Cochrane Risk Of Bias Research Articles

Treatment Stability and Intermolar Width Changes in Patients Undergoing Surgically Aided Rapid Palatal Expansion: A Systematic Review

Introduction: The primary objectives of this systematic review were to critically evaluate clinical research assessing the stability of treatment outcomes following surgically aided rapid palatal expansion (SARPE) and to review published studies on intermolar width measurements taken before and after the treatment.Materials and Methods: A complete search across the electronic databases of the Cochrane Library, Google Scholar, PUBMED, Europe PMC and Science Direct, and a complimentary manual search of all orthodontic journals until 2024 were carried out. Selection criteria were used in the evaluation of the articles.Selection Criteria: Based on the PICOS (population, intervention, comparison, outcome, study design), the inclusion criteria were established. Adult patients with constricted maxillary arches and resulting transverse discrepancies were included in the study, and SARPE was carried out to address this clinical problem. Although many studies have been conducted on this topic, only randomized clinical trials were covered in this review. Excluded from this review were case reports, conference papers, animal experiments, in vitro research, case series, and FEM studies.Data Collection and Analysis: The primary outcome of the systematic review was the assessment of treatment stability and intermolar width changes in patients who underwent surgically aided rapid palatal expansion (SARPE). The selection of studies and data collection were conducted using standard methodological techniques. The assessment of the risk of bias was conducted, and the results were synthesized. Cochrane Risk of Bias was used for evaluating the outcomes obtained in the various studies. They were assessed by the GRADE protocol for Outcome Assessment for listing the parameters studied.Results: No significant difference in stability was noted between the two groups.Conclusion: With adequate literature review and outcome assessment, it can be concluded from this review that weak evidence exists to conclusively prove the stability of SARPE in the inter-molar and inter-first premolar regions. Immediate post-surgical stability is dependent on a variety of factors that have not been standardized in the various RCTs. Further well-designed trials that establish the extent of transverse discrepancies along with defining the obtained results with clarity are required before we obtain sufficiently conclusive outcomes.

A Systematic Review and Meta-Analysis of Interventions Targeted to Parents for Improving the Oral Health of Children from Culturally and Linguistically Diverse (CALD) Backgrounds.

A high prevalence of dental caries is a significant health problem, especially in the pediatric population. Low-income minority groups, including the refugee and immigrant populations, are at higher risk of compromised oral health. It has been suggested that migrant parents do not have enough understanding of oral health, risk factors associated with dental caries, or the progress of dental decay. This systematic review aims to study quantitative literature on oral health interventions, health promotion programs, or behaviour change interventions targeting the parents/ caregivers of culturally and linguistically diverse (CALD) children. A systematic search of electronic databases, including MEDLINE, EMBASE, PUBMED, CINAHL, SCOPUS, WEB OF SCIENCE, COCHRANE, and PROQUEST, was conducted until August 2023. Randomised (RCT) or non-randomised controlled trials (NRCTs) were included. Two reviewers independently assessed the quality of the included studies using the Cochrane Risk of Bias (RoB) 2.0 and ROBINS-I tools. Meta-analysis was performed as appropriate. The initial search from the databases retrieved 2073 articles. After the removal of duplicates, 1683 articles remained. Finally, 69 articles were reviewed in full text, and 15 articles were considered eligible in this review. The RoB assessment for RCTs rated three as low-risk and three as high-risk. The serious RoB in these NRCTs mostly pertained to measurement bias based on self-reporting oral health behaviours. The meta-analysis pooling of results (for RCTs and NRCTs) favoured interventions for CALD parents' oral health knowledge [0.73 (95% CI, 0.08 to 1.38) for RCTs, 1.73 (95% CI; 1.45 to 2.02) for NRCTs] and attitudes [0.86 (95% CI, 0.31 to 1.42)]. Relatively high heterogeneity was observed. Oral health educational interventions can be effective in improving the oral health literacy of CALD parents' oral health knowledge and attitudes, especially when facilitated by lay health advisors. However, the low quality of evidence due to high heterogeneity and high RoB further highlighted the need for well-designed RCTs targeting CALD parents.

Effects of repetitive transcranial magnetic stimulation combined with repetitive peripheral magnetic stimulation on upper limb motor function after stroke: a systematic review and meta-analysis

ObjectiveTo evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) combined with repetitive peripheral magnetic stimulation (rPMS) on upper limb motor dysfunction after stroke.MethodsWe systematically searched databases up to May 2024, including PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIP, Wanfang, and CBM. Randomized controlled trials (RCTs) examining the application of rTMS combined rPMS on upper limb motor dysfunction after stroke were included based on predefined inclusion criteria. We used Cochrane Risk of Bias 2 tool to assess bias risk of the included RCTs. Meta-analysis was conducted using RevMan 5.4 and Stata 17.0 software.ResultsA total of 9 RCTs involving 483 participants were included in this study. Compared with the control groups that used either conventional therapy or rTMS alone, the experimental group that used rTMS combined rPMS showed significant improvements in stroke patients' upper limb motor function [MD = 3.65, 95% CI (2.75, 4.54), P < 0.05], ability of daily living [MD = 4.50, 95% CI (3.50, 5.50), P < 0.05], and spasticity [MD = –0.34, 95% CI (−0.48, −0.20), P < 0.05]. Meanwhile, in terms of neurophysiological indicators, significant differences were found both for motor evoked potential latency [MD = −1.77, 95% CI (−3.19, −0.35), P < 0.05] and motor evoked potential amplitude [MD = 0.25, 95% CI (0.01, 0.49), P < 0.05].ConclusionThis study provides low-level evidence that the therapy of LF-rTMS or HF-rTMS combined with rPMS can improve the upper limb motor function and daily living ability of stroke patients. However, given that the low quality of the evidence for the evaluation results, further evidence from high-quality studies is needed to substantiate this conclusion.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024539195, PROSPERO Platform [CRD42024539195].

Over-the-Scope Clips vs Standard Endoscopic Interventions for First-line Treatment of NVUGI Bleeding: A Meta-analysis of Randomized Trials

Background and Aims: Recently, over-the-scope clips (OTSCs) have been extensively studied for hemostasis of nonvariceal upper gastrointestinal bleeding (NVUGIB). Our goal was to compare the efficacy of OTSCs with standard endoscopic interventions (SEIs) as first-line treatments. Methods: A comprehensive search of electronic databases was performed to identify Randomized Clinical Trials (RCTs) comparing OTSCs with SEIs as first-line therapy for NVUGIB. This search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Results: Out of 819 reviewed studies, 5 RCTs comprising a total of 555 patients (277 OTSCs vs. 278 SEIs) were included. The OTSC group had a lower 30-day rebleeding rate (Risk Ratio [RR]: 0.43; 95% Confidence Interval [CI]: 0.24, 0.77; I²: 0%; p = 0.004) and a higher clinical success rate (RR: 1.19; 95% CI: 1.11, 1.28; I²: 0%; p < 0.00001). There was no significant difference in technical success (RR: 1.06; 95% CI: 0.98, 1.14; I² = 73%; p = 0.13), 30-day all-cause mortality (RR: 0.50; 95% CI: 0.22, 1.14; I²: 0%; p = 0.10), need for further intervention (RR: 1.22; 95% CI: 0.43, 3.47; I²: 0%; p = 0.71), or length of hospital stay (Mean Difference: 0.31; 95% CI: -1.08, 1.70; I²: 0%; p = 0.66). The risk of bias, which was assessed using the Cochrane Risk of Bias 2.0 tool, indicated some concerns of bias. Conclusion: OTSCs are more efficient than SEIs as a first-line treatment in terms of rebleeding within 30 days and clinical success rates.

Recurrence of Retinopathy of Prematurity Following Anti-vascular Endothelial Growth Factor (Anti-VEGF) Therapy: A Systematic Review and Meta-Analysis.

Retinopathy of prematurity (ROP) is a neovascular disorder which affects premature infantsand can lead to childhood blindness. Treatment includes laser photocoagulation and intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections, both effective options. However, laser photocoagulation can lead to refractive errors, while anti-VEGF therapy can result in disease recurrence. Our systematic review aimed to evaluate the recurrence rates of ROP following treatment with anti-VEGF agents compared to other anti-VEGF agents and laser photocoagulation. We also aimed to measure the retreatment intervals and assess successful retreatment rates to identify the most effectivetreatment modality. Our review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included both randomized controlled trials (RCTs) and non-randomized comparative studies (NCS). A thorough search of MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases was performed. Studies were assessed using the Cochrane Risk of Bias (RoB2) tool and the Newcastle-Ottawa Scale (NOS). Random-effects and fixed-effects models were used to measure pooled estimates. The outcomes were reported as risk ratios (RR) and standardized mean differences (SMD). A total of 21 studies (six RCTs and 15NCS) with 6,152 eyes were included. Overall, anti-VEGF agents showed a higher risk of recurrence compared to laser photocoagulation (RR=2.14, 95% CI: 1.06-4.33, p=0.03). Conbercept demonstrated a significantly lower risk of recurrence than laser photocoagulation and ranibizumab (RR=0.47, 95% CI: 0.39-0.58, p<0.00001), while aflibercept showed a higher recurrence risk compared to bevacizumab (RR=12.61, 95% CI: 6.43-24.73, p<0.00001). Bevacizumab was associated with a longer retreatment interval than laser photocoagulation (SMD=0.89, 95% CI: 0.61-1.17, p<0.00001). No significant differences in retreatment success rates between bevacizumab and laser photocoagulation were observed. Anti-VEGF therapy is effective in the treatment of ROP; however, it is associated with a higher risk of recurrence compared to laser photocoagulation. Conbercept shows greater efficacy in reducing recurrence risk and prolonging the retreatment interval compared to ranibizumab. Aflibercept demonstrated inconsistent outcomes. No significant difference in recurrence rates was observed between bevacizumab and ranibizumab. Recurrences occurred significantly later when anti-VEGF therapy was used compared to laser photocoagulation. Successful retreatment rates between bevacizumab and laser photocoagulation were similar.

First-choice hormonal therapies for children with infantile epileptic spasms syndrome in South Asia: A network meta-analysis of randomized controlled trials.

Considering the peculiar challenges with infantile epileptic spasms syndrome (IESS) in South Asia and a wide variation in the usage of hormonal therapies, we compared the efficacy and safety of various hormonal therapies for children with IESS in South Asia. We searched PubMed, Embase, Scopus, and Web of Science databases from the inception until April 2024. We included only randomized clinical trials (RCTs) evaluating the efficacy and safety of hormonal therapies for IESS in the South Asian region. Complete cessation of epileptic spasms (ES), electro-clinical response, and time taken to be spasm-free at 2 or 6 weeks of therapy were efficacy outcomes, while the occurrence of adverse events was the safety outcome. Effect estimates were reported as odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI) and Cochrane risk of bias 2.0 (ROB 2.0) used for quality assessment of each study. The surface under the cumulative ranking curve (SUCRA) was used to rank the different therapies and reported as a p-score ranging from 0 to 1. Of 747 citations, nine RCTs comprising 566 children with IESS were included. After 2-week treatment, dexamethasone (OR: 6.72; 95% CI: 1.47, 30.72), adrenocorticotropic hormone therapy (ACTH) high dose (HD) (OR: 5.30; 95% CI: 1.05, 26.91), and prednisolone HD (OR: 2.41; 95% CI:1.07, 5.46) had shown significantly greater efficacy for cessation of EScompared with ACTH low dose (LD). Similarly, for electroclinical response, dexamethasone (OR: 9.63; 95% CI: 1.99, 46.70) and prednisolone HD (OR: 3.46; 95% CI: 1.38, 8.68) had greater efficacy compared with ACTH LD. Safety outcomes revealed that hypertension was significantly less common with ACTH LD and prednisolone HD as compared with ACTH HD. This study provides quality evidence on preferred first-choice hormonal therapy for managing IESS in South Asia. ACTH HD, dexamethasone, and prednisolone HD are the most effective hormonal therapy options with dose-dependent therapeutic efficacy. PLAIN LANGUAGE SUMMARY: This study provides insights into the selection of first-line hormonal therapies among the various treatments for managing infantile epileptic spasms syndrome (IESS) in South Asia. The study findings suggested that the effectiveness of these therapies is dose-dependent, with high doses of ACTH, dexamethasone, and prednisolone being the most effective for achieving cessation of epileptic spasms.

Impact of exercise intervention with or without curcumin supplementation on body fat composition, glucose, and lipid metabolism in obese adults: A meta-analysis.

This study was carried out to systematically review and evaluate the influence of exercise with and without curcumin on body fat composition, glucose, and lipid metabolism in obese adults. Search for eligible studies through four databases, and then proceed with screening. The inclusion criteria are as follows: (1) obese adults; (2) randomized controlled trial (RCT); (3) classified the exercise intervention with curcumin supplementation as the exercise with curcumin (CU) group and without curcumin supplementation as the exercise without curcumin (EX) group; (4) Conducted pre- and post-training assessments, which include body fat composition, glucose and lipid metabolism parameters. Use the Cochrane bias risk assessment tool to evaluate the quality of the selected study. Select standardized mean difference (SMD) as the appropriate effect scale index, and use Revman 5.4 software to analyze the mean difference of the selected article data with a 95% confidence interval (CI). A total of seven studies fulfilled the inclusion criteria and were selected for the meta-analysis. The included studies involved 72 males and 111 females, where 94 belonged to the EX group and 89 from the CU group. The CU group benefited more from the reduced Fat% (SMD, 2.18 [0.12, 4.24], p < 0.05, I2 = 0%, p for heterogeneity = 0.98) than the EX group. The study demonstrated that the combined exercise intervention with curcumin supplementation significantly reduced Fat% in obese adults compared with exercise without supplementing curcumin.

The impact of scaling and root planning combined with mouthwash during pregnancy on preterm birth and low birth weight: a systematic review and meta-analysis

BackgroundThe effect of treating periodontal disease (PD) during pregnancy on adverse birth outcomes, such as preterm birth (PTB) and/or low birth weight (LBW), remains unclear. This is partially due to the fact that Randomized Controlled Trials (RCTs) have used different combinations of treatment approaches to test this hypothesis. In this meta-analysis of RCTs, we assessed the impact of treating PD during pregnancy with scaling and root planning (SRP) and mouthwash use on PTB and LBW.MethodsA systematic review with meta-analysis was conducted following PRISMA guidelines. A comprehensive search strategy was employed across electronic databases, including PubMed/Medline, Embase, and Google Scholar. Quality assessment was performed using the Cochrane Risk of Bias 2 Tool. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effect models.ResultsOut of 133 initially identified reports, 9 RCTs involving 3,985 pregnant women met the inclusion criteria. Periodontal treatment with SRP and mouthwash use in pregnancy was associated with a lower risk of PTB and LBW in meta-analysis with random effects models (pooled RR for PTB = 0.44, 95% CI: 0.22–0.88) and (pooled RR for LBW = 0.33, 95% CI: 0.13–0.84). Substantial heterogeneity was observed among studies (I2 = 91% and 90% for PTB and LBW, respectively), with sensitivity analysis suggesting potential sources of heterogeneity. Funnel plot assessment for publication bias showed evidence of asymmetry.ConclusionSRP with mouthwash use during pregnancy were associated with significantly lower risks of PTB and LBW. Larger, well-conducted RCTs are warranted to address this issue, as existing trials are small and exhibit methodological and statistical heterogeneity.

The Effect of Black Chokeberry (Aronia melanocarpa) on Human Inflammation Biomarkers and Antioxidant Enzymes: A Systematic Review of Randomized Controlled Trials.

Consuming antioxidant-rich foods has been associated with potential benefits in managing chronic diseases by reducing oxidative stress and inflammation. This systematic review aimed to evaluate the effects of Aronia melanocarpa (aronia berry or chokeberry) on human inflammation biomarkers and antioxidant enzymes. A systematic search was conducted across multiple databases, including PubMed, Scopus, Science Direct, and Web of Science, to identify relevant studies investigating the potential effects of aronia on human inflammation biomarkers and antioxidant enzymes between April 2022 and November 2023. The selection of studies followed the PRISMA guidelines, data screening was conducted by 4 independent reviewers, and data extraction and risk-of-bias assessments were performed by 2 independent reviewers using the Cochrane Risk of Bias 2 tool. A total of 1986 studies were screened, and 18 studies that met the inclusion criteria were included in a systematic review that investigated the anti-inflammatory effects of aronia on various health parameters. These studies primarily focused on the effects of aronia on cardiometabolic diseases, performance in sport, and other health parameters. This study examined the effects of Aronia intervention on human health outcomes using aronia juice, extract, or oven-dried powder for a period of 4 to 13 weeks. The primary health parameters considered were C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), interleukin-8 (IL-8), interleukin-10 (IL-10), interleukin-1ß (IL-1ß), superoxide dismutase (SOD), catalase (CAT), and reduced glutathione peroxidase (GSH-Px). The results showed that aronia had a beneficial effect on several inflammatory cytokines, including reductions in CRP, TNF-α and IL-6 concentrations, as well as elevated IL-10 levels. Moreover, positive changes have been observed in antioxidant enzyme systems, including; elevated SOD, GSH-Px and CAT activity. The findings of the presented studies provide evidence that Aronia melanocarpa may have beneficial effects on inflammatory markers. PROSPERO registration No. CRD42022325633.

The Efficacy of Active Warming in Prehospital Trauma Care: A Systematic Review and Meta-Analysis

Background/Objectives: Hypothermia can affect multiple organ systems and reduce patient comfort and is an independent predictor of mortality in trauma patients. Early prevention and management prehospitally is critical and can be approached by “warming” patients using active and/or passive measures. Therefore, this systematic review aimed to determine the efficacy of prehospital active warming (AW) in trauma patients. Methods: MEDLINE, Embase, Web of Science and CENTRAL were searched up to June 2024 for studies meeting our inclusion and exclusion criteria. Six studies were identified: four randomised controlled trials (RCTs), a non-randomised trial and an observational study. A risk-of-bias assessment was conducted using either the Cochrane Risk of Bias 2 tool or the ROBINS-I tool. Results: For the primary outcome of end core body temperature (CBT), our meta-analysis calculated a statistically significant mean difference of 0.62 °C ([95%CI: 0.17, 1.07], p = 0.007), favouring AW. For the secondary outcomes of end heart rate and end systolic blood pressure, the mean differences favoured the AW and control groups, respectively, but were not statistically significant (p = 0.45 and p = 0.64). Two of the four RCTs had an overall moderate to high risk of bias, whilst the two observational studies had a high risk of bias. Conclusions: Overall, our results suggest that AW may be effective at managing CBT, but our results are limited by a small sample size, a serious/high overall risk of bias and variable study characteristics. Larger, high-quality studies are needed to inform clinical practice and guidelines.

Comparative analysis of rotary versus manual instrumentation in paediatric pulpectomy procedures: A systematic review and meta-analysis.

The use of rotary file in permanent teeth is well-documented, but there is limited scientific evidence for its effectiveness in primary teeth. A meta-analysis was conducted to compare rotary and manual tools in primary tooth pulpectomy procedures. Ten databases were searched from 2000 to 2024 to find relevant literature. The Cochrane Risk of Bias (ROB) tool assessed bias in randomised control trials. STATA software version 18 conducted the meta-analysis. A random-effects model was used for instrumentation time and obturation quality evaluation while sensitivity analysis followed high heterogeneity detection. Twenty RCTs were included after screening 723 studies. Publication bias and heterogeneity were found for instrumentation time, leading to removal of nine studies. Significant difference in mean instrumentation time (1.42) was noted. Obturation quality assessment showed an odds ratio of 1.82. Use of rotary instrumentation yielded superior outcomes compared with manual instrumentation for pulpectomy for primary teeth.

Effectiveness of Computer-Based Psychoeducational Self-Help Platforms for Eating Disorders (With or Without an Associated App): Protocol for a Systematic Review.

Access to psychological health care is extremely difficult, especially for individuals with severely stigmatized disorders such as eating disorders (EDs). There has been an increase in children, adolescents, and adults with ED symptoms and ED, especially following the COVID-19 pandemic. Computer-based self-help platforms (± associated apps) allow people to bridge the treatment gap and receive support when in-person treatment is unavailable or not preferred. The aim of this systematic review is to evaluate the effectiveness of computer-based self-help platforms for EDs, some of which may have associated apps. The proposed systematic review will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. This review will report and evaluate the literature concerning the efficacy of self-help platforms for EDs. Articles were obtained from the Ovid MEDLINE, Embase, Global Health, and APA PsycInfo. The inclusion criteria included research with original data and gray literature; research evaluating the efficacy of web-based psychoeducational self-help platforms for EDs; people with an ED diagnosis, ED symptoms, at risk of developing EDs, or from the general population without ED-related behaviors; pre- and post-computer-based ± associated apps intervention clinical outcome of ED symptoms; pre- and post-computer-based ± associated apps intervention associated mental health difficulties; and literature in English. The exclusion criteria were solely guided self-help platforms, only in-person interventions with no computer-based ± associated apps comparison group, only in-person-delivered CBT, self-help platforms for conditions other than eating disorders, systematic reviews, meta-analyses, posters, leaflets, books, reviews, and research that only reported physical outcomes. Two independent authors used the search terms to conduct the initial search. The collated articles then were screened by their titles and abstracts, and finally, full-text screenings were conducted. The Cochrane Risk of Bias 2 tool will be used to assess the risks of bias in the included studies. Data extraction will be conducted, included studies will undergo narrative synthesis, and results will be presented in tables. The systematic review will be submitted to a peer-reviewed journal. The authors conducted a database search for articles published by May 31, 2024. In total, 14 studies were included in the systematic review. Data charting, synthesis, and analysis were completed in Microsoft Excel by the end of July 2024. Results will be grouped based on the intervention stages. The results are expected to be published by the end of 2024. Overall, the systematic review found that computer-based self-help platforms are effective in reducing global ED psychopathology and ED-related behaviors. Self-help platforms are helpful first-stage resource in a tiered health care system. PROSPERO CRD42024520866; https://tinyurl.com/5ys2unsw. DERR1-10.2196/60165.

Comparison of first-line chemotherapy regimens in unresectable locally advanced or metastatic pancreatic cancer: a systematic review and Bayesian network meta-analysis

In advanced pancreatic ductal adenocarcinoma (PDAC), first-line chemotherapy is the standard of care. Due to the absence of head-to-head comparisons in clinical trials, we performed this systematic review and network meta-analysis to compare treatment options for PDAC in terms of their efficacy and toxicity. PubMed, the Cochrane Central Register of Controlled Trials, Embase, and oncological meetings websites were searched until Nov 15, 2023. We included phase 2-3 randomised controlled trials published after Jan 1, 2000, evaluating first-line treatments in patients with previously untreated, unresectable, locally advanced or metastatic PDAC. Primary endpoints assessed were progression-free survival and overall survival. Summary data were extracted from published reports. The deviance information criterion was used to choose between a random-effects or fixed-effects model. Hazard ratios (HRs) with 95% credible intervals were estimated using a Bayesian approach. The risk of bias was evaluated using the Cochrane Risk of Bias 2 (RoB 2) tool and studies were graded as low, some concerns, or high risk of bias. The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. This systematic review and network meta-analysis is registered with PROSPERO, CRD42023450330. 6050 records were screened and 79 randomised controlled trials (22 168 patients) were included in the analysis. Gemcitabine was the most frequent comparator (in 50 [63%] of 79 trials) and was considered as the reference treatment. A fixed-effect model was used to analyse the primary outcomes. Regarding progression-free survival (71 trials, 19 479 patients), the most effective treatments were gemcitabine plus nab-paclitaxel alternating folinic acid, fluorouracil, and oxaliplatin ([FOLFOX] HR 0·32, 95% credible interval 0·22-0·47), cisplatin, nab-paclitaxel, capecitabine, and gemcitabine ([PAXG] 0·35, 0·22-0·55), and liposomal irinotecan in combination with fluorouracil, leucovorin, and oxaliplatin ([NALIRIFOX] 0·43, 0·34-0·54), followed by fluorouracil, leucovorin, irinotecan, and oxaliplatin ([FOLFIRINOX] 0·55, 0·47-0·65) and gemcitabine plus nab-paclitaxel (0·62, 0·54-0·72). Similar results were observed for overall survival (79 trials, 22 104 patients): PAXG (HR 0·40, 95% credible interval 0·25-0·65), gemcitabine plus nab-paclitaxel alternating FOLFOX (0·46, 0·32-0·66), and NALIRIFOX (0·56, 0·45-0·70) had the highest benefit, followed by FOLFIRINOX (0·66, 0·56-0·78) and gemcitabine plus nab-paclitaxel (0·67, 0·59-0·77). The overall risk of bias was low to some concerns. Certainty of evidence was low. Our findings suggest that NALIRIFOX and FOLFIRINOX should be the preferred options for patients who can tolerate these regimens, with gemcitabine plus nab-paclitaxel remaining a viable alternative, particularly in patients unfit for triplet therapy. Phase 3 randomised controlled trials investigating concomitant or sequential quadruplets are warranted. None.

Electronic Health Interventions and Cervical Cancer Screening: Systematic Review and Meta-Analysis.

Cervical cancer is a significant cause of mortality in women. Although screening has reduced cervical cancer mortality, screening rates remain suboptimal. Electronic health interventions emerge as promising strategies to effectively tackle this issue. This systematic review and meta-analysis aimed to determine the effectiveness of electronic health interventions in cervical cancer screening. On December 29, 2023, we performed an extensive search for randomized controlled trials evaluating electronic health interventions to promote cervical cancer screening in adults. The search covered multiple databases, including MEDLINE, the Cochrane Central Registry of Controlled Trials, Embase, PsycINFO, PubMed, Scopus, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature. These studies examined the effectiveness of electronic health interventions on cervical cancer screening. Studies published between 2013 and 2022 were included. Two independent reviewers evaluated the titles, abstracts, and full-text publications, also assessing the risk of bias using the Cochrane Risk of Bias 2 tool. Subgroup analysis was conducted based on subjects, intervention type, and economic level. The Mantel-Haenszel method was used within a random-effects model to pool the relative risk of participation in cervical cancer screening. A screening of 713 records identified 14 articles (15 studies) with 23,102 participants, which were included in the final analysis. The intervention strategies used in these studies included short messaging services (4/14), multimode interventions (4/14), phone calls (2/14), web videos (3/14), and internet-based booking (1/14). The results indicated that electronic health interventions were more effective than control interventions for improving cervical cancer screening rates (relative risk [RR] 1.464, 95% CI 1.285-1.667; P<.001; I2=84%), cervical cancer screening (intention-to-treat) (RR 1.382, 95% CI 1.214-1.574; P<.001; I2=82%), and cervical cancer screening (per-protocol; RR 1.565, 95% CI 1.381-1.772; P<.001; I2=74%). Subgroup analysis revealed that phone calls (RR 1.82, 95% CI 1.40-2.38), multimode (RR 1.62, 95% CI 1.26-2.08), SMS (RR 1.41, 95% CI 1.14-1.73), and video- and internet-based booking (RR 1.25, 95% CI 1.03-1.51) interventions were superior to usual care. In addition, electronic health interventions did not show a statistically significant improvement in cervical cancer screening rates among women with HPV (RR 1.17, 95% CI 0.95-1.45). Electronic health interventions had a greater impact on improving cervical cancer screening rates among women in low- and middle-income areas (RR 1.51, 95% CI 1.27-1.79). There were no indications of small study effects or publication bias. Electronic health interventions are recommended in cervical cancer screening programs due to their potential to increase participation rates. However, significant heterogeneity remained in this meta-analysis. Researchers should conduct large-scale studies focusing on the cost-effectiveness of these interventions. CRD42024502884; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=502884.

Social Disadvantage and Disparities in Chronic Liver Disease: A Systematic Review

Introduction: Social determinants of health (SDOH) may impact chronic liver disease (CLD) outcomes but are not clearly understood. We conducted a systematic review to describe the associations of SDOH with mortality, hospitalizations, and readmissions among patients with CLD. Methods: This review was registered (PROSPERO ID: CRD42022346654) and identified articles through MEDLINE, Embase, Cochrane Library, and Scopus databases. The review included studies that reported SDOH characteristics within the domains of economic stability, health care access, education, social and community context, and the neighborhood built environment. Associated outcomes of interest were mortality, hospitalizations, or readmissions. The Cochrane Risk of Bias in Non-randomized Studies for Exposure (ROBINS-E) was used to assess study quality and risk of bias. Results: A total of 5,205 abstracts were screened, 60 articles underwent full-text review, and 27 articles were included in the final review. Poor economic stability, healthcare access, social support, and household/environmental conditions were associated with higher mortality and hospital readmissions among patients with CLD. Increasing distance (≥25 miles away) from a liver transplantation (LT) center was associated with higher mortality despite increasing access to the LT waitlist. When assessing the overall risk of bias among included studies, most had “Some Concern” (N=13, 48.1%) or “High Risk” (N=11, 40.7%) while a minority had “Very High Risk” (N=3, 11.1%). No studies were categorized as “Low Risk.” Conclusions: Unfavorable SDOH were associated with increased mortality and hospital readmissions among patients with CLD. Rigorous empirical research is needed to identify evidence-based strategies that aim to mitigate disparities among vulnerable populations.

Efficacy of beta blockers in patients with thoracic aortic aneurysm: meta-analysis of randomized controlled trials

Abstract Studies investigating the efficacy of β-blocker agents on patients with thoracic aortic aneurysm have produced heterogeneous and conflicting results. This study was aimed to assess protective effects of β-blockers in terms of aortic events (dissection, rupture) and mortality in patients with thoracic aortic aneurysm. A systematic literature search was performed through Ovid MEDLINE, EMBASE, Web of Science, Pubmed and The Cochrane Central Register of Controlled Trials (Cochrane CENTRAL), all from inception to May 10, 2022. Randomized controlled trials exploring the efficacy of β-blocker agents in patients with thoracic aortic aneurysm were considered for inclusion with no population restriction. Two independent reviewers performed the literature search. Two reviewers independently extracted all available prespecified relevant data in accordance with the International Prospective Register of Systematic Reviews protocol. Summary effect measures of the primary outcomes were obtained by pooling the data with an inverse variance–weighted random-effects model. The overall risk of bias assessment was conducted by using the Cochrane Risk of Bias 2 tool A sensitivity analysis was performed regarding whether the conclusions reached might differ substantially if a single study was omitted. The primary outcome was aortic events (aortic dissection/rupture). Secondary outcomes were death (all-cause mortality) and aortic dissection. Two independent reviewers identified 4 RCTs presented in 5 reports from 1494 unique studies screened. Three trials involving 129 eligible participants compared β blockers (propranolol and celiprolol) with no treatment. One trial involving 32 eligible participants compared β blocker (atenolol) with placebo. This systematic review and meta-analysis included 161 patients with thoracic aortic aneurysm (mean age, 27.6 years; 80 [49.7%] male, mean follow-up 6.7 years). The pooled risk ratio in the β-blocker arm for aortic events was 0.74 [95% CI (0.20; 2.71), I2: 0%, p=0.64] when comparing to the placebo or no treatment in patients with thoracic aortic aneurysm. The pooled risk ratio for death (all-cause mortality) and aortic dissection in the β-blocker arm were 0.45 [95% CI (0.10; 1.98), I2: 0%, p=0.29] and 0.58 [95% CI (0.15; 2.24), I2: 0%, p=0.43], respectively. The risk of aortic dissection, rupture, or death were essentially identical, regardless of treatment group and subgroup analysis. A sensitivity analysis revealed that none of the studies significantly influenced the pooled risk estimate to any great extent. We found no evidence of benefit from β-blocker treatment. More robust data regarding β-blocker use in patients with thoracic aortic aneurysms from randomized controlled trials are needed to establish evidence based recommendations and to determine whether current evidence comes from absense of evidence or evidence of absense.Forest plot for death (all-cause)

Effectiveness of spiritual care interventions among patients in the intensive care unit: A systematic review and meta-analysis.

Spiritual care interventions can be an important source of emotional support for patients in the intensive care unit (ICU). However, there is wide variation in the literature and no quantitative assessment to synthesize the results of these studies. To examine the effectiveness of spiritual care interventions on disease-related physiological parameter and treatment outcomes and psychosocial well-being outcomes among patients in the ICU. A comprehensive search was conducted across 11 databases from inception to 27 May 2024. Studies involving the implementation of spiritual care interventions for patients in the ICU were included. Cochrane's bias risk tool and JBI Critical Appraisal Checklist were used to examine the methodological quality of included studies. Review Manager 5.3 was used to conduct meta-analyses. A total of 18 studies were included. Meta-analysis showed that spiritual care interventions could significantly reduce mean arterial pressure (MAP) (MD: -12.12, 95% CI: [-23.68, -0.56], p = .04), length of stay in the ICU (MD: -5.49, 95% CI: [-8.99, -2.00], p = .002), and improved consciousness (MD: 3.91, 95% CI: [1.42, 6.39], p = .002), anxiety (SMD: -1.78, 95% CI: [-3.06, -0.50], p = .006), spiritual well-being (SMD: 1.57, 95% CI: [0.05, 3.08], p = .04) and comfort (MD: 15.53, 95% CI: [10.81, 20.25], p < .01) among patients in the ICU, but had no significant effects on heart rate (HR), respiratory rate (RR), pulse rate (PR), blood pressure (BP), oxygen saturation (SpO2), duration of ventilator use and pain. Spiritual care interventions could reduce MAP and length of stay in the ICU; improve consciousness, anxiety, spiritual well-being and comfort among patients in the ICU; and are still inconclusive for HR, RR, PR, BP, SpO2, duration of ventilator use and pain. Urgent efforts are needed to better integrate spiritual care interventions into clinical care to enhance patient well-being. Spiritual care interventions could improve well-being of patients in the ICU.

Behavior Change Techniques Used in Self-Management Interventions Based on mHealth Apps for Adults With Hypertension: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Hypertension has become an important global public health challenge. Mobile health (mHealth) intervention is a viable strategy to improve outcomes for patients with hypertension. However, evidence on the effect of mHealth app interventions on self-management in patients with hypertension is yet to be updated, and the active ingredients promoting behavior change in interventions remain unclear. We aimed to evaluate the effect of mHealth app self-management interventions on blood pressure (BP) management and investigate the use of behavior change techniques (BCTs) in mHealth app interventions. We conducted a literature search in 6 electronic databases from January 2009 to October 2023 for studies reporting the application of mHealth apps in self-management interventions. The Cochrane Risk of Bias (version 2) tool for randomized controlled trials was used to assess the quality of the studies. BCTs were coded according to the Taxonomy of BCTs (version 1). The extracted data were analyzed using RevMan5.4 software (Cochrane Collaboration). We reviewed 20 studies, of which 16 were included in the meta-analysis. In total, 21 different BCTs (mean 8.7, SD 3.8 BCTs) from 12 BCT categories were reported in mHealth app interventions. The most common BCTs were self-monitoring of outcomes of behavior, feedback on outcomes of behavior, instruction on how to perform the behavior, and pharmacological support. The mHealth app interventions resulted in a -5.78 mm Hg (95% CI -7.97 mm Hg to -3.59 mm Hg; P<.001) reduction in systolic BP and a -3.28 mm Hg (95% CI -4.39 mm Hg to -2.17 mm Hg; P<.001) reduction in diastolic BP. The effect of interventions on BP reduction was associated with risk factors, such as hypertension, that were addressed by the mHealth app intervention (multiple risk factors vs a single risk factor: -6.50 mm Hg, 95% CI -9.00 mm Hg to -3.99 mm Hg vs -1.54 mm Hg, 95% CI -4.15 mm Hg to 1.06 mm Hg; P=.007); the presence of a theoretical foundation (with vs without behavior change theory: -10.06 mm Hg, 95% CI -16.42 mm Hg to -3.70 mm Hg vs -4.13 mm Hg, 95% CI -5.50 to -2.75 mm Hg; P=.07); intervention duration (3 vs ≥6 months: -8.87 mm Hg, 95% CI -10.90 mm Hg to -6.83 mm Hg vs -5.76 mm Hg, 95% CI -8.74 mm Hg to -2.77 mm Hg; P=.09); and the number of BCTs (≥11 vs <11 BCTs: -9.68 mm Hg, 95% CI -13.49 mm Hg to -5.87 mm Hg vs -2.88 mm Hg, 95% CI -3.90 mm Hg to -1.86 mm Hg; P<.001). The self-management interventions based on mHealth apps were effective strategies for lowering BP in patients with hypertension. The effect of interventions was influenced by factors related to the study's intervention design and BCT.

Efficacy of Yoga in Reducing Depressive Symptoms: A Systematic Review

Introduction: The fast pace of changes in contemporary life increases the need to adapt, which leads to depressive pathologies due to psychological suffering. Yoga has therefore emerged as a complementary approach to the treatment of depression. Objective: To analyze the efficacy of yoga in reducing depressive symptoms. Materials and methods: This is a systematic literature review, which followed the Joanna Briggs Institute methodology for systematic reviews of efficacy, with the review protocol registered on Prospero under the code CRD42023448158. To devise the research question, the Pico strategy was adopted, in which “P” stands for people with depression, “I” for yoga; “C” for people who have not been submitted to yoga, and “O” for improvement/reduction of depressive symptoms. The requirements of the Prisma flowchart were followed and the search was conducted in the Medline/PubMed, Web of Science, Lilacs, BDEnf, Ibecs, PsycINFO, and Cinahl databases. The Jadad scale was used to assess methodological quality and the Cochrane Risk of Bias 2 to assess the risk of bias. Results: A total of 1138 studies were found, of which 10 were selected for data extraction, detailed reading, and qualitative synthesis. Yoga, especially mindfulness yoga, has been shown to be an effective intervention for various conditions, including depression. Its benefits include significant improvements in depression severity, health-related quality of life, motor dysfunction, mobility, spiritual well-being, and parasympathetic nervous system activity. Conclusion: The studies highlight the efficacy of yoga in reducing depressive symptoms in various populations and contexts, highlighting its effectiveness as a complementary therapeutic approach in the management of depression.

The impact of 3 different dietary interventions on overweight or obese adults: A network meta-analysis.

This network meta-analysis aims to investigate and compare the effectiveness of 3 dietary interventions - Mediterranean, ketogenic, and low-fat diet - on overweight and obese adults, with a comparison to traditional low-calorie diet. A systematic review was conducted in both Chinese and English databases, including the China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database (VIP), SinoMed, PubMed, Web of Science, Cochrane Library and Embase to identify relevant randomized controlled trials (RCTs) up to January 31, 2024. Two researchers independently screened and extracted data from the identified literature. The quality of these studies was assessed using the Cochrane bias risk assessment tool. A random-effects network meta-analysis was performed using Review Manager 5.4.1 and Stata 16.0 software. A total of 17 randomized controlled trials involving 5802 subjects were included in this study. The network meta-analysis revealed a descending order of effectiveness for reducing body weight (BW), body mass index (BMI), and waist circumference (WC): ketogenic diet > low-fat diet > low-calorie diet > Mediterranean diet. The ketogenic diet was identified as the most effective intervention for reducing BW, BMI, and WC in the studied dietary comparisons. It consistently showed superior outcomes, ranking highest in effectiveness among the 4 evaluated dietary approaches. Nevertheless, additional high-quality randomized controlled trials are necessary to validate these findings.