria were studies on international accreditation or certification schemes for hospital settings with relevance to nursing published in English or German. Screening and data analysis adhered to the Joanna Briggs Institute’s methodology, with reporting following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guideline (PRISMA-ScR).ResultsThe search identified 17.315 records. After removing duplicates and screening of titles/abstracts, 336 full-texts remained. A total of 124 studies were included, identifying seven international accreditation/certification schemes: European Foundation for Quality Management, Evaluation and Quality Improvement Program, International Organization for Standardization 9001, Joint Commission International®, Magnet Recognition Program®, Pathway to Excellence® Program, Qmentum®. The different schemes ranged from nursing-specific to having no specific focus on, but relevance for, nursing and varied in their topics, focus on structure, process and outcome quality and structure and content of requirements. Additionally, outcome indicators varied, with differences in the extent to which indicators were nurse-sensitive, compulsoriness of data collection, and use of external benchmarking.ConclusionsThe seven international schemes show large conceptual variations as to their focus on nursing and differences in the degree of nurse-specific outcome indicators. Hospital and nursing managers, policymakers, patients and the public need to understand the content and outcome dimensions of the schemes when making decisions or assessing hospital quality data.

Clip It or Let It: The Efficacy of Mitral Valve Transcatheter Edge-to-Edge Repair Versus Conservative Treatment in Reducing Mortality Among Patients With Ischemic Mitral Regurgitation

BACKGROUND: Despite revascularization and optimal medial therapy (OMT) residual ischemic mitral regurgitation (IMR) continues in a self-aggravating vicious cycle to affect prognosis and survival adversely. Mitral valve surgery in combination with coronary artery bypass graft remains a subject of debate due to the absence of a net overall benefit. Mitral valve transcatheter edge-to-edge repair (M-TEER) has been gaining grounds as a viable option from observational studies, but results from randomized controlled trials (RCTs) have yielded mixed results. Thus, this study was conducted to determine whether the current collective data support the efficacy of M-TEER with OMT versus OMT alone in patients with clinically significant IMR. METHODS: A literature search from PubMed/MEDLINE, Cochrane Review Central, Clinical Trials Registry, ResearchGate, Mendeley, and Google Scholar for relevant RCTs and observational studies was conducted and reviewed independently by three reviewers. Published and unpublished studies indexed from inception until 2023 were included. The pooled estimates for the primary outcome of all-cause mortality and secondary outcomes of cardiac mortality and heart failure hospitalizations were measured using R Studio statistical software (R Foundation forStatistical Computing, Vienna, Austria). RESULTS: Seven eligible studies (five observational and two RCTs) allocated 1610 IMR patients to M-TEER + OMT (n = 942) or OMT alone (n = 668). The effect estimate using random-effects model demonstrated M-TEER with OMT to significantly reduce 1-year (odds ratio [OR], 0.67; 95% confidence interval [CI], 0.52–0.86; P = 0.002) and 2-year (OR, 0.50; 95% CI, 0.38–0.67; P < 0.00001) all-cause mortality. Cardiac mortality (OR, 0.58; 95% CI, 0.27–1.23; P = 0.15) and heart failure hospitalization (OR, 0.45; 95% CI, 0.18–1.13; P = 0.09) did not reach statistical significance between the treatment arms. CONCLUSION: In patients with IMR, M-TEER on top of OMT was able to afford a 2-year allcause mortality advantage. KEYWORDS: ischemic mitral regurgitation, mitral valve transcatheter edge-to-edge repair, optimal medical therapy

Influence of study characteristics on harm estimates from randomised controlled trials in patients with inflammatory arthritis receiving biological or synthetic antirheumatic drugs: a meta-epidemiological study

ObjectiveTo examine the association between study characteristics and the harms reported in randomised controlled trials (RCTs) on biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) in patients with inflammatory arthritis...

Antipsychotic drugs for anorexia nervosa.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of antipsychotic drugs (both first- and second-generation antipsychotics) compared to placebo on body weight gain, psychological symptoms, acceptability, and adverse events for people with anorexia nervosa.

Larger versus smaller red blood cell volume per transfusion in hospitalized adults, children, and preterm neonates.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: The objective of this review is to compare the effectiveness and safety of larger versus smaller RBC volume per transfusion for anemia in hospitalized adults, children, and preterm neonates.

Artificial intelligence and myocarditis-a systematic review of current applications.

Myocarditis, marked by heart muscle inflammation, poses significant clinical challenges. This study, guided by PRISMA guidelines, explores the expanding role of artificial intelligence (AI) in myocarditis, aiming to consolidate current knowledge and guide future research.Following PRISMA guidelines, a systematic review was conducted across PubMed, Cochrane Reviews, Scopus, Embase, and Web of Science databases. MeSH terms including artificial intelligence, deep learning, machine learning, myocarditis, and inflammatory cardiomyopathy were used. Inclusion criteria involved original articles utilizing AI for myocarditis, while exclusion criteria eliminated reviews, editorials, and non-AI-focused studies.The search yielded 616 articles, with 42 meeting inclusion criteria after screening. The identified articles, spanning diagnostic, survival prediction, and molecular analysis aspects, were analyzed in each subsection. Diagnostic studies showcased the versatility of AI algorithms, achieving high accuracies in myocarditis detection. Survival prediction models exhibited robust discriminatory power, particularly in emergency settings and pediatric populations. Molecular analyses demonstrated AI's potential in deciphering complex immune interactions.This systematic review provides a comprehensive overview of AI applications in myocarditis, highlighting transformative potential in diagnostics, survival prediction, and molecular understanding. Collaborative efforts are crucial for overcoming limitations and realizing AI's full potential in improving myocarditis care.

A Methodological Quality Assessment of Meta-Analyses on Sleep Disorder Treatments Using AMSTAR 2.

Meta-analyses (MAs) provide up-to-date, quantified evidence on treatment effects, which may be useful for clinical and policy decision-making. However, the quality of MAs varies, and methodological flaws can limit their reliability. This review evaluated the methodological quality of MAs on sleep disorder treatments. We searched MEDLINE, EMBASE, and PsycINFO for eligible MAs on randomized controlled trials of sleep disorder treatments published between 2018 and 2023. We extracted MAs' bibliographical characteristics with a predesigned form and appraised their methodological quality using AMSTAR (A Measurement Tool to Assess Systematic Reviews) 2. We explored the associations between bibliographical characteristics and methodological quality ratings using Kruskal-Wallis tests and Spearman's rank correlation coefficients. Among the 104 MAs, the majority (n=82; 78.9%) had critically low quality, 19 (18.3%) had low quality, and only 3 (2.9%) had high quality. Regarding AMSTAR 2 critical domains, 97 (93.3%) MAs did not provide a list of excluded studies and justify the exclusions, 75 (72.1%) did not use a comprehensive literature search strategy, and 56 (53.9%) lacked a registered protocol and did not justify protocol deviations. Cochrane reviews (p=0.018), MAs with European corresponding authors (p<0.001), and MAs receiving European funding (p<0.001) performed better than their counterparts. The methodological quality of recent MAs on sleep disorder treatments is unsatisfactory. Future reviewers should address the identified critical methodological issues. In addition, substantial resources and funding should be allocated to support training in evidence synthesis and critical appraisal for researchers and clinicians.

Exploring the fragility of meta-analyses in ophthalmology: a systematic review.

The fragility index (FI) of a meta-analysis evaluates the extent that the statistical significance can be changed by modifying the event status of individuals from included trials. Understanding the FI improves the interpretation of the results of meta-analyses and can help to inform changes to clinical practice. This review determined the fragility of ophthalmology-related meta-analyses. Meta-analyses of randomized controlled trials with binary outcomes published in a journal classified as 'Ophthalmology' according to the Journal Citation Report or an Ophthalmology-related Cochrane Review were included. An iterative process determined the FI of each meta-analysis. Multivariable linear regression modeling evaluated the relationship between the FI and potential predictive factors in statistically significant and non-significant meta-analyses. 175 meta-analyses were included. The median FI was 6 (Q1-Q3: 3-12). This meant that moving 6 outcomes from one group to another would reverse the study's findings. The FI was 1 for 18 (10.2%) of the included meta-analyses and was ≤5 for 75 (42.4%) of the included meta-analyses. The number of events (p < 0.001) and the p-value (p < 0.001) were the best predictors of the FI in both significant and non-significant meta-analyses. The statistical significance of meta-analyses in ophthalmology often hinges on the outcome of a few patients. The number of events and the p-value are the most important factors in determining the fragility of the evidence. The FI is an easily interpretable measure that can supplement the reader's understanding of the strength of the evidence being presented. CRD42022377589.

Cardiovascular morbidity, mortality and risk management in patients with abdominal aortic aneurysms

Introduction: Cardiovascular events are the most common cause of mortality in patients with an abdominal aortic aneurysm (AAA) regardless of intervention to treat the aneurysm. This systematic review aims to quantify the risk of cardiovascular morbidity and mortality in all patients with AAA before and after repair. Methods: The review was conducted in line with the framework of Cochrane reviews and Standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases were searched for studies that published cardiovascular mortality and/or morbidity rates of people diagnosed with an AAA. Studies only discussing AAA-related deaths or papers looking at aneurysms caused by connective tissue disorders, thoracic aortic aneurysms or ectatic abdominal aortas were excluded. Data on patient demographics, prevalence of comorbidities and medical therapy were extracted where possible. Results: 17 studies with 78,500 patients were included. The weighted mean prevalence of antiplatelet therapy and lipid-lowering therapy prescriptions was 62.8% and 60.2%, respectively. Pooled mortality rates secondary to myocardial infarction were 5.7% at 5 years with a 2.87% risk of death per year and 11.4% at 10 years with a 1.48% risk of death per year. The pooled mortality rate secondary to an acute cerebrovascular event was 1.9% at 5 years with a 0.38% risk of death per year. The pooled overall cardiovascular mortality rate was 14.5% at 5 years with a 5.43% risk of death per year. Conclusions: This review demonstrates suboptimal prescription of best medical therapy alongside a significant incidence of cardiovascular morbidity and mortality in patients with AAAs. Greater emphasis should be placed on optimisation of antiplatelet therapy and lipid-lowering therapy in primary care and vascular surgery services with the aim of improving cardiovascular-related outcomes for this patient cohort.