Grey Reference Research Articles

Impact of CB1 receptor antagonism on skeletal muscle hypertrophy and metabolic health: a systematic review of preclinical studies.

The endocannabinoid system (ECS), regulating such processes as energy homeostasis, inflammation, and muscle function, centers around cannabinoid receptors, including CB1. These receptors are mainly located in the central nervous system and skeletal muscles. Hyperactivity of CB1 receptors is linked to metabolic disorders and chronic inflammation, highlighting their potential as therapeutic targets for muscle hypertrophy and metabolic health. This systematic review, registered with PROSPERO (CRD42023462735), follows PRISMA-P guidelines and uses the PICO framework. It evaluates the effects of CB1 receptor antagonism on muscle hypertrophy in animal models and cell lines. Interventions include pharmacological antagonists, genetic modifications, and exercise-induced antagonism. A comprehensive search of databases such as PubMed, EMBASE, CINAHL, and SPORTDiscus, supplemented by gray literature and reference lists, yielded 571 references. From these, ten studies were selected, involving 338 rodents, using CB1 antagonists like rimonabant and AM251. The findings suggest that CB1 receptor antagonism enhances insulin sensitivity and glucose tolerance, reduces body fat, and promotes muscle growth through pathways such as PI3K/Akt and mTOR, as well as by improving autophagy and mitochondrial function. This review proposes CB1 receptor antagonism as a promising approach for enhancing muscle hypertrophy and improving metabolic health, with potential applications in treating such conditions as obesity, type 2 diabetes, and sarcopenia. Future research should aim to standardize intervention protocols and explore integrated therapies to fully harness the benefits of CB1 modulation.

Conventional methods and electronic apical locator in determining working length in different primary teeth: systematic review and meta-analysis of clinical studies.

The aim of the current systematic review was to investigate differences in the measurement of working length in primary teeth between electronic apex locators (EAL) and radiographic methods (conventional radiography [CR] and digital radiography [DR]). A systematic search was conducted in six electronic databases (Medline via PubMed, Web of Science, Science Direct, Virtual Health Library, Scopus and Cochrane Database of Systematic Reviews). Gray literature and reference lists of included studies were also examined. The guiding question of the study was formulated using the PECO strategy (Population, Exposure, Comparator, Outcome): P: primary teeth submitted to pulpectomy; E: measurement of working length using the radiographic methods; C: measurement of working length using electronic apex locator; O: difference in working length. The methodological quality (QUADAS-2) and certainty of the evidence (GRADE) were assessed. Meta-analyses were performed, e foram considerados os tipos de radiografia, grupo de dentes, geração de localizadores apicais. I² statistics were calculated. Twenty-five studies were included in the review. Of these, eighteen studies were eligible for meta-analysis. Most studies demonstrated fair methodological quality. The working length measured using CR was, on average, 0.52 mm greater when compared to EAL (95% CI: 0.15-0.89, I2 = 75%). When comparing EAL and DR, no statistically significant difference was found (MD = 0.06 mm, 95% CI: -0.12 to 0.24; I2 = 0%). The majority of articles (n = 20) were considered to have fair quality and five had high quality. The findings of the present review demonstrate a difference in the measurement of working length using CR in comparison with EAL. No difference was found between the EAL and DR methods. The certainty of the evidence was considered low for all outcomes.

Establishment of a risk prediction model for peripherally inserted central catheter-related bloodstream infections based on a systematic review and meta-analysis of 20 cohorts.

Peripherally inserted central catheters (PICCs) are commonly used for extended intravenous therapy but are associated with a significant risk of bloodstream infections (BSIs), which increase morbidity and healthcare costs. The aim of this study was to identify patients at high risk of developing PICC-related bloodstream infections (PICC-RBSIs) to establish new and more specific targets for precise prevention and intervention. A search was conducted from the earliest available record to May 2024 among the following databases: Embase, MEDLINE, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Scopus, and Chinese National Knowledge Infrastructure (CNKI). Hand searching for gray literature and reference lists of included papers was also performed. We assessed the quality of the studies using the Newcastle-Ottawa Scale (NOS) checklist. Two reviewers screened all the retrieved articles, extracted the data, and critically appraised the studies. Data analysis was performed using RevMan statistical software. A total of 20 cohort studies involving 51,907 individuals were included in the analysis. The statistically significant risk factors identified were hospital length of stay, line type (tunneled), history of PICC placement, multiple lumens, previous infections, chemotherapy, total parenteral nutrition, hematological cancers, delays in catheter care, local signs of infection (e.g., localized rashes), previous BSIs, and diabetes mellitus. Due to high heterogeneity among studies regarding previous BSIs, this factor was excluded from the final predictive model, while all other risk factors were included. The present meta-analysis identified risk factors for PICC-RBSIs and developed a predictive model based on these findings, incorporating 10 risk factors that integrate both patient-specific and procedural factors. Integrating the risk prediction model for PICC-RBSI into clinical guidelines and training is essential. Healthcare providers should be trained to use this model to identify high-risk patients and implement preventive measures proactively. This integration could enhance personalized care, reduce infection incidence, and improve patient outcomes. Future research should update the model with new risk factors and validate its effectiveness in diverse clinical settings.

Artificial intelligence in the care of children and adolescents with chronic diseases: a systematic review

The integration of artificial intelligence (AI) and machine learning (ML) has shown potential for various applications in the medical field, particularly for diagnosing and managing chronic diseases among children and adolescents. This systematic review aims to comprehensively analyze and synthesize research on the use of AI for monitoring, guiding, and assisting pediatric patients with chronic diseases. Five major electronic databases were searched (Medline, Scopus, PsycINFO, ACM, Web of Science), along with manual searches of gray literature, personal archives, and reference lists of relevant papers. All original studies as well as conference abstracts and proceedings, focusing on AI applications for pediatric chronic disease care were included. Thirty-one studies met the inclusion criteria. We extracted AI method used, study design, population, intervention, and main results. Two researchers independently extracted data and resolved discrepancies through discussion. AI applications are diverse, encompassing, e.g., disease classification, outcome prediction, or decision support. AI generally performed well, though most models were tested on retrospective data. AI-based tools have shown promise in mental health analysis, e.g., by using speech sampling or social media data to predict therapy outcomes for various chronic conditions. Conclusions: While AI holds potential in pediatric chronic disease care, most reviewed studies are small-scale research projects. Prospective clinical implementations are needed to validate its effectiveness in real-world scenarios. Ethical considerations, cultural influences, and stakeholder attitudes should be integrated into future research.What is known:• Artificial Intelligence (AI) will play a more dominant role in medicine and healthcare in the future and many applications are already being developed.What is new:• Our review provides an overview on how AI-driven systems might be able to support children and adolescents with chronic illnesses. • While many applications are being researched, few have been tested on real-world, prospective, clinical data.

Cancer Nursing Frameworks to Guide Clinical Capability, Education and Careers: A Scoping Review of the International Literature.

This review aimed to provide a current global profile of all existing cancer nursing competency, capability, education and career frameworks and map capabilities and competencies to the clinical, facilitation of education, management and research pillars of practice. Scoping review. Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Epistemonikos, Google Scholar, Medline, and PubMed. Gray literature searches and reference list searches were also performed. This review was guided by Arksey and O'Malley's method and followed PRISMA guidelines for reporting. Screening and data extraction was conducted independently by two or more authors. The quality of frameworks were assessed using The Joanna Briggs Institute (JBI) critical appraisal checklist for textual evidence: policy/consensus guidelines. Data were analyzed and narratively synthesized by experienced cancer nurse researchers. Thirty-four articles were included, comprising of 29 cancer nursing frameworks. Frameworks were categorized as competency frameworks, career and education frameworks, education/learning pathways, and career/professional development frameworks. Competencies and capabilities described in the frameworks were mapped to the four pillars of practice including clinical (n = 27), facilitation of learning (n = 20), leadership and management (n = 23), and research and scholarship (n = 24). Comprehensive cancer nursing frameworks are pivotal in enabling nurse leaders to grow and develop the cancer nursing workforce globally. They are also integral to support cancer nurses in providing high-quality, effective, and safe care for patients and their families across the cancer continuum. This is the first review to comprehensively capture and synthesize the capabilities, educational components, and career pathways outlined in existing cancer nursing frameworks worldwide and highlights where areas of improvement are needed to support professional growth, job satisfaction and retention of cancer nurses. This article is a review of frameworks and does not include patient or public contribution.

Longitudinal stability of extra‐cerebral off‐target binding in [F‐18]MK6240 PET images

AbstractBackgroundThe spread of tau in Alzheimer’s Disease (AD) can be tracked in vivo using [F‐18]MK6240, a PET radioligand that binds to tau aggregates in AD with high affinity. However, significant MK6240 signal is also observed in the meninges and sinus and the extra cerebral binding (ECB) signal from these regions can spill into exterior brain regions complicating evaluation of early stage AD tauopathy. This study evaluates the magnitude and variability of ECB in a large imaging cohort to identify trends in this signal.MethodParticipants included in this study were imaged at the University of Wisconsin–Madison on a Biograph mCT (n = 488) or ECAT HR+ (n = 475) PET scanner including 208 with longitudinal data taken an average of 2.0±1.0 years apart. Reconstructed PET images were smoothed using a 6mm3 gaussian kernel then processed using a standardized pipeline to generate SUVR images using the inferior cerebellar grey matter reference region. Meninges and sinus SUVR were compared across demographic groups of interest within the cohort and longitudinal changes in signal were quantified using the absolute change from baseline to follow up scans.ResultsWhile there were not significant differences in ECB signal seen with age (pmeninges= 0.89, psinus= 0.98), amyloid (pmeninges= 0.43, psinus= 0.95) or tau statuses (pmeninges= 0.18, psinus= 0.35) a significantly higher average SUVR in the meninges and sinus for female (pmeninges< 0.001, psinus< 0.001) and APOE4+ participants (pmeninges= 0.007, psinus= 0.05) was observed. Longitudinally there was an average absolute SUVR difference between scans of 0.21±0.34 (12.1±10.9%) in the meninges and 0.24±0.33 (12.9±10.4%) in the sinus. This is more than triple the average longitudinal SUVR variability of 0.06±0.06 (6.5±6.0%) in the entorhinal region in our amyloid negative participants. APOE4+ participants additionally showed a significantly higher absolute change in the meninges (p = 0.05), however, the increase in the sinus was not significant (p = 0.59).ConclusionsMK6240 ECB can be highly variable and has the potential to bias tracer uptake outcomes. While we observed trends related to sex and genetic risk factors, further work to identify the underlying sources and correct for ECB is ongoing.

Estimating the time between Aβ positivity and elevated regional tau in preclinical AD

AbstractBackgroundUnderstanding when Aβ positive cognitively normal individuals develop tau pathology has important implications for treatment with anti‐Aβ therapies. We employed a changepoint regression approach to estimate time from Aβ‐PET positivity to regionally elevated tau‐PET in a population‐based cohort of primarily cognitively unimpaired individuals.MethodParticipants from Insight 46 (1946 British birth cohort) underwent two [18F]florbetapir Aβ‐PET scans and a sub‐sample enriched for Aβ were also scanned with [18F]MK‐6240 tau‐PET, characteristics are presented in Table 1. Age at Aβ‐PET positivity, defined through Gaussian mixture modelling (GMM) as >12 Centiloids, was estimated using the SILA algorithm (Betthauser et al. 2022). Tau‐PET SUVRs from a temporal‐meta, Braak I‐VI and 34 bilateral FreeSurfer7 regions were calculated 90‐110 mins post‐injection using an inferior cerebellar grey matter reference region. Tau‐PET positivity cutpoints for each region were defined using the 99th percentile of the lower distribution from GMM. For each region, we tested changepoints in the slope of the linear regression between tau‐PET SUVR and time from estimated Aβ positivity with Bonferroni correction (5% significance, p<.001).ResultAt tau‐PET scan, 90 individuals (60%) were >0 years from estimated Aβ positivity. There was a statistically significant difference in slopes before and after the changepoint for all composite regions excluding Braak VI (Figure 1). Changepoint estimates show that tau accumulation started ∼2.5yrs after estimated Aβ positivity in Braak stages I‐III; and ∼10‐12.5yrs for Braak stages IV‐V, and the temporal‐meta region (Figure 2A). Regional estimates broadly followed Braak stages for 16/36 regions showing significant evidence of change in slopes (Figure 2B). Tau positivity rates before changepoints did not exceed 5%, whereas post‐changepoint tau positivity rates were between ∼10% and ∼50%. Regions with later changepoints tended to exhibit higher post‐changepoint slopes with greater uncertainty.ConclusionElevated tau‐PET signal occurs ∼2.5 years after estimated age of Aβ onset in Braak stages I‐III and ∼10‐12.5 years in temporal‐meta and Braak stages IV‐V, with uncertainty within these groupings. These estimates for later Braak stages are consistent with results from previous work on the timing of positive tau PET visual reads. These findings may have implications for determining the optimal time to administer Aβ immunotherapies in asymptomatic individuals.

Improved Disease Subtyping and Staging using Dual Biomarker Amyloid PET

AbstractBackgroundData‐driven disease progression models of Alzheimer’s disease (AD) have identified subtypes in regional patterns of Aβ deposition using amyloid PET. In addition to Aβ accumulation, early frame measures of tracer delivery from amyloid PET are strongly correlated with blood flow. This work explores whether combining tracer delivery with amyloid binding measures can improve the subtype and stage characterisation over amyloid binding alone.MethodsData was included from participants in three studies: Insight46, a neuroimaging sub‐study of the Medical Research Council National Survey of Health and Development (n=405), AVID2, a study of patients with a differential diagnosis of Alzheimer’s Disease (n=15), and YOAD, a study of patients with clinically diagnosed young onset Alzheimer’s disease (n=15). All participants underwent a full dynamic 18F‐Florbetapir PET/MR scan. PET images were reconstructed from 0‐2 and 40‐50 minutes post injection to generate the tracer delivery and amyloid binding images, respectively. T1 parcellations were used to calculate regional standardised uptake value ratios (SUVRs) using a cerebellar grey matter reference region. Tracer delivery and amyloid binding SUVRs for 6 cortical regions were converted into z‐scores, assuming unimodal and bimodal distributions respectively, and modelled using subtype and stage inference (SuStaIn). Participants fitted as stage zero were excluded.ResultsFigure 1 shows the three subtypes found using regional amyloid binding SUVR. Subtype 2 accumulates amyloid first in the occipital lobe, while for subtypes 1 and 3, which accumulate Aβ first in the precuneus and insula respectively, this is the last area to show Aβ deposition. Two distinct subtypes were found with blood flow SUVR; frontal or precuneus first blood flow reduction, Figure 2. When both measures are combined, Figure 3, the data show that subtypes 1 and 2 exhibit amyloid accumulation before blood flow changes, whereas subtype 3 shows blood flow changes in all regions first. The two blood flow subtypes are spread across all three combined subtypes, suggesting that each amyloid subtype may have several blood flow subtypes.ConclusionsCombining blood flow and amyloid SUVR within SuStaIn reveals new patterns of disease progression compared to amyloid alone. This may help us better understand heterogeneity in aging and disease.

Impact of edentulism on community-dwelling adults in low-income, middle-income and high-income countries: a systematic review

ObjectivesThis study aims to comprehensively explore the consequences of edentulism on community-dwelling adults in low-income, middle-income and high-income countries.DesignSystematic review and Synthesis Without Meta-Analysis (SWiM).Data sourcesMEDLINE, Embase, Scopus, Web of...

The characteristics of event-related potentials in generalized anxiety disorder: A systematic review and meta-analysis.

Previous studies have reported inconsistent findings regarding event-related potentials (ERPs) abnormalities in individuals with generalized anxiety disorder (GAD). This meta-analysis aimed to systematically review and synthesize the existing evidence on ERP alterations in individuals with GAD. A comprehensive literature search was conducted in PubMed, the Cochrane Library, Excerpta Medica Database, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Database (VIP), Wanfang database, and China Biology Medicine (CBM) databases from inception to November 11, 2024. Gray literature and reference lists were also manually searched. Studies investigating ERP component differences between individuals with GAD and healthy controls were included. Two independent reviewers conducted study selection, data extraction, and risk of bias assessment. Influence and sensitivity analyses were performed to assess the robustness of the pooled results. Effect sizes (SMD, Hedge's g) were calculated for latency and amplitude differences. Heterogeneity was assessed using the I2 statistic. Meta-regression and subgroup analyses were conducted to explore the source of heterogeneity. Trim-and-fill analyses were applied to assess potential publication bias. Data synthesis was performed using R (version 4.2.3) software. A total of 37 studies involving 1086 individuals with GAD and 1315 healthy controls were included. The overall risk of bias was rated as low for 25 studies and moderate for 12 studies. Ten ERP components were included in the quantitative meta-analysis: P3, N2, N1, P2, Error Related Negativity (ERN), Correction Related Negativity (CRN), Mismatch Negativity (MMN), P1 (amplitude), Pe, and LPP. Pooled results indicated that individuals with GAD exhibited decreased P3 amplitude (g=-0.54, 95% CI: -0.70 to -0.38, I2=20%, P=0.22) and increased ERN amplitude (g=-0.42, 95% CI: -0.72 to -0.12, I2=40%, P=0.11) compared to healthy controls. In addition, delayed latency of P3 (g=0.43, 95% CI: 0.09 to 0.78, I2=75%, P<0.01), N2 (g=0.36, 95% CI: 0.11 to 0.62, I2=30%, P=0.20), and MMN (g=0.63, 95% CI: 0.52 to 0.75, I2=0%, P<0.0001) was observed in individuals with GAD. Due to the limited number of included studies, the results of N170, N1/P2, N270, N400, VPP, BAEP, P1 (latency), P50, EPN and Nf were summarized narratively. Individuals with GAD were reported to have increased N170, N400, and VPP amplitude and delayed P1 latency compared to healthy controls. Age, sex ratio, sample size, diagnostic criteria, task-related modality, and paradigm were identified as potential influencing factors of ERP characteristics. Individuals with GAD exhibit increased ERN amplitude and decreased P3 amplitude in contrast with healthy controls. In addition, delayed latency of P3, N2, and MMN is detected in individuals with GAD. The identified ERP components in individuals with GAD are associated with attention, cognition, visual perception, error or conflict monitoring, semantic information integration, and auditory sensory memory processes. Due to the limited number of included studies and high heterogeneity, further studies with high quality are needed to confirm these findings.

Linking the estimated time of onset of low locus coeruleus integrity to the estimated time of onset of elevated entorhinal tau

AbstractBackgroundEstimating the time course of locus coeruleus integrity changes is important for a better understanding of the pathophysiological cascade and for identifying the optimal window of opportunity for prevention trials. We used samples iterative local approximation (SILA) to determine the individual estimated time of onset of low LC integrity and related this to early cortical tau deposition and cognitive decline.Methods101 individuals from the Harvard Aging Brain Study+ with longitudinal 3T MRI‐LC imaging, 18F‐Flortaucipir (FTP)‐PET imaging (n=92 with longitudinal data), longitudinal cognitive assessments and baseline PiB‐PET imaging were included (mean age: 69.97 years (SD: 12.46); 62 females; Table 1). LC intensity was derived by normalizing the LC to the pontine reference and averaging 5‐voxel‐clusters with the highest intensities (GMM‐based cut‐off: &lt;1.34 = LC+). FTP‐burden was quantified in the entorhinal cortex (cerebellar grey reference region, partial volume corrected, GMM‐based cut‐off: &gt;1.41 SUVr = EC+). SILA was used to model trajectories of LC intensity and EC FTP separately. Time to onset of LC+ was correlated with baseline entorhinal tau and neocortical amyloid. Repeated measures correlations related the time to onset to LC+ to longitudinal entorhinal FTP and longitudinal PACC scores. Time to onset to LC+ and elevated EC+ were correlated to each other.Results75.25% (n=76) of the individuals were considered LC+ (Figure 1A) and 40.22% (n=37) was EC+ (Figure 2A). Being closer to the LC+ time to onset was correlated with higher entorhinal FTP (r=0.34, p&lt;0.001), but not with neocortical PiB (r=0.09, p=0.42; Figure 1B‐C). Moving closer to the time to onset to LC+ was associated with faster accumulation of entorhinal FTP (r=0.40, p&lt;0.001), and faster cognitive decline (r=‐0.39, p&lt;0.001; Figure 1D‐E). The LC+/EC+ onset trajectories were positively correlated (r=0.23, p=0.025; Figure 2B), and 36% of the individuals was LC‐EC‐, 3% LC‐EC+, 50% LC+EC‐ and 36% LC+EC+, and the time between LC+EC‐ to LC+EC+ was 6.06 years (SD:3.15; Figure 2C).ConclusionsLC integrity imaging allows for temporal modeling and our data suggests that LC integrity precedes accumulation of entorhinal tau by on average 6 years. Future work will evaluate the impact of risk and protective factors on these trajectories.

Increased Risk of Dentoalveolar Trauma in Patients with Autism Spectrum Disorder: A Systematic Review with Meta-Analysis.

The prevalence of traumatic dental injuries (TDI) in patients with autism spectrum disorders (ASD) remains unclear. Given these discrepancies, an updated review of the evidence on the risk of TDI in patients with ASD is essential. This systematic review and meta-analysis aimed to evaluate the prevalence of TDI in patients with ASD and compare it to that in neurotypical patients. This study protocol was registered on PROSPERO (CRD42024580127) and followed the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA guidelines. A comprehensive search of four databases-MEDLINE/PubMed, Web of Science, Scopus, and Embase-was conducted for articles published up to August 2024. Moreover, the gray literature (ProQuest) and reference lists were screened. The inclusion criteria required participants with ASD to assess TDI across deciduous, mixed, and permanent dentition regardless of age. No restrictions were applied on TDI type, language, or publication date. Additionally, case reports, reviews, letters, and studies addressing other oral disorders without specific TDI data were excluded. A single-arm meta-analysis evaluated the cumulative proportion and 95% confidence interval (CI) of TDI in patients with ASD. Moreover, a comparative meta-analysis was performed to assess the risk of TDI between ASD and neurotypical patients, calculating the odds ratio (OR) with a 95% CI, and a p < 0.05 was deemed significant, using the R program. Quality assessment was performed using the National Heart, Lung, and Blood Institute tool, and the certainty of evidence was evaluated using GRADE. A total of 22 studies were included to determine the overall prevalence of TDI, of which 16 studies directly compared patients with ASD to neurotypical individuals. In total, 3817 participants were evaluated, including 2162 individuals with ASD and 1655 neurotypical patients. A single-arm meta-analysis estimated a TDI prevalence of 22% (Confidence Interval [CI]: 17-27%) among patients with ASD. A significant difference in the risk was observed between ASD and neurotypical patients (p = 0.003; Odds Ratio [OR]: 1.67; CI: 1.19-2.26). However, substantial heterogeneity was observed in this analysis. Although the majority of studies were rated as high quality, the certainty of the evidence was considered very low. Despite the limitations of this study, the findings suggest that patients with ASD are at a higher risk of developing TDI than the risk observed in neurotypical patients. Therefore, preventive educational initiatives are recommended to reduce the risk of TDI in this population.

Cultural Influences, Experiences and Interventions Targeting Self-Management Behaviours for Prediabetes or Type 2 Diabetes in First-Generation Immigrants: A Scoping Review.

To map the existing evidence and identify research gaps regarding the self-management of prediabetes or type 2 diabetes among first-generation immigrants ≥ 18 years. A scoping review followed the JBI guidelines and was in accordance with the PRISMA extension for Scoping Reviews. A systematic search of CINAHL, Cochrane, EMBASE, MEDLINE, PsycINFO, ProQuest, SCOPUS and the Web of Science was conducted. Grey literature and reference lists of included studies were searched for additional citations. Articles published in English from the database inception to February 2023 were included. We included 96 studies, of which 28.1% were published within the last 5 years. Most studies (71.9%) were conducted in the United States. Study participants were recruited mainly from community settings and English was their second language. The most common study methodologies used were cross-sectional surveys and phenomenological interviews. Only two studies specifically focussed on individuals with prediabetes. Multiple factors, such as age, gender, country of origin and other societal, linguistic, cultural and resource barriers or facilitators, as well as patient's cultural unique experiences, were of particular significance for self-management behaviours. Although several studies reported that culturally tailored interventions were feasible and acceptable among first-generation immigrants living with type 2 diabetes but not prediabetes, the duration and intensity of these interventions varied. Health professionals should consider various demographic, societal, linguistic and cultural factors, such as participants' low English language proficiency, and provide appropriate support for this group to ensure better self-management behaviours. Tailoring interventions to individual and cultural preferences in collaboration with key stakeholders is crucial for adult immigrants with prediabetes and type 2 diabetes across diverse cultural and ethnic groups. Developing and applying culturally tailored self-management interventions for the targeted population, particularly those with prediabetes, should be an important direction for future research. No Patient or Public Contribution.

Engaging family caregivers with structured communication for safe care transitions: A making healthcare safer rapid review

Objectives To summarize and assess the effectiveness of patient safety practices (PSPs) for engaging family caregivers with structured communication to improve care transitions safety. This review provides information for clinicians, health system leaders, and policymakers to better inform approaches to improve patient safety during care transitions. Methods We searched PubMed, Embase, and the Cochrane Library for eligible studies published in 2010 through 30 June 2023, and reviewed gray literature searches and reference lists of relevant systematic reviews. We used prespecified inclusion and exclusion criteria to assess relevant studies. Findings We identified 323 unique records and assessed 86 full-text articles for possible inclusion. We included nine studies (two randomized controlled trials, six pre-post studies, and one single-arm study) which assessed PSPs focused on hospital discharge to home, transfers from intensive care units, and transitions from residential care to home. We found that PSPs for engaging family caregivers with structured communication improved caregiver satisfaction (low strength of evidence) in residential care transitions. For other outcomes, we rated the evidence as insufficient to permit conclusions. None of the studies reported rates of unintended harms. Conclusions There is little evidence on the effectiveness of PSPs using structured communication with family-caregivers to improve care transitions safety. One study showed improvement in caregiver satisfaction. More high-quality research is needed to assess the effectiveness of these PSPs and unintended harms.

Literature Review to Understand the Burden and Current Non-surgical Management of Moderate-Severe Pain Associated with Knee Osteoarthritis.

To conduct a literature review exploring the humanistic burden, costs, and guideline recommendations for non-surgical management of moderate-severe pain in knee osteoarthritis (KOA). Published studies (2018-25 April 2023) assessing the burden of moderate-severe pain in KOA were identified by searching Medline, Embase, EconLit, and Cochrane database, supplemented with grey literature hand searches and reference list snowballing. Treatment guidelines were also identified for key countries. This review included 106 publications and 37 treatment guidelines. Patients with moderate-severe pain were found to experience a low quality of life (QoL) and an impaired ability to perform daily tasks. The economic burden of KOA was substantial, including cost of medical visits, non-operative treatment (physical therapy and hyaluronic acid [HA] being key drivers) and productivity losses. Non-steroidal anti-inflammatory drugs (NSAIDs) were among the most frequently used pharmacological treatments, with intra-articular (IA) injections used to varying degrees. Opioid use was also frequently reported. Guidelines universally recommended NSAIDs, albeit with limited dose and duration for oral NSAIDs. IA-corticosteroids were conditionally/moderately recommended for short-term use by most guidelines, while IA-HA and opioids were rarely recommended. Guidelines are not specific to patients with moderate-severe pain and do not distinguish between different KOA phenotypes. KOA with moderate-severe pain is associated with substantial humanistic and economic burden. Real-world data suggest that some treatments are regularly used at high cost regardless of the lack of evidence-based recommendations. There remains a need for new treatment options that successfully relieve pain, improve QoL and delay the need for surgery. Graphical abstract available for this article.

A Mixed Methods Systematic Review of the Effectiveness, Acceptability, and Feasibility of Advanced Care Plans for Older Adults Without Life-Limiting Conditions

Context: Advance care planning (ACP) is a comprehensive procedure aimed at helping individuals understand and articulate their values, life goals, and preferences concerning future medical treatment. Despite extensive research on ACP in populations with terminal illnesses, dementia, and those in long-term care, there is a lack of focus on its impact among older adults without life-limiting conditions. Objectives: To investigate the effectiveness, acceptability, and feasibility of ACP for older adults without life-limiting conditions. Methods: We searched 11 electronic databases, spanning from inception to November 2023, complemented by extensive grey literature and reference searches. Rigorous quality assessments were conducted using the Mixed Methods Appraisal Tool (MMAT). Our approach adopted a dynamic convergent mixed-methods design, incorporating thematic and narrative synthesis. Findings: From over 12,600 citations, a total of 16 studies, comprising four randomised controlled trials (RCTs), nine qualitative studies, and three mixed methods studies met the inclusion criteria. Limited findings indicate that ACP interventions are generally effective in improving document completion rates and reducing hospital readmissions. Acceptability and feasibility of these interventions were high, although significantly influenced by cultural and religious factors. Limitations: Evidence supporting the effectiveness, acceptability, and feasibility of ACP in reducing unplanned hospital admissions in older adults without life-limiting conditions was limited. We excluded observations based on unwell older people, though some material with unclear distinctions may have been included. Quality assessments revealed that one of four RCTs had a high risk of bias, three had unclear risks; all nine qualitative studies had low risk; and one of three mixed methods studies had low risk while two had unclear risks. Implications: Further targeted research is necessary to assess the intervention’s value for this population. Rigorous real-world evidence studies involving older adults without life-limiting conditions and their proxies is crucial to enabling providers to tailor ACPs to diverse populations, whilst respecting individuals’ religious and cultural beliefs.

Global prevalence of teething problems in infants and children-A systematic review and meta-analysis.

Eruption of primary teeth is associated with local and systemic manifestations. Understanding the global prevalence is necessary to formulate the standard guidelines for management. To evaluate the global prevalence of problems associated with teething in infants and children aged 0-36 months. PubMed, LILACS, Web of Science, Scopus, and EMBASE were searched on May 31, 2023, and it was updated on January 31, 2024. Gray literature and reference search were performed. Cross-sectional, case-control, and cohort studies done in hospital or community settings, reporting the prevalence of signs and symptoms during the eruption of primary teeth in infants aged 0-36 months, were included. Two reviewers extracted data using a pre-piloted sheet. Data were analyzed and pooled by using random-effects meta-analyses. Twenty-five studies were included. The global prevalence of teething problems was 80.0% (95% confidence interval [CI]: 67.8-89.9). The most common local symptom was increased biting (65.9%, 95% CI 37.5-89.3), and irritability (60.7%, 95% CI 50.6-70.3) was the most common general symptom. The pooled prevalence of teething problems was estimated to be 80%. There was a variability in the prevalence of teething problems based on geographic location.

Mentorship in health research institutions in Africa: A systematic review of approaches, benefits, successes, gaps and challenges.

In Africa, where the burden of diseases is disproportionately high, significant challenges arise from a shortage of skilled researchers, lack of research funding, and limited mentorship opportunities. The continent faces a substantial gap in research output largely attributed to the dearth of mentorship opportunities for early career researchers. To explore existing mentorship approaches, identify challenges, gaps, successes, and benefits, and provide insights for strengthening mentorship programs in African health research institutions. We registered the review protocol on the International Prospective Register of Systematic Reviews [CRD42021285018] and searched six electronic databases-EMBASE, AJOL, Web of Science, PubMed, DOAJ, and JSTOR from inception to 10 November 2023, for studies published in English reporting on approaches of mentorship in health research in African countries. We also searched grey literature repositories, institutional websites, and reference lists of included studies for additional literature. Two independent reviewers conducted screening of titles and abstracts of identified studies, full-text screening, assessment of methodological quality, and data extraction. We assessed study quality against the Mixed Methods Appraisal Tool (MMAT). We resolved any disagreements through discussion and consensus. We employed a narrative approach to synthesize the findings. We retrieved 1799 articles and after screening, included 21 studies in the review. The reviewers identified 20 mentorship programs for health researchers (N = 1198) in 12 African countries mostly focusing on early-career researchers and junior faculty members. A few included mid-career and senior researchers. We categorized the programs under three key mentoring approaches: international collaborative programs, regional and in-country collaborations, and specialized capacity-building initiatives. Our review highlighted the following successes and benefits of health research mentorship programs: the establishment of collaborations and partnerships, development of research programs and capacities, improvement of individual skills and confidence, increased publications, and successful grant applications. The gaps identified were limited funding, lack of a mentorship culture, negative attitudes towards research careers, and lack of prioritization of research mentorship. Our review highlights a diverse landscape of health research mentorship aspects predominantly targeting early career researchers and heavily driven by the North. There is a need for locally driven mentorship initiatives in Africa to strengthen mentorship to advance health research in the region. PROSPERO registration number: CRD42021285018.

Lip Symmetry After Cleft Lip Repair Fisher in Unilateral Cleft Lip: A Systematic Review

The purpose of this research is to learn the outcomes of lip symmetry after cleft lip repair by Fisher in unilateral cleft lip compared with other techniques. This systematic review searched English full-text available articles in 4 databases: Cochrane, PubMed, ScienceDirect, and Google Scholar, and hand searched through grey literature and reference lists. Subjects were those with unilateral cleft lip without syndromic disorders who had primary cleft lip repair. The authors compared the technique by Fisher with other cleft lip repair techniques. Outcomes were lip symmetry determined quantitatively by lip anthropometric measurement and qualitatively by the Steffensen grading criteria. Four studies were included with a total of 150 cleft lip repairs, comparing the technique by Fisher with techniques by Millard, Mohler, and modified Millard. The 4 studies underwent critical appraisal, data analysis, qualitative synthesis, and meta-analysis. Assessment with Cochrane Risk of Bias 2 for randomized controlled trials and “Risk of Bias in Nonrandomized Studies–of Interventions” for nonrandomized studies displayed an overall high risk of bias in the included studies. “Grading of recommendations, assessment, development, and evaluation” revealed a very low quality of evidence for this review. All 4 studies noted better subjective lip symmetry in the technique by Fisher, but lip and vermilion height were better after the technique by Millard. This review found superior lip symmetry quality but inferior lip symmetry anthropometry after the technique by Fisher compared with the technique by Millard and its modifications, with a low quality of evidence.

Collaborative performance of CCER project concerning uncertain industrial benchmark and average sector reference points

In the framework of Chinese Certified Emission Reduction (CCER), carbon reduction projects greatly contribute to achieve the "dual carbon" targets. According to prospect theory, the collaborative performance of a CCER is greatly influenced by uncertain external reference points, such as industrial benchmark and average sector levels. This study proposes a novel method to assess the perceived collaborative performance of CCER projects concerning dual grey reference points. Specially, an aggression method is proposed to calculate the comprehensive performance of a CCER project through data standardization. According to comparison results between comprehensive performance and grey reference points, four scenarios are exploded with associated probabilities. Moreover, the perceived performance assessment of a CCER project is explored including competitive perception performance (CPP) and industry performance increment (IPI), which are generated by the comparisons to industrial benchmark and average sector references. Finally, a numerical case is conducted to demonstrate its feasibility and effectiveness. This paper contributes to (1) Aggregation process of CCER actual performance through data standardization operation; (2) Computation method for perceived collaborative performances influenced by dual grey external reference levels; (3) Feasibility analysis reflecting the evolution of the perceived collaborative performances. Policy implications can assist CCER participants in selecting relevant carbon reduction key performance indicators (KPIs), identifying suitable innovation strategies, determining appropriate benchmarks, and mitigating information uncertainty.