In this perspective paper, I re-examine the evidence base behind the common advice that older adults should " drink plenty of water before feeling thirsty " especially during heat exposure and exercise. I first discuss the seminal mechanistic studies that have shaped current thinking, with particular attention to their dominant experimental paradigms. I then contrast this foundation with more recent studies quantifying ad libitum drinking during prolonged heat exposure or exercise in older vs. younger adults. Finally, I outline key research priorities needed to refine hydration guidance for aging populations. Overall, the aim is to prompt a more critical appraisal of long-standing assumptions and to highlight that our knowledge in this area remains surprisingly limited.

Evidence-based research (EBR) has become a cornerstone in the scientific, medical, and social sciences disciplines, informing decision-making processes and advancing knowledge across various fields. Evidence-based practice emphasizes integration of EBR, clinical expertise, and patient preferences to guide clinical practice. However, the mere existence of research evidence is not enough; it is essential to critically appraise the evidence to ensure its reliability, validity, and relevance to the context in which it is applied. Critical appraisal involves systematically evaluating the design, methodology, results, and conclusions of a research study to assess its quality and applicability. This article will provide an in-depth insight about reporting and critical appraisal of EBR, examining the principles of critical appraisal, available tools for reporting and appraising a research paper, challenges faced in critical appraisal, and how to make the most of the journal club.

Critical appraisal is a core component of JBI qualitative evidence synthesis, offering insights into the quality of included studies and their potential influence on synthesized findings. However, limited guidance exists on whether, when, and how to exclude studies based on appraisal results. This study examined the methods used in JBI qualitative systematic reviews and the implications for synthesized findings. In this study, a systematic analysis of qualitative reviews published between 2018 and 2022 in JBI Evidence Synthesis was conducted. Data on decisions and their justifications were extracted from reviews and protocols. Descriptive and content analysis explored variations in the reported methods. Forty-five reviews were included. Approaches reported varied widely: 24% of reviews included all studies regardless of quality, while others applied exclusion criteria (36%), cutoff scores (11%), or multiple methods (9%). Limited justifications were provided for the approaches. Few reviews cited methodological references to support their decisions. Review authors reported their approach in various sections of the review, with inconsistencies identified in 18% of the sample. In addition, unclear or ambiguous descriptions were also identified in 18% of the included reviews. No clear differences were observed in ConQual scores between reviews that excluded studies and those that did not. Overall, the variability raises concerns about the credibility, transparency, and reproducibility of JBI qualitative systematic reviews. Decisions regarding the inclusion or exclusion of studies based on critical appraisal need to be clearly justified and consistently reported. Further methodological research is needed to support rigorous decision-making and to improve the reliability of synthesized findings.

Tendinopathies are prevalent in athletic populations, particularly in sports requiring repetitive high-load activities. Eccentric training is widely recommended for rehabilitation, yet variability in protocols and inconsistent methodological reporting limit standardization. This scoping review aimed to map existing evidence on eccentric training for tendinopathies in athletes, characterize intervention parameters, evaluate clinical outcomes and safety, and identify methodological gaps to inform future practice and research. Searches of PubMed, Scopus, and Web of Science were conducted. Eligible studies included athletes with tendinopathy undergoing eccentric training interventions. Randomized and non-randomized controlled trials were considered. Data extraction included intervention design, tendon site, loading parameters, outcomes, and adverse events. Critical appraisal was performed using RoB 2 and ROBINS-I tools. Thirty-one studies were included. Most examined patellar tendinopathy in volleyball and basketball players or Achilles tendinopathy in runners and soccer athletes. Protocols varied substantially in load, frequency, and progression strategies. Pain monitoring was integral, often allowing exercise into moderate discomfort. Eccentric training consistently improved pain and function, with heavy slow resistance and adjunct modalities showing comparable or additive effects. Return-to-sport rates were high, and adverse events were minimal. However, performance outcomes, tendon structure, and safety reporting were inconsistently assessed. Eccentric training consistently reduces pain and improves function in athletes with tendinopathy. Evidence is less consistent regarding performance outcomes, tendon remodeling, and comparative superiority over alternative interventions. Standardized reporting of protocols, safety, and sport-specific adaptations is needed to strengthen recommendations for athletic rehabilitation.

Designs of the clinical trials aiming at evaluating cell and gene therapy products: A critical appraisal from a literature review

Introduction: Temporary Anchorage Devices (TADs) enable distalisation of the mandibular dentition in patients with mild to moderate Class III jaw bases. The extent of distalisation is influenced by the Mandibular Posterior Anatomical Limit (MPAL), which varies with growth patterns. Aim: To evaluate and compare the MPAL across different growth patterns in skeletal Class III patients. Materials and Methods: The present systematic review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD42024616501). A comprehensive search of PubMed, Web of Science, Embase, Scopus, Cochrane Library, Google Scholar, and OpenGrey was conducted from inception up to December 2024. Following the PICOS framework: (P) adult patients with skeletal Class III malocclusion and varying vertical growth patterns; (I) no intervention, grouping by growth pattern; (C) comparisons between normodivergent, hypodivergent, and hyperdivergent patterns; (O) MPAL measured on Cone Beam Computed Tomography (CBCT); (S) observational cross-sectional studies. Extracted data was used to study measurements of MPAL in different growth patterns included reference planes, reference point and reference levels; additional parameters were third molar status, sex distribution, and racial background. Risk of bias was assessed using the Critical Appraisal Checklist of the Joanna Briggs Institute (JBI). Results: Out of 5117 studies 11 studies on class III malocclusion with varying growth patterns, used the mandibular occlusal plane as the reference. Nine studies used the Posterior Occlusal Plane (POL) as the reference line and the most lingual point of the second molar’s distal root as the reference point; five measured at the subfurcation level and six at the sub-CEJ level. Conclusion: In class III malocclusion, the MPAL distance decreases from the furcation to the apex, making apical distance critical during distalisation. The racial group of the subjects, third molar status, vertical pattern and skeletal sagittal pattern all had an impact on MPAL. Of the three development patterns, patients with hyperdivergent growth patterns have the smallest MPAL and the highest risk of cortical contact in molar distalisation, whereas those with hypodivergent growth patterns have the lowest risk.

Letter to the Editor: A Critical Appraisal of CMR Evidence on Thrombus Aspiration in STEMI

What is the psychological impact on parents of learning about SUDEP? A mixed methods systematic review.

Reported mouth self-examination methods for oral cancer screening: a systematic review.

Methods used to identify and classify medication-related admissions and readmissions to hospitals: A systematic review.

Fostering critical thinking competence in nurses: A systematic review.

Myristica fragrans: A comprehensive review of its botanical characterization, traditional uses, phytochemistry, and pharmacological properties.

This study aimed to synthesize qualitative evidence on the lived experiences of cancer-related fatigue (CRF) in patients with head and neck cancer to inform targeted nursing interventions. Four Chinese and six English databases were systematically searched from inception to March 2025 for qualitative studies exploring CRF experiences. The quality of included studies was assessed using the JBI Critical Appraisal Checklist, and findings were synthesized using the JBI meta-aggregation methodology. Eight studies were included, generating 54 findings which were aggregated into six categories and three synthesized themes: essential characteristics and dynamic evolution; multidimensional influence and vicious circle; and management dilemmas and long-term challenges. The review highlights that CRF is a dynamic, individualized experience significantly impacting quality of life, yet current management strategies remain often insufficient. Consequently, multidisciplinary nursing interventions prioritizing comprehensive assessment, self-management support, and psychological care are essential to optimize patients' long-term adaptation and well-being.

Brazilian Academy of Paediatric Otorhinolaryngology Task Force - lingual frenulum disorders in childhood - evidence-based recommendations.

Interventions to improve cancer screening adherence in migrants and ethnic minorities in the European Region: A systematic review.

Ethical challenges around mandatory vaccination among nurses: A systematic review of qualitative and quantitative evidence.

Introduction: Traumatic haemorrhage is a major cause of preventable death, and blood transfusion is a crucial component of damage control resuscitation. Several diagnostic strategies exist to anticipate hypovolaemic shock and subsequent blood transfusion requirements, but their pre-hospital utility is inconsistent. Capnography or end-tidal carbon dioxide (EtCO 2 ) measurement has received growing recognition for prognostic capability in metabolic, respiratory and cardiac disease. This systematic review examines EtCO 2 efficacy in predicting hypovolaemic shock and subsequent blood transfusion in pre-hospital adult trauma patients.The aims and objectives of this study were, first, to determine if early EtCO 2 measurement in pre-hospital adult trauma patients can reliably predict hypovolaemic shock and/or blood transfusion when compared to existing strategies and scoring tools and, second, to identify if an EtCO 2 predictive threshold can facilitate this. Methods: A systematic review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was conducted. Seven electronic databases were searched using relevant indexed terms and keywords. Inclusion criteria were adult (>13 years) trauma patients with suspected or confirmed haemorrhage and with early (pre-diagnostic) EtCO 2 data from mainstream or side-stream devices, as related in peer-reviewed publications. All articles (n = 1932) were double-blind screened at abstract and title, then at full-text stage by two reviewers. Issues were discussed by the authors. Critical Appraisal Skills Programme (CASP) tools were used. Findings were narratively synthesised. Results: Thirteen articles were included. Significant heterogeneity, quality limitations and inconsistent reporting hindered direct comparison of results. Nevertheless, 10 comparator strategies/tools were identified and most studies demonstrated EtCO 2 ’s efficacy in predicting hypovolaemic shock / blood transfusion, with thresholds below 35 mmHg consistently suggested as predictive. Conclusion: A universal definition for major blood transfusion is still lacking. Further research is needed to identify accurate markers of haemorrhage, including EtCO 2 as a potential predictor. A high index of suspicion for haemorrhage and need for blood transfusion is recommended for adult trauma patients with EtCO 2 levels below 35 mmHg (4.7 kPa).

The Use of Diagnostic Ultrasound for the Assessment of Rotator Cuff Tendinopathy: A Systematic Review.

Immune checkpoint inhibitors (ICIs) have been widely implemented in current oncology practice. However, there is limited data regarding ICI administration in pregnancy. This systematic review aims to evaluate the risk-benefit of ICI exposure in pregnant women. We conducted searches in databases including PubMed, Scopus, Web of Science, and Embase from January 1, 2011 through April 30, 2025. Included studies were those that involved women with a cancer diagnosis who received ICI treatment while pregnant and had clinical findings of the fetus post-ICI treatment. Methodological quality and potential sources of bias were assessed using Joanna Briggs Institute Critical Appraisal Tools. The search generated 2539 citations. After removal of 696 duplicates, a total of 1843 citations were screened. Twenty case reports and three retrospective studies were included in the systematic review. Fetal complications and fetal immune-related adverse events among the case reports were at 23% and 11.5%, respectively. Preterm delivery occurred in 54% of case reports, and no fetal mortalities were reported. Regarding the observational studies, preterm delivery occurred in 20.9%-25.5% of cases, fetal mortality occurred in 2.2%-15.3% of cases, intrauterine growth restriction occurred in 6.5%-7.1% of cases, and complications attributable to prematurity were reported in 2.6%-5.5% of cases. The data from this systematic review suggests that the risk for fetal complications may be lower than previously reported. As ICIs continue to expand their role in the treatment of malignancy, their use in pregnancy is more likely to come into clinical question. Clinicians should approach ICI use in pregnancy with individualized, multi-disciplinary risk-benefit discussions.

Global and regional knowledge of antibiotic use and resistance among the general public: a systematic review and meta-analysis.