Evidence Synthesis Research Articles

Huntington's disease (HD) has prevalent, life-altering consequences for affected individuals, relatives, familial caregivers and systemic functioning. However, the shared psychosocial impacts of HD across family systems are inadequately understood, and a synthesis of evidence regarding these experiences is currently lacking. This thematic synthesis provides an up-to-date integration of qualitative research describing psychological, social and relational difficulties experienced by HD families. A systematic search across PsycINFO, CINAHL, MEDLINE and Scopus identified nine qualitative studies. Four interconnected superordinate themes were developed, describing a disintegration of HD families from society, HD-related emotional and psychological burdens, an interplay of extrinsic stressors and recalibration of the family system. These findings extend existing knowledge about systemic impacts of HD, highlighting diverse and pervasive psychological and social difficulties faced by families. The synthesis recommends the development of interventions and clinical understandings to appropriately support family systems around psychosocial and relationship dynamic challenges in the unique context of HD.

Data extraction is a critical but error-prone and labor-intensive task in evidence synthesis. Unlike other artificial intelligence (AI) technologies, large language models (LLMs) do not require labeled training data for data extraction. To compare an AI-assisted versus a traditional, human-only data extraction process. Study within reviews (SWAR) using a prospective, parallel-group comparison with blinded data adjudicators. Workflow validation within 6 ongoing systematic reviews of interventions under real-world conditions. Initial data extraction using an LLM (Claude, versions 2.1, 3.0 Opus, and 3.5 Sonnet) verified by a human reviewer. Concordance, time on task, accuracy, sensitivity, positive predictive value, and error analysis. The 6 systematic reviews in the SWAR yielded 9341 data elements from 63 studies. Concordance between the 2 methods was 77.2% (95% CI, 76.3% to 78.0%). Compared with the reference standard, the AI-assisted approach had an accuracy of 91.0% (CI, 90.4% to 91.6%) and the human-only approach an accuracy of 89.0% (CI, 88.3% to 89.6%). Sensitivities were 89.4% (CI, 88.6% to 90.1%) and 86.5% (CI, 85.7% to 87.3%), respectively, with positive predictive values of 99.2% (CI, 99.0% to 99.4%) and 98.9% (CI, 98.6% to 99.1%). Incorrect data were extracted in 9.0% (CI, 8.4% to 9.6%) of AI-assisted cases and 11.0% (CI, 10.4% to 11.7%) of human-only cases, with corresponding proportions of major errors of 2.5% (CI, 2.2% to 2.8%) versus 2.7% (CI, 2.4% to 3.1%). Missed data items were the most frequent error type in both approaches. The AI-assisted method reduced data extraction time by a median of 41 minutes per study. Assessing concordance and classifying errors required subjective judgment. Consistently tracking time on task was challenging. Data extraction assisted by AI may offer a viable, more efficient alternative to human-only methods. Agency for Healthcare Research and Quality and RTI International.

Introduction: Autism is characterised by lifelong differences in communication, behaviour, and social interaction [1]. Despite growing recognition of autistic individuals in healthcare professions [2], little is known about supporting autistic learners in simulation-based healthcare education (SBHE). This scoping review aimed to identify existing research on autistic learners in SBHE, map the current evidence base, and identify gaps to inform future research and educational practice. Methods: We conducted a formal scoping review following PRISMA-ScR guidelines in May 2024 [3]. A comprehensive search strategy was developed with assistance from a research librarian, and the protocol was prospectively registered with the Open Science Framework on 12 April 2024. Eligibility criteria included studies involving autistic learners in simulation-based healthcare education contexts. We searched multiple databases between 1 January 2000 and 15 May 2024, identifying 1457 potentially relevant articles. Results: Despite a thorough search, no studies met our inclusion criteria, revealing a significant gap in the literature regarding autistic learners in SBHE. Through synthesis of related evidence from autism in higher education and healthcare settings, we identified potential challenges autistic learners may face in SBHE: sensory over-responsivity [1], difficulties with interpersonal communication underpinned by the ‘double empathy problem’ [3], imagination differences affecting suspension of disbelief, and distinct information processing patterns including weak central coherence. Discussion: We suggest adapting the Autistic SPACE framework [2] - originally developed for supporting autistic patients - to address the needs of autistic learners in SBHE. This approach emphasises considerations for Sensory needs, Predictability, Acceptance, Communication, and Empathy, providing structured recommendations for creating more inclusive simulation environments. Further research directly examining the experiences of autistic learners in SBHE is urgently needed to develop evidence-based support strategies. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

Background: Menstrual Hygiene Management (MHM) is a significant public health issue that intersects with education, gender equality, and human rights. In many low- and middle-income countries, socio-cultural norms and a lack of resources create substantial barriers for adolescents. Objective: This review synthesizes recent evidence on the socio-cultural and educational impacts of inadequate MHM, with a specific focus on findings from Nepal, to provide context-specific and actionable recommendations. Methods: A systematic literature review was conducted using Google Scholar, Semantic Scholar, and PubMed. The search included key terms such as "menstrual hygiene management Nepal," "cultural taboos menstruation," "school absenteeism," and "menstrual knowledge." Priority was given to peer-reviewed articles published between 2018 and 2024. Results: The synthesis reveals that profound cultural stigmas and restrictions during menstruation are pervasive, leading to fear, shame, and isolation among girls. Knowledge about menstruation is often inadequate before menarche, sourced primarily from friends and mothers with limited understanding. These factors, combined with poor school WASH facilities, directly contribute to high rates of school absenteeism, with girls reporting concentration difficulties and a decline in academic performance during their periods. Conclusion: Inadequate MHM severely constrains the educational opportunities and psychosocial well-being of adolescent girls. Effective interventions must be multi-pronged, addressing deep-seated cultural taboos through comprehensive education, improving water, sanitation, and hygiene (WASH) infrastructure in schools, and ensuring access to affordable menstrual products.

Pancreatic pseudocysts (PPs) and walled-off necrosis (WON) are two distinct sequelae of acute and chronic pancreatitis, requiring accurate differentiation to guide appropriate management. Computed tomography (CT) and magnetic resonance imaging (MRI) remain essential for distinguishing PPs from WON, assessing their content, and identifying potential complications. Endoscopic ultrasound (EUS) has emerged as a key modality for both diagnosis and drainage planning, offering high-resolution imaging and the possibility of real-time aspiration. Management strategies have evolved significantly, shifting from surgical to minimally invasive approaches. Endoscopic drainage, including EUS-guided transmural drainage with double-pigtail or lumen-apposing metal stents (LAMS), has become the preferred strategy for symptomatic or infected collections. Endoscopic necrosectomy is increasingly performed for WON, providing a less invasive alternative to surgical debridement. However, patient selection and procedural techniques remain topics of ongoing debate. The aim of this review is to provide a comprehensive synthesis of current evidence regarding the diagnosis and management of pancreatic pseudocyst and walled-off necrosis. We will synthesize current evidence on diagnostic criteria, imaging modalities, and therapeutic algorithms for PPs and WON. We will discuss technical aspects, success rates, and complications associated with drainage modalities, comparing endoscopic, percutaneous, and surgical approaches. Special attention will be given to recent advancements in interventional endoscopy and their impact on patient outcomes. By integrating clinical insights with the latest literature, this review aims to provide an up-to-date reference for clinicians managing pancreatic fluid collections. A literature search was performed using PubMed, Scopus, Web of Science, and MEDLINE databases to identify relevant studies on diagnostic criteria, imaging techniques, and management strategies.

The article presents a review of contemporary bioquantum methods proposed for the treatment of multiple sclerosis, with focused attention on laser therapy, plasma therapy, and proton–plasma therapy. The analysis examines the physical and biological mechanisms of action for each modality, including modulation of neuroinflammation, reduction of oxidative stress, stabilization of mitochondrial function, regulation of microglial and astrocytic activity, and potential restoration of blood–brain barrier integrity. Advantages and limitations are evaluated with respect to technical feasibility, accuracy of energy delivery, biological specificity, safety profile, and scalability for routine clinical practice. The review compares clinical and paraclinical outcomes, including relapse dynamics, lesion burden and tissue integrity measured by magnetic resonance imaging, levels of neurofilament light chain as a marker of neuroaxonal injury, validated fatigue and disability scales, and patient-reported quality-of-life indices. Attention is paid to candidate selection across relapsing–remitting and progressive phenotypes, parameterization of treatment protocols, and interactions with established disease-modifying therapies. Ethical and regulatory considerations are examined, including device classification, adherence to Good Clinical Practice, independent oversight, transparent adverse event reporting, and strategies to minimize publication bias. Health-economic aspects, workforce competencies, and pathways for technology adoption are addressed. The synthesis of current evidence supports cautious optimism: bioquantum interventions may offer adjunctive neuroprotective and immunomodulatory effects; however, the existing literature remains insufficient for firm conclusions. The field requires rigorously designed, adequately powered, multicenter, sham-controlled trials with standardized protocols, pre-registered analyses, validated outcome measures, and long-term follow-up to determine effectiveness, safety, durability of benefit, and generalizability to real-world clinical settings.

The aim of this systematic literature review (SLR) of reviews was to update the evidence, established in a 2017 SLR, on the impact of obesity and weight loss by various interventions on health-related quality of life (HRQoL). In total, eight SLRs and/or meta-analyses published since 2017 were identified. The results consistently demonstrated a negative association between obesity and HRQoL, with some evidence suggesting poorer HRQoL in people with adverse metabolic profiles. In addition to substantial weight or body mass index reduction, metabolic and bariatric surgery (MBS) or endoscopic bariatric therapies resulted in significant and clinically relevant HRQoL improvements, with pronounced and persistent effects on the physical components in particular. HRQoL typically improved within 1-2 years after MBS and stabilised or deteriorated while remaining above baseline in subsequent years, likely due to weight regain. Evidence for the benefits of exercise interventions on HRQoL was inconclusive. Notably, no SLRs on anti-obesity medications were identified, limiting conclusions on this emerging treatment area. This updated SLR expands on previous findings from the 2017 SLR, providing additional insights into underexplored areas, including the role of metabolic profiles in HRQoL and trends of HRQoL after MBS. Evidence synthesis remains challenging due to heterogeneity in HRQoL measurements used in this field.

Rett syndrome (RTT) presents with a wide range of symptoms spanning various clinical areas. Capturing symptom change as the disorder progresses is challenging. Wearable sensors offer a non-invasive and objective means of monitoring disease states in neurodevelopmental disorders. The goal of this study was to conduct a systematic literature review to critically appraise the literature on the use of wearable sensors in individuals with RTT. The PRISMA criteria were used to search four databases without time restriction and identified 226 records. After removing duplicates, the titles and abstracts of 184 records were screened, 147 were excluded, and 37 were assessed for eligibility. Ten (10) articles remained, and a further two were included after additional searching. In total, 12 articles were included in the final analysis. The sample size ranged from 7 to 47 subjects with an age range of 1 to 41 years. Different wearable biosensor devices were used across studies, with the Empatica E4 wearable device being most frequently used in 33% (4/12) of the studies. All the studies demonstrated a high methodological quality with a low risk of bias. Evidence from wearable sensors, combined with machine learning methods, enabled the prediction of different sleep patterns and clinical severity in RTT. Given the small sample size and the limitations of available data for training machine learning models, we highlight areas for consideration. The review emphasises the need to enhance research on the application of wearable sensors in epilepsy and gastrointestinal manifestations/morbidity in RTT. Increased electrodermal activity (EDA), % of maximum heart rate (HRmax%) and the heart rate to low-frequency power (HR/LF) ratio were identified as physiological measures potentially associated with disease states. Based on the evidence synthesis, the role of physiological parameters and their association with symptom management in RTT is discussed.

Antithrombotic therapy plays a pivotal role in reducing thromboembolic complications, including stroke and valve thrombosis, following Transcatheter Aortic Valve Implantation (TAVI). However, the benefits of such therapy must be balanced against the increased risk of major bleeding events. The optimal antithrombotic strategy in this setting remains a matter of ongoing debate, given the heterogeneity of patient profiles and procedural variables. Among TAVI recipients, women represent a growing proportion and exhibit distinct anatomical, physiological, and clinical characteristics that influence both thrombotic and bleeding risk. Compared to men, women more frequently experience vascular complications and major bleeding events, despite better survival outcomes. These differences are driven by smaller vessel caliber, higher vascular tortuosity, and altered platelet reactivity. Consequently, sex-specific risk stratification is essential when considering antiplatelet or anticoagulant regimens post-TAVI. This review provides a comprehensive synthesis of current evidence regarding antithrombotic strategies in the post-TAVI setting, with a dedicated focus on sex-related differences. Particular emphasis is placed on the female population, assessing ischemic and hemorrhagic outcomes and the implications for long-term management. Improving outcomes in women undergoing TAVI necessitates tailored antithrombotic strategies that balance efficacy and safety. Ongoing research and dedicated trials are essential to refine these strategies and to inform future guideline updates in this expanding patient population.

Sarcopenia in total joint Arthroplasty: Risk factor for poor postoperative outcomes and higher costs of care.

Enhancing AI for citation screening in literature reviews: Improving accuracy with ensemble models.

Refugee integration in national health systems of low- and middle-income countries (LMICs): evidence synthesis and future research agenda.

Alphavirus chikungunya (CHIKV) is an arthropod-borne alphavirus of the Togaviridae family, transmitted primarily by Aedes aegypti and Ae. albopictus mosquitoes. CHIKV infection often results in debilitating manifestations that compromise quality of life and generate significant socioeconomic impacts. Recurrent epidemics in tropical and subtropical regions underscore the urgent need to better understand the host immune responses and their contribution to disease outcome. CHIKV establishes infection by overcoming the host’s initial immunological barriers. Innate immune cells, including fibroblasts, dendritic cells, macrophages, monocytes, neutrophils and natural killer (NK) cells, are among the first to respond to infection, ensuring a rapid antiviral defense and supporting the development of adaptive immune responses. However, excessive release of inflammatory mediators and prolonged infiltration of innate cells into joint tissues contribute to disease chronicity and the persistence of arthralgia. In this review, we provide a comprehensive synthesis of current evidence on innate cells that serve as targets for CHIKV infection, highlighting mechanisms that promote effective antiviral defense as well as those responsible for pathological inflammation and chronic disease and identifying key gaps that remain to be addressed.

Bleeding patients face significant morbidity and mortality due to impaired hemostasis. Hemostatic resuscitation has evolved, yet the optimal approach remains unclear. The primary objective was to assess the benefits and risks of transfusion guided by TEG/ROTEM versus standard of care in bleeding patients in an updated review. This systematic review of randomized controlled trials with meta-analyses and trial sequential analysis was conducted according to Cochrane Collaboration methodology, PRISMA, and GRADE guidelines. A literature search was conducted in five major databases. Both pediatric and adult patients were included. The primary outcome was mortality, and secondary outcomes were the administration of blood products, blood loss, surgical reintervention, and dialysis-dependent renal injury. This systematic review included 35 randomized trials (n = 3096), primarily elective cardiac surgery. TEG-/ROTEM-guided algorithms led to a statistically significant reduction in mortality (RR = 0.76, 95% CI 0.63-0.92) I2: 0%. Furthermore, a significant reduction in transfused fresh frozen plasma (RR = 0.52, 95% CI 0.35-0.76) I2: 94%, platelets (RR = 0.69, 95% CI 0.55-0.87) I2: 60%, the risk for surgical reintervention (RR = 0.63, 95% CI 0.45-0.88) I2: 0%, and bleeding with a standard mean difference of -0.31 (95% CI, -0.51 to -0.11) I2: 72% was found. According to GRADE methodology, the certainty of the evidence was very low for all outcomes. Trial sequential analysis of mortality analysis indicated that 64% of the optimal information size was reached with a crossed alpha-boundary. TEG-/ROTEM-guided transfusion algorithms may reduce the risk of mortality, bleeding volume, and the need for fresh frozen plasma, platelets, and surgical reintervention, but the evidence is very uncertain. Furthermore, the results were primarily based on the adult population undergoing elective cardiac surgery. This updated systematic review presents a synthesis of evidence for how thromboelastography or rotational thromboelastometry has been implemented in study conditions to guide tranfusion in bleeding patients. The certainty for the evidence is very limited.

Functional neural plasticity after compassion-based interventions: A scoping review of longitudinal neuroimaging studies.

Diagnostic Test Accuracy Meta-Analysis: A Practical Guide to Hierarchical Models.

Global strategies to achieve SDG 3.2 for ending preventable deaths of children under-five: A realist review.

Domestic wastewater is a significant source of environmental contamination, largely due to its elevated Biological Oxygen Demand (BOD), which reflects the accumulation of oxygen-consuming organic matter in water bodies. Biofilter-based systems, including aerobic and anaerobic processes, have gained attention as sustainable technologies for BOD reduction. Nonetheless, reported variations in treatment performance highlight the need for a comprehensive synthesis of available evidence. This systematic review evaluates the effectiveness of aerobic and anaerobic biofilter applications in lowering BOD concentrations in domestic wastewater. The review was conducted in accordance with PRISMA guidelines. Searches were carried out in Scopus, DOAJ, ScienceDirect, PubMed and Google Scholar using the Publish or Perish software. Eligible studies, published between 2019 and 2025, were selected through predefined inclusion and exclusion criteria following the PICOS framework. After removing duplicates, full-text screening and methodological quality assessment were performed. From 987 initial records, ten studies satisfied the eligibility criteria. Evidence indicates that both aerobic and anaerobic biofilters substantially reduce BOD. Aerobic systems generally provide quicker degradation, while anaerobic systems are more energy-conserving and generate less sludge. Several reports suggested that sequential or hybrid configurations of both processes can enhance treatment efficiency. Aerobic and anaerobic biofilter technologies are effective for mitigating BOD in domestic wastewater. Integrative systems appear particularly promising due to their synergistic benefits. Future investigations should prioritize standardizing operational parameters and exploring the feasibility of large-scale implementation in wastewater management.

Platelet-rich plasma in the management of vulvovaginal disorders: a systematic review.

Evidence syntheses on the associations between blood pressure (BP) parameters and cognitive decline and/or dementia have taken different methodological approaches and targeted different BP parameters and outcomes. The aim of this umbrella review was to provide a high-level synthesis of published systematic reviews with meta-analyses on these associations. PubMed, Embase, PsycINFO, and Cochrane were searched up to April 2025 for eligible reviews. Risk of bias was assessed using the AMSTAR-2 tool and overlap of constituent studies between reviews was explored. Among 31 included reviews, eight reported positive associations between higher BP and greater incidence of cognitive decline or dementia, five drew neutral conclusions, and one reported an inverse relationship. Greater mid-life BP was associated with greater risk of all-cause dementia, whereas late-life hypertension might have a mixed or overall neutral association. Three reviews reported associations between higher BP variability and all-cause dementia, and two for cognitive decline. Reviews also reported associations between higher pulse wave velocity and orthostatic hypotension and poorer outcomes. No reviews examined pulse pressure, mean-arterial pressure or cumulative BP load. Most reviews were of low quality, with considerable heterogeneity in BP parameter definitions and outcome criteria. Overlap of constituent studies for each BP parameter was low. In addition to high BP, incorporating variability, pulse wave velocity and orthostatic hypertension into risk assessments of cognitive decline or dementia and adopting standardized definitions for BP parameters and cognitive outcomes may improve comparability across future studies and strengthen clinical guidance.