High-quality Intervention Studies Research Articles

The effect of high-fibre diets on glycaemic control in women with diabetes in pregnancy: A systematic review and meta-analysis.

We searched four databases (Cochrane Library, MEDLINE, Embase and Web of Science) to identify RCTs exploring the effect of dietary fibre, high-fibre diets or fibre supplementation on fasting blood glucose (FBG), 2-h postprandial blood glucose (PBG) and requirement for insulin therapy, among other glycaemic makers in pregnant women with diabetes. Data were pooled for each outcome to calculate change from baseline mean (SD) and overall mean difference (MD) between control and intervention groups. Of 1462 identified studies, data from 20 eligible trials containing 1061 participants were pooled. On meta-analysis, a higher fibre intake was associated with reduced FBG (MD: -0.35 mmol/L, 95% CI: -0.53, -0.18, p < 0.01), PBG (MD: -0.90 mmol/L, 95% CI: -1.39, -0.40, p < 0.01) and requirement for insulin (OR: 0.24, 95% CI: 0.13, 0.46, p < 0.01). There was significant heterogeneity for FBG and PBG (>90%), attributable to differences in Intervention type for PBG (Dietary Approach to Stop Hypertension [DASH] diet, low glycaemic index, supplement; p < 0.01) and study duration (for FBG: p = 0.002; not for PBG). Studies were mostly scored as high risk of bias due to lack of blinding (Cochrane Risk of Bias Tool v.2.0). High-quality dietary intervention studies in pregnancy are lacking. Our results suggest that high-fibre diets improve fasting and postprandial glycaemia and reduce the likelihood of requiring insulin in women with diabetes in pregnancy.

Associations Between Combinations of 24-Hour Movement Behaviors and Dietary Outcomes in Children and Adolescents: A Systematic Review

Background/Objectives: Twenty-four-hour movement behaviors, including physical activity, sedentary time, and sleep, are associated with a range of health outcomes. However, the relationship between the combinations of these behaviors and dietary outcomes in young populations remains unclear. We conducted a systematic review to explore how combined movement behaviors are linked to dietary outcomes in children and adolescents. Methods: We searched MEDLINE, Embase, and PsycINFO from January 2017 to July 2024, including studies that were (1) written in English, (2) published in peer-reviewed journals, (3) quantitatively analyzed two or three movement behaviors with dietary outcomes, and (4) focused on populations aged between 0 and 18 years. Results: Ten cross-sectional studies met these criteria. The majority of studies (6 out of 10) assessed all three movement behaviors, although sleep was less frequently examined, appearing in only 4 of the studies. Our findings indicated that adhering to all movement recommendations was consistently associated with healthier dietary patterns, including a higher consumption of fruits, vegetables, nuts, fish, and cereals, and a lower intake of sweets and pastries. Additionally, adhering to physical activity and sedentary time guidelines was linked to improved dietary habits in children, including more fruit and vegetable intake and less sugary drink and snack consumption. Conversely, higher sedentary time and inadequate sleep were linked to poorer dietary outcomes, particularly lower fruit intake and hydration. Conclusions: This review suggests that meeting movement behavior guidelines correlates with healthier dietary outcomes in children and adolescents. However, given the limited number of studies and their cross-sectional design, further high-quality research, including longitudinal and intervention studies, is needed to clarify causal relationships.

How effective are non-pharmacological interventions for family caregivers? A systematic review with meta-analyses

Informal caregiving is associated with mental disorders and reduced quality of life. The aim of this systematic review was to summarize the results of methodologically high-quality intervention studies on the effectiveness of non-pharmacological interventions on patient-relevant outcomes for family caregivers in Germany. We searched three large scientific literature databases for intervention studies with a control group and a low or moderate risk of bias on the effectiveness of non-pharmacological interventions for family caregivers in Germany. Among 4,376 publications reviewed, 10 intervention studies with good methodological quality were identified. These investigated multi-component interventions or cognitive behavioral therapy for family caregivers of people with dementia (8 studies), stroke (1 study) and with general care dependency (1 study). The control groups received information material as a minimal intervention or usual standard care. Meta-analyses showed a statistically significant slight reduction in depressive symptoms 3-6 months after the start of the study as a result of cognitive behavioral therapy (standardized mean difference -0.27; 95% confidence interval -0.44 - -0.10), but this no longer reached statistical significance after 9-12 months (-0.21; -0.51 - 0.09). Multi-component interventions showed no changes in depressive symptoms either after 3-6 or after 9-12 months (-0.18; -0.40 - 0.03 and -0.14; -0.47 - 0.14, respectively). In contrast, the mental component of quality of life of family caregivers improved statistically significantly in the multi-component intervention groups compared to the control groups: slightly after 3-6 months (0.28; 0.01 - 0.56) and moderately after 9-12 months (0.45; 0.09 - 0.82). The interventions had no effect on the physical component of quality of life. The reduction of depressive symptoms by behavioral therapy interventions for family caregivers appears to be only slight and not sustainable. The mental component of quality of life of people affected may be improved in the longer term by multi-component interventions. Current scientifically examined interventions for informal caregivers do not appear to have a sufficient and sustainable effect. Greater effects could possibly be achieved through more elaborate behavioral approaches, but also structural preventive measures.

The Benefits of the Mediterranean Diet on Inflamm-Aging in Childhood Obesity.

(1) Background: Numerous elements of the Mediterranean diet (MD) have antioxidant and anti-inflammatory qualities. (2) Methods: We present a narrative review of the potential benefits of the Mediterranean dietary pattern (MD) in mitigating aging-related inflammation (inflamm-aging) associated with childhood obesity. The mechanisms underlying chronic inflammation in obesity are also discussed. A total of 130 papers were included after screening abstracts and full texts. (3) Results: A complex interplay between obesity, chronic inflammation, and related comorbidities is documented. The MD emerges as a promising dietary pattern for mitigating inflammation. Studies suggest that the MD may contribute to weight control, improved lipid profiles, insulin sensitivity, and endothelial function, thereby reducing the risk of metabolic syndrome in children and adolescents with obesity. (4) Conclusions: While evidence supporting the anti-inflammatory effects of the MD in pediatric obesity is still evolving, the existing literature underscores its potential as a preventive and therapeutic strategy. However, MD adherence remains low among children and adolescents, necessitating targeted interventions to promote healthier dietary habits. Future high-quality intervention studies are necessary to elucidate the specific impact of the MD on inflammation in diverse pediatric populations with obesity and associated comorbidities.

Non-pharmacological Management of Hypertension in Arab Countries: A Scoping Review

Background: Non-pharmacological interventions, such as healthy dietary approaches and physical activity, have always been a crucial part of hypertension (HTN) control in clinical practice. These non-pharmacological interventions, however, have never been reviewed in the literature of Arab countries. This review has quantified and evaluated non-pharmacological interventional studies conducted in Arab countries until 2023. Methods: Medline, Web of Science, PubMed, the Cochrane Library, Embase, Science Direct, Scopus, ERIC, ProQuest, Springer, Google Scholar, and CINAHL were explored from database inception until September 2023. Articles of relevance were screened based on their titles and abstracts for selection criteria. Eligible studies were reviewed, and information was retrieved. Jadad scores and the Downs and Black checklist were used to evaluate randomized controlled trials (RCTs) and quasi-experimental studies, respectively. Results: A total of 12 RCTs and 5 quasi-experimental studies met the selection criteria. The studied interventions were eHealth applications, educational programs, wet cupping, physical exercise, adherence therapy, green tea, lifestyle interventions, dietary approaches to stop HTN, motivational interviewing, and cold hibiscus beverages. The most commonly used outcome measure was blood pressure. Nine studies scored high quality. The low and neutral quality scores were mainly due to loss of blindness, poor reporting of participants’ characteristics, loss of follow-up, and failure to account for potential confounders. Conclusion: There is a scarcity of HTN non-pharmacological interventional studies, aside from the low or modest quality of nearly 50% of them. Hence, it is recommended that further high-quality interventional studies focus on the areas of dietary approaches (especially DASH), exercise, theory-based education, and behavioral counseling in Arab countries.

Outcomes of Superior Capsular Reconstruction Using the Long Head of the Biceps Tendon in Large to Massive Rotator Cuff Tears: A Meta-Analysis and Systematic Review.

(1) Background: Addressing large to massive rotator cuff tears (LMRCTs) poses complex challenges. This systematic review investigated outcomes of superior capsular reconstruction (SCR) with the long head of the biceps tendon (LHBT) compared to conventional rotator cuff repair (RCR) for LMRCTs. (2) Methods: A systematic search across the MEDLINE/PubMed, EMBASE, Cochrane Library, and Scopus databases until 1 October 2023 identified studies that directly compared SCR with LHBT with conventional RCR in patients with LMRCTs and included a minimum of a 12-month follow-up period. The assessed outcome measures encompassed retear rates, functional outcomes, range of motion (ROM), and acromiohumeral interval (AHI). Risk of bias assessment was conducted via the Robins-I tool. (3) Results: In six studies with 456 cases (210 SCR using LHBT and 246 using RCR), SCR with LHBT significantly reduced retear rates (OR = 0.21; 95% CI, 0.12-0.36; p < 0.01; I2 = 0%). Furthermore, SCR with LHBT showed significant improvement in range of forward flexion (SMD 0.32, 95% CI: 0.09-0.55, p < 0.01, I2 = 39%) and AHI (SMD 0.61, 95% CI: 0.31-0.92, p < 0.01, I2 = 0%) postoperatively. (4) Conclusion: SCR with LHBT is a safe and effective treatment for LMRCTs, reducing retear rates, maintaining greater postoperative AHI, and improving ROM compared to conventional RCR. Additional high-quality interventional studies are needed to confirm these results.

Effect of dietary fibre on cognitive function and mental health in children and adolescents: a systematic review and meta-analysis.

Objective: The purpose of this study is to investigate the impact of dietary fibre on the mental health and cognitive function of children and adolescents. Methods: All interventional and observational studies that contained information on the relevant population (children and adolescents), intervention/exposures (high dietary fibre consumption) and outcomes (mental and cognitive parameters) were eligible. Eight electronic databases (Embase, Medline, Pubmed, Web of Science, Scopus, PsycINFO, Cochrane Library and ClinicalTrials.gov) were searched up to December 11, 2023. Results: A total of 15 studies (n = 4628) met inclusion criteria, consisting of 9 intervention trials and 6 observational studies. According to observational studies, higher dietary fibre consumption was associated with a 49% reduction in the odds of depression compared to lower intake (P < 0.0001; OR = 0.51; 95% CI: 0.38, 0.69; I2 = 0%). Furthermore, no significant correlations were found between dietary fibre consumption and intelligence or anxiety. Among intervention studies, no significant difference was observed between fibre supplementation and placebo in terms of anxiety (standardized mean difference (SMD): -0.23; 95% CI: -0.72, 0.27), stress (SMD: 0.03; 95% CI: -0.21, 0.28), memory (SMD: 0.46; 95% CI: -0.79, 1.71), or attention (SMD: -2.72; 95% CI: -6.30, 0.86). Conclusion: Evidence from observation studies demonstrated that higher dietary fibre consumption is associated with a decreased odds of depression symptoms, both in childhood and adolescence. However, the causal relationship between dietary fibre intake and mental and cognitive function in children and adolescents still requires further clarification through high-quality intervention studies in the future.

Integrating smart phone applications in the management of cirrhotic patients: A scoping review.

Chronic liver disease and cirrhosis is a significant cause of healthcare utilization and patient morbidity and mortality worldwide. Smartphone applications have high uptake in most communities and therefore have great potential to provide remote support solutions to this patient population. The aim of this scoping review was therefore to provide a comprehensive overview using narrative synthesis on the use of smartphone-application-based digital interventions in cirrhotic populations. PRISMA guidelines were followed, with two independent researchers identifying 10 relevant studies. Patients studied were predominantly those with decompensated cirrhosis, and hepatic encephalopathy was the most common complication studied. Smartphones were the most common platform used, but training periods, prior to commencement of the study, were rarely offered. Patient engagement rates with the technology were reported only in three studies, but all reported high (>50%) rates of engagement. Only one study examined the clinical effects of their digital intervention, with a 38% reduction in readmission rate reported. Overall, the use of smartphone apps in cirrhosis is in an early phase of development and evaluation but preliminary studies suggest significant potential as an adjunct to routine medical care. Further high-quality studies of well-designed digital interventions are needed to advance this promising early experience.

Prevention of Central Line-Associated Bloodstream Infection via Quality Improvement

Introduction: The economic burden of CLABSIs is substantial, with each infection estimated to add between $45,000 to $55,000 to hospital costs. The aim of this systematic review was to synthesize the current evidence on the prevention of CLABSI through quality improvement initiatives. Methods: A literature search was conducted using the following electronic databases: PubMed, MEDLINE, CINAHL, Cochrane Library, and EMBASE. The search was limited to studies published in the last 15 years, to ensure the relevance and timeliness of the data. The inclusion criteria were strictly defined to select high-quality interventional studies. Included studies were those that focused on interventions for the prevention of CLABSI and were conducted in hospital settings. Studies were excluded if they were non-interventional (such as reviews, editorials, and opinion pieces), focused on populations outside of hospital settings, or did not provide clear outcome measures related to CLABSI rates. Results: A number of 8 studies were included with a common theme among the interventions was the implementation of comprehensive care bundles, which included components like staff education, hand hygiene protocols, and standardized catheter maintenance procedures. Comprehensive care bundles were particularly effective, with risk ratios (RRs) as low as 0.20 and 0.21, highlighting a reduction in infection rates by approximately 80%. Interventions involving antimicrobial catheters showed RRs ranging from 0.33 to 0.71, indicating a substantial decrease in CLABSI incidences. Moreover, staff training and education interventions resulted in RRs between 0.36 and 0.46, underscoring their importance in infection control. Conclusions: The review revealed a broad range of sample sizes and methodologies, underscore the critical role of multifaceted, context-specific approaches in significantly reducing the incidence of CLABSIs and improving patient safety in hospital settings.

Dietary acid load and its interaction with CETP TaqB1 polymorphisms on lipid profile among patients with Type 2 diabetes mellitus

ObjectiveGene-diet interaction plays a key role in the inter-individual differences in lipid abnormalities as a major risk factor for cardiovascular diseases (CVDs). Thus, we explored the interaction between CETP TaqB1 polymorphism with dietary acid load (DAL) on lipid profile among type 2 diabetes mellitus (T2DM).MethodThis cross-sectional study conducted on 220 Iranian patients with T2DM. Dietary acid load (PRAL and NEAP) was calculated via a validated food-frequency questionnaire (FFQ). The polymerase chain reaction (PCR) used for genotyping Taq1B polymorphism. Biochemical markers were measured by standard protocol. The interaction between CETP Taq1B polymorphism and DAL (PRAL and NEAP) on lipid profile was performed by a generalized linear regression model (GLM).ResultsThe overall prevalence of rs708272 genotypes was 8.6%, 72.7% and 18.6% for B1B1, B1B2 and B2B2 genotype respectively. This study showed that people with the B1B1 genotype had greater LDL, TC, LDL/HDL, and TG when they consumed diets that scored higher on the NEAP and PRAL indexes than those with the B1B2 and B2B2 genotypes. Besides, carriers of the B1B1 allele who were in the highest tertile of NEAP, had lower HDL (P Interaction < 0.05).ConclusionsIn summary, the lipid profile might be improved in B1B1 homozygotes by less adherence to DAL indexes, however, the findings should be validated in high-quality interventional studies.

Intravenous Liposomal Amphotericin B Efficacy and Safety for Cutaneous and Mucosal Leishmaniasis: A Systematic Review and Meta-analysis.

Tegumentary leishmaniasis is often subject to limited funding, underpowered studies, and a paucity of high-quality interventional studies. Intravenous liposomal amphotericin B (L-AmB) has been increasingly used to treat cutaneous and mucosal leishmaniasis (CL and ML, respectively) despite the lack of well-conducted interventional studies. We conducted a systematic review to consolidate the descriptive evidence on the efficacy and safety of L-AmB in treating CL and ML. Several online databases and the reference lists of included studies were searched to extract data from 132 studies comprising both case reports and case series. The population, intervention, comparison, outcome, and study design strategy and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used. Of 132 studies included, 92 were case reports and 40 were case series. Of the 92 cases, 65 (82.3%) were considered cured after receiving L-AmB as part of their treatment regimen. Twenty-one of the 92 (22.8%) cases reported adverse reactions to L-AmB. A pooled cure rate of 87.0% (95% CI, 79.0%-92.0%) was reported for the 38 case series that reported on treatment efficacy; 40.7% of the cases were associated with an adverse reaction. Observational data on cure rates using L-AmB suggest efficacy between 80% and 90%, similar to rates reported for other antileishmanial drugs. The highest efficacy rates were observed when a single cycle of L-AmB was administered to patients with mild-moderate CL and ML. The limitations of this study include the heterogeneity observed among the included studies and the increased likelihood of publication bias associated with the inclusion of case reports and case series. This systematic review further illustrates the need for high-quality comparative trials of intravenous L-AmB for the treatment of tegumentary leishmaniasis.

The Impact of Dance Movement Interventions on Psychological Health in Older Adults without Dementia: A Systematic Review and Meta-Analysis.

Lifestyle-based multimodal interventions that integrate physical, sensory, cognitive and social enrichment are suggested to promote healthy mental aging and resilience against aging and Alzheimer's disease (AD). This meta-analysis examined the efficacy of dance movement interventions (DMI) as an integrated mind-body activity on outcomes of psychological health in older adults. Pre-registration was carried out with PROSPERO (CRD42021265112). PubMed, Web of Science and PsycINFO were searched for randomized controlled trials (RCT) evaluating the effects of DMI (>4 weeks' duration) compared to comparators on measures of psychological health (primary outcome) and cognitive function (additional outcome) among older adults without dementia (aged ≥55). Data of 14 primary RCT (n = 983, n-DMI = 494, n-control = 489) were synthesized using a random effects meta-analysis with robust variance estimation. DMI had a small positive effect on overall psychological health (g = 0.30; 95% confidence interval [CI]: 0.06, 0.53; p = 0.02, I2= 65.04) compared to control conditions. Small effects of DMI on positive and negative psychological domains as well as quality of life were not statistically significant. DMI had a medium positive effect on general cognitive function (g = 0.50; 95% CI: 0.12, 0.89, p = 0.02, I2= 79.61) over comparators. None of the primary intervention studies evaluated measures of neuroplasticity. We found that DMI was effective in promoting mental health amongst older adults without dementia, suggesting that the multimodal enrichment tool is a potential strategy for health promotion and prevention of AD. High-quality intervention studies are needed to expand evidence on DMI-induced changes in specific psychological domains and identify underlying neurophysiological correlates.

Physical activity interventions for adults with hearing loss: a systematic review

ABSTRACT Growing epidemiological evidence suggests that adults with hearing loss engage in less physical activity than those without, which may increase the risk of chronic health conditions. This review aimed to systematically evaluate existing evidence assessing the effectiveness of physical activity interventions in adults with hearing loss. The review also aimed to identify the behaviour change techniques used in the included studies. A systematic search of the literature was completed and reported in line with the Preferred Reporting Items for Systematic reviews and Meta-Analysis. Two studies met the eligibility criteria, both found overall improvements for physical function, namely, aerobic fitness and muscle strength in adults with hearing loss. Limited evidence was available for the impact on psychosocial wellbeing. The evidence was judged to be of low quality and subject to bias. Further theoretically driven, high-quality intervention studies that incorporate additional behaviour techniques (e.g., providing additional environmental cues) are necessary.

Psychological interventions for cancer-related post-traumatic stress disorder: narrative review.

This narrative review updates the evidence base for cancer-related post-traumatic stress disorder (PTSD). Databases were searched in December 2021, and included EMBASE, Medline, PsycINFO and PubMed. Adults diagnosed with cancer who had symptoms of PTSD were included. The initial search identified 182 records, and 11 studies were included in the final review. Psychological interventions were varied, and cognitive-behavioural therapy and eye movement desensitisation and reprocessing were perceived to be most efficacious. The studies were also independently rated for methodological quality, which was found to be hugely variable. There remains a lack of high-quality intervention studies for PTSD in cancer, and there is a wide range of approaches to managing these conditions, with a large heterogeneity in the cancer populations examined and methodologies used. Specific studies designed with patient and public engagement and that tailor the PTSD intervention to particular cancer populations under investigation are required.

Outpatient rehabilitative care for patients with Long-COVID - a guideline-based clinical practice guideline

Even after weeks and months, persisting and also newly occurring symptoms after SARS-CoV-2 infection are common and lead in many cases to a broad spectrum of impairments and participation restrictions in all areas of daily life. Scientific evidence on therapeutic options still is limited. The aim of this work is therefore to provide pragmatic treatment recommendations analogous to the current therapeutic appliances guideline. In addition to a search in six electronic databases, the experiences from the treatment of more than hundred affected persons from the post-COVID outpatient rehabilitation service were used. Additionally, experiences with patients with similar symptoms from other diseases were included. All authors worked together to develop the pragmatic recommendations for the treatment of the main symptoms within the framework of outpatient therapy measures. A list of recommended diagnostics and functional assessments prior to therapy was also developed. For the main symptoms fatigue, dyspnoea and cognitive impairment, the catalog of therapeutic products offers a wide range of therapeutic options under the diagnosis U09.9. The therapy packages should be composed individually and adapted to the patient's performance level that regularly should be (re-)assessed. Informing the patient about possible relapses and deteriorations and how to deal with them should be also part of the treatment regimen. Physical modalities and rehabilitation interventions should be used in out-patient rehabilitation setting for the treatment of Long-COVID. In this regard, it is also important to take into account and treat serious complications after the disease, such as post-intensive care syndrome. Due to the rapid evolution of the knowledge a frequent review of scientific papers and recommendations should be conducted. High-quality intervention studies are necessary to achieve greater evidence in this field.

Dietary patterns and fertility status in men: Mediterranean diet does make a difference in ameliorating the rise in male infertility problems due to changing lifestyle

Dietary patterns and fertility status in men: Mediterranean diet does make a difference in ameliorating the rise in male infertility problems due to changing lifestyle

CSF rhinorrhoea after endonasal intervention to the skull base (CRANIAL): A multicentre prospective observational study.

Despite progress in endonasal skull-base neurosurgery, cerebrospinal fluid (CSF) rhinorrhoea remains common and significant. The CRANIAL study sought to determine 1) the scope of skull-base repair methods used, and 2) corresponding rates of postoperative CSF rhinorrhoea in the endonasal transsphenoidal approach (TSA) and the expanded endonasal approach (EEA) for skull-base tumors. A prospective observational cohort study of 30 centres performing endonasal skull-base neurosurgery in the UK and Ireland (representing 91% of adult units). Patients were identified for 6 months and followed up for 6 months. Data collection and analysis was guided by our published protocol and pilot studies. Descriptive statistics, univariate and multivariable logistic regression models were used for analysis. A total of 866 patients were included - 726 TSA (84%) and 140 EEA (16%). There was significant heterogeneity in repair protocols across centres. In TSA cases, nasal packing (519/726, 72%), tissue glues (474/726, 65%) and hemostatic agents (439/726, 61%) were the most common skull base repair techniques. Comparatively, pedicled flaps (90/140, 64%), CSF diversion (38/140, 27%), buttresses (17/140, 12%) and gasket sealing (11/140, 9%) were more commonly used in EEA cases. CSF rhinorrhoea (biochemically confirmed or requiring re-operation) occurred in 3.9% of TSA (28/726) and 7.1% of EEA (10/140) cases. A significant number of patients with CSF rhinorrhoea (15/38, 39%) occurred when no intraoperative CSF leak was reported. On multivariate analysis, there may be marginal benefits with using tissue glues in TSA (OR: 0.2, CI: 0.1-0.7, p<0.01), but no other technique reached significance. There was evidence that certain characteristics make CSF rhinorrhoea more likely - such as previous endonasal surgery and the presence of intraoperative CSF leak. There is a wide range of skull base repair techniques used across centres. Overall, CSF rhinorrhoea rates across the UK and Ireland are lower than generally reported in the literature. A large proportion of postoperative leaks occurred in the context of occult intraoperative CSF leaks, and decisions for universal sellar repairs should consider the risks and cost-effectiveness of repair strategies. Future work could include longer-term, higher-volume studies, such as a registry; and high-quality interventional studies.

The maximum phonation time as marker for voice treatment efficacy: A network meta-analysis.

There is a diversity in treatment approaches for voice therapy in which aerodynamic treatment effects between the approaches are lacking. The evidence of voice treatments on the maximum phonation time (MPT) was quantified using the statistical approach of a network meta-analysis (NMA). Three databases and manual search from inception to November 2021 were evaluated. Studies were considered which were reports of randomised controlled/clinical trials (RCT) evaluating the efficacy of a specific voice therapy treatment using MPT as an outcome measure in adult participants with voice disorders. Studies were excluded if participants had been diagnosed with neurological-motor-speech disorders or who were vocally healthy. Furthermore, no medical, pharmacological, or technical instrumental treatments were used. Preferred Reporting Items for systematic reviews and meta-analyses extension statement guidelines were followed. Two reviewers independently screened citations, extracted data, and assessed risk of bias using PEDro scale. Random effects model was used for meta-analysis. We identified finally 12 RCT studies (treatment groups n=285, and control group without an intervention n=62). Eight interventions were evaluated. The only effective intervention with a significant effect was vocal function exercises (VFE) (mean pre-post difference 6.16 s, 95% confidence interval, 1.18-11.13 s). VFE effectively improved MPT from pre- to post-treatment in comparison with other voice interventions which were identified in the present NMA. Further high-quality intervention studies with large samples sizes, multidimensional measures, and homogeneous groups of dysphonia are needed to support evidence-based practice in laryngology.

Status and clinical influencing factors of involuntary admission in chinese patients with schizophrenia

BackgroundThough controversial for its various disadvantages, involuntary admission (IA) is necessary in providing mental health care for patients suffering from schizophrenia in China. This article examines the IA rate in a representative sample, and under which circumstances are these patients more likely to be admitted involuntarily.MethodsAdult patients consecutively admitted to two typical hospitals in Shanghai between 2013 and 2014 with a diagnosis of ICD-10 schizophrenia were included. 2167 patients were included in this study. Sociodemographic and clinical data, as well as personal information of psychiatrists who made risk assessment, were collected. The whole sample was divided into voluntary and involuntary admission groups. Group comparisons were performed with SPSS 17.0, using one-way ANOVA, Wilcoxon rank sum test, Chi-squares and Logistic regression.ResultsAmong 2167 inpatients, the majority (2003, 92.4%) were involuntarily admitted. Clinical features, including age of patients (p < 0.001, OR = 1.037), lacking of insight (p < 0.001, OR = 3.691), were statistically significant for IA. Psychiatrist’s age (p < 0.001, OR = 1.042) was independently associated with IA. However, risk behaviors had dramatically affected patients’ admission status, of which the strongest predictor of IA was noncompliance with treatment (p < 0.001, OR = 3.597). The areas under the curve of the ROC and accuracy for the regression model were 0.815 and 0.927, respectively.ConclusionIA patients account for a major proportion of all those hospitalized with schizophrenia in China. Insights and risk behaviors contributed the most reasons for admission status of patients. This research shed light on necessity of further qualitative studies learning detailed evaluation processes of IA and high-quality interventional studies aiming to limit the performance of IA among patients with schizophrenia.

Storytelling in Pregnancy and Childbirth: An Integrative Review of the Literature.

An integrative review of the literature was conducted, including peer-reviewed articles published between 2001 and 2022. The following databases were used to search for relevant studies: PubMed, CINAHL, PsycINFO, Web of Science, Ovid, Google Scholar, ScienceDirect, Cochrane Library, Magiran, Irandoc, and SID. A process of thematic synthesis was used to make sense of the data extracted. Whilst 21 studies were retrieved, only 12 were relevant and thus met the inclusion criteria set. Two themes were identified from our thematic synthesis: (1) effects of childbirth storytelling on the storyteller and (2) effects of childbirth storytelling on the listener of the story. Subthemes included "reducing fear of childbirth," "transferring information and raising awareness in line with community culture," and "adjusting expectations." The use of storytelling can be used as an effective method in educational interventions during pregnancy and childbirth. Due to limited high-quality intervention studies in this field, future studies could usefully be more robustly designed and incorporate digital storytelling methods to inform future directions.