High Risk Of Bias Research Articles

Validation of prognostic models predicting mortality or ICU admission in patients with COVID-19 in low- and middle-income countries: a global individual participant data meta-analysis

BackgroundWe evaluated the performance of prognostic models for predicting mortality or ICU admission in hospitalized patients with COVID-19 in the World Health Organization (WHO) Global Clinical Platform, a repository of individual-level clinical data of patients hospitalized with COVID-19, including in low- and middle-income countries (LMICs).MethodsWe identified eligible multivariable prognostic models for predicting overall mortality and ICU admission during hospital stay in patients with confirmed or suspected COVID-19 from a living review of COVID-19 prediction models. These models were evaluated using data contributed to the WHO Global Clinical Platform for COVID-19 from nine LMICs (Burkina Faso, Cameroon, Democratic Republic of Congo, Guinea, India, Niger, Nigeria, Zambia, and Zimbabwe). Model performance was assessed in terms of discrimination and calibration.ResultsOut of 144 eligible models, 140 were excluded due to a high risk of bias, predictors unavailable in LIMCs, or insufficient model description. Among 11,338 participants, the remaining models showed good discrimination for predicting in-hospital mortality (3 models), with areas under the curve (AUCs) ranging between 0.76 (95% CI 0.71–0.81) and 0.84 (95% CI 0.77–0.89). An AUC of 0.74 (95% CI 0.70–0.78) was found for predicting ICU admission risk (one model). All models showed signs of miscalibration and overfitting, with extensive heterogeneity between countries.ConclusionsAmong the available COVID-19 prognostic models, only a few could be validated on data collected from LMICs, mainly due to limited predictor availability. Despite their discriminative ability, selected models for mortality prediction or ICU admission showed varying and suboptimal calibration.

Does lower limb kinesio taping affect pain, muscle strength, and balance following fatigue in healthy subjects? A systematic review and meta analysis of parallel randomized controlled trials

BackgroundKinesio tape (KT) has gained popularity in sports and rehabilitation due to its ease of use and potential benefits. However, its effectiveness is not well understood especially in addressing fatigue, a condition that can impair muscle function and increase the musculoskeletal risk of injury. Given KT's potential impact on muscle activity and recovery, this review aims to evaluate the effects of lower limb KT on pain, strength, and balance following fatigue.MethodsA comprehensive search was conducted in five databases (Scopus, PubMed, Cochrane, ScienceDirect, and PEDRO) up to January 2024. The search employed keywords related to KT, fatigue, and delayed onset muscle soreness. We included parallel randomized controlled trials that compared KT to control groups, including sham tape, rigid tape, or no-tape. The methodological quality of the included studies was assessed using the Cochrane risk-of-bias tool. Meta-analyses were conducted for pain and strength outcomes, but not balance due to the limited number of articles addressing this outcome.ResultsAfter screening 320 initial records, 16 studies were included in the analysis, all of which were characterized by a high risk of methodological bias. The meta-analysis on 837 subjects demonstrated that KT significantly reduced fatigue-related pain, with a moderate effect size (SMD = -0.44, p < 0.0001, I2 = 32%). Subgroup analysis revealed significant pain reduction after 48 h, with no substantial effects immediately or at 24 h. The meta-analysis on muscle strength, involving 605 subjects, showed a significant improvement in the KT group, with a moderate to strong effect size (SMD = 0.46, p < 0.0001, I2 = 45%). Subgroup analysis indicated strength improvements at all time points: immediate, 48 h, and beyond 48 h. Results regarding balance were mixed; two studies reported a positive effect of KT on balance, while two others showed no significant impact.ConclusionsKT effectively reduces pain following fatigue, particularly noticeable after 48 h, and significantly enhances muscle strength, with potential balance improvements. These findings highlight KT's non-invasive, and cost-effective advantages. However, due to high risk of bias and methodological variability, further rigorous research is essential to substantiate these benefits and refine the therapeutic application of KT.

Comparative Effectiveness of Regenerative Endodontic Treatment Versus Apexification for Necrotic Immature Permanent Teeth With or Without Apical Periodontitis: An Umbrella Review.

The evidence related to the superiority of the recommended treatment protocols for necrotic immature permanent teeth is unclear. We aimed to compare the clinical, radiographic, and overall success rates of apexification and regenerative endodontic treatment (RET), assess the methodological quality, and assess the strength of evidence for outcomes. A search was performed in PubMed, Scopus, LILACS, EMBASE, Web of Science, and the Cochrane Library. The titles, abstracts and full texts of systematic reviews (SRs) comparing RET and apexification were screened. The quality and strength of evidence were analyzed via AMSTAR-2, ROBIS, and modified Kohler's criteria. Twelve SRs were included, with nine having meta-analytic outcomes. The quality of only one study was high, and the risk of bias was low in two studies. Comparable success and survival rates for RET and apexification, with no superiority of any treatment, were reported. RET was superior in stimulating root thickness and lengthening. Weak evidence was noted for a higher clinical and radiographic success rate of the apical plug technique and for root lengthening and an increase in root thickness in RET. RET and apexification exhibited comparable success rates of > 85% across all domains. Most comparisons did not reveal significant differences in clinical, radiographic, or overall success. However, the quality of evidence was weak (class IV) for both outcomes, and the majority of systematic reviews exhibited low or critically low quality and high risk of bias.

Major clinical approaches to endodontic treatment in the treatment scenario of patients with head and neck cancer: a systematic review

Introduction: In the context of endodontic treatments and cancer, head and neck squamous cell carcinoma is the 6th most common form of cancer in the world, with more than 400,000 deaths annually. The great challenge is endodontic treatment after radiotherapy processes. Furthermore, the promising applications of exosomes in targeted therapy and we propose future directions for the use of exosomes in clinical and endodontic treatment. Objective: The present study developed a systematic review to elucidate the main clinical approaches to endodontic treatment in the treatment scenario of patients with head and neck cancer. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from July to September 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 124 articles were found, 35 articles were evaluated in full and 20 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=89.2%&lt;50%. It was concluded that biomechanical preparation using a reciprocating system and 2.5% NaOCl in irradiated teeth demonstrated efficacy in reducing endodontic contaminants. Moreover, Ca(OH)2 as intracanal medication should be performed in irradiated patients with infected root canals. Also, radiotherapy causes changes in pulp behavior patterns in the short term; however, recovery and return to mean values occur after long periods. The probiotic SsK12 significantly reduced the incidence, onset, and duration of severe oral mucositis with a good safety profile. Artificial intelligence has valuable applications in the field of modern endodontics with promising results, especially in endodontic treatments in patients with head and neck cancer.

Safety and Accuracy of Guided Interradicular Miniscrew Insertion: A Systematic Review and Meta-Analysis

Background: Achieving ideal anchorage is crucial in orthodontics for controlled tooth movement. Miniscrews (MSs) have improved skeletal anchorage, but freehand placement poses risks like root damage and limited precision. Guided techniques, including radiographic guides and computer-assisted methods (static [sCAS] and dynamic [dCAS]), were developed to enhance accuracy and safety. Objective: This systematic review and meta-analysis aimed to evaluate the safety and accuracy of MS placement using different guidance approaches. Materials: A systematic search up to March 2024 identified studies on guided MS insertion, assessing safety (root contact/damage) and accuracy (angular, coronal, and apical deviations) of guided vs. freehand placement. Two reviewers assessed the risk of bias and study quality using RoB 2 for RCTs, NOS for cohort studies, and an adapted tool for pre-clinical studies. Random-effects meta-analysis was performed for studies with common parameters, and safety outcomes were pooled using logit-transformed proportions. Heterogeneity was evaluated with I² and χ² tests. Results: Eleven studies (652 MSs) were included, though no dCAS studies were analyzed. The only RCT had “some concerns” regarding risk of bias, cohort studies ranged from medium to low quality, and most pre-clinical studies had high bias risk. sCAS significantly reduced root damage compared to freehand methods (OR = 0.11; 95% CI: 0.04–0.36; p &lt; 0.001; I² = 1%) and reduced angular and linear deviations. Due to heterogeneity, no quantitative synthesis of accuracy outcomes was performed. Conclusions: sCAS improves the safety and accuracy of MS insertion compared to freehand and radiographic guide methods. These results highlight the clinical benefits of sCAS in orthodontics. Future studies should refine protocols and explore dCAS for further accuracy improvements.

Efficacy of low-intensity pulsed ultrasound in orthodontic tooth movement and orthodontically induced root resorption in animal and human studies: a systematic review and meta-analysis.

To evaluate the efficacy of low-intensity pulsed ultrasound (LIPUS) in orthodontic tooth movement (OTM) and orthodontically induced root resorption (OIRR) across animal and human studies. An electronic search in MEDLINE, Embase, Web of Science, Cochrane Library, National Knowledge Infrastructure, and Wanfang Database up to May 2024 identified 931 records screened using predefined PICOS criteria. 18 animal and 8 human studies met the inclusion criteria, with 12 suitable for meta-analysis. Methodological qualities for animal studies were assessed using the SYRCLE tool and ARRIVE guidelines. For clinical trials, the Cochrane RoB 2.0 tool and ROBINS-I were applied to evaluate the risk of bias in randomized clinical trials (RCTs) and controlled clinical trials (CCTs), respectively. Evidence quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, and quantitative analysis employed RevMan software with an inverse variance method and random effects models for all included studies. Most animal and human studies had a high or unclear risk of bias. LIPUS significantly accelerated OTM in rats, showing increases of 0.08mm (95% CI, 0.02 to 0.13; P = 0.006), 0.11mm (95% CI, 0.04 to 0.17; P = 0.001), and 0.11mm (95% CI, 0.06 to 0.16; P < 0.0001) on days 5, 7, and 14. In clinical trials, LIPUS reduced treatment duration with clear aligners by 352.07 days (95% CI, -524.81 to -179.34; P < 0.0001), but had no significant effect on OIRR (P > 0.05). GRADE analysis indicated very low evidence quality for both outcomes. LIPUS may accelerate OTM but shows weak evidence for alleviating OIRR. More well-designed studies with standardized methodology are needed. LIPUS could benefit OTM acceleration, but its effect on OIRR remains inconclusive.

Exploring the role of health-related quality of life measures in predictive modelling for oncology: a systematic review.

Health related quality of life (HRQoL) is increasingly assessed in oncology research and routine care, which has led to the inclusion of HRQoL in prediction models. This review aims to describe the current state of oncological prediction models incorporating HRQoL.A systematic literature search for the inclusion of HRQoL in prediction models in oncology was conducted. Selection criteria were a longitudinal study design and inclusion of HRQoL data in prediction models as predictor, outcome, or both. Risk of bias was assessed using the PROBAST tool and quality of reporting was scored with an adapted TRIPOD reporting guideline.From 4747 abstracts, 98 records were included in this review. High risk of bias was found in 71% of the publications. HRQoL was mainly incorporated as predictor (78% (55% predictor only, 23% both predictor and outcome)), with physical functioning and symptom domains selected most frequently as predictor. Few models (23%) predicted HRQoL domains by other or baseline HRQoL domains. HRQoL was used as outcome in 21% of the publications, with a focus on predicting symptoms. There were no difference between AI-based (16%) and classical methods (84%) in model type selection or model performance when using HRQoL data.This review highlights the role of HRQoL as a tool in predicting disease outcomes. Prediction of and with HRQoL is still in its infancy as most of the models are not fully developed. Current models focus mostly on the physical aspects of HRQoL to predict clinical outcomes, and few utilize AI-based methods.

Effects of Transcranial Electrical Stimulation on Physiological Responses to Acute Stress: A Systematic Review

AbstractPhysiological responses to acute stress generally proceed through two phases: first, a rapid and transient sympathetic and parasympathetic nervous system response, and second, a slow and relatively sustained hypothalamic-pituitary-adrenal (HPA) response. These responses are associated with changes in heart rate, heart rate variability, electrodermal responses, blood pressure, and salivary biomarkers such as alpha amylase and cortisol. Through the interactions of biochemical responses to stress and distributed brain regions including the amygdala, hippocampus, striatum, and prefrontal cortex, acute stress exposure can also adversely affect cognitive function. Transcranial electrical stimulation (tES), including transcranial direct, alternating, and random noise stimulation (tDCS, tACS, tRNS), has been examined for its potential ability to modulate physiological responses to stress and buffer negative impacts of stress on cognitive function. This systematic review surveyed research examining the effects of tES on physiological responses to acute stress in healthy neurotypical samples, examining cardiorespiratory (e.g., blood pressure, heart rate), peripheral (e.g., electrodermal), and biochemical (e.g., alpha amylase, salivary cortisol) outcomes. Sixteen reports were identified for inclusion. The articles showed low to high risk of bias, used a diverse set of acute stress induction techniques and tES methodologies, and examined a wide range of physiological outcomes. We found mixed evidence for the effectiveness of tES in reducing acute stress responses, and suggest that some tES methodologies may be more promising than others. Several directions for continuing research are proposed to help elucidate the mechanisms underlying tES effects on acute stress responses and clarify its potential for application to cognitive enhancement domains.

The therapeutic potential of exercise in post-traumatic stress disorder and its underlying mechanisms: A living systematic review of human and non-human studies

Background Exercise for post-traumatic stress disorder (PTSD) is a potentially effective adjunct to psychotherapy. However, the biopsychosocial mechanisms of exercise are not well understood. This co-produced living systematic review synthesizes evidence from human and non-human studies. Methods We Included controlled human and non-human studies involving searches of multiple electronic databases (until 31.10.23). Records were screened, extracted, assessed for risk of bias, and reconciled by two independent reviewers. The primary outcome for human studies was PTSD symptom severity, while outcomes of interest for non-human studies included freezing behaviour, fear memory, fear generalization, startle response, and locomotion. Data were synthesised with random-effects meta-analysis. Results Eleven human studies met the eligibility criteria. Overall, exercise was not associated with symptom severity improvement compared to control (standardized mean difference [SMD] -0.08, 95% confidence interval [CI] -0.24 to 0.07; 8 studies, one at low risk of bias). High-intensity exercise reduced PTSD symptoms scores more than moderate-intensity exercise. There was insufficient data to examine the effects of exercise on functional impairment, PTSD symptom clusters, and PTSD remission. Only three studies, all at high risk of bias, examined mechanisms of exercise with inconclusive results. Exercise was associated with improvement in all behavioural outcomes, including locomotor activity (SMD 1.30, 95% CI 0.74 to 1.87, 14 studies), and changes in several neurobiological markers, including increase in brain-derived neurotrophic factor (SMD 1.79, 95% CI 0.56 to 3.01). Conclusions While non-human studies provide compelling evidence for the beneficial effects of exercise, human trials do not. Evidence from non-human studies suggest that exercise might increase the levels of brain-derived neurotrophic factor, enhance cognitive appraisal, and improve perceived exertion. Overall, the paucity of data on the effectiveness of exercise in PTSD and mechanisms of action underscore the need for rigorous trials. Registration The protocol was registered with PROSPERO (ID:453615; 22.08.2023).

A Narrative Review in Hip Surgery: Key Findings from a Leading Orthopedic Journal in 2022–2023

Background/Objectives: Orthopedic hip surgery has undergone advances driven by innovations in surgical techniques and improved patient care protocols. The aim was to synthesize and appraise all studies relevant to hip surgery published in Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA) in 2022–2023. Methods: The search included all studies published in KSSTA from 1 January 2022 to 31 December 2023. Quality assessment was performed using appropriate tools for randomized controlled trials (RCTs), non-RCTs, and systematic reviews. Due to the diverse nature of the included studies, a narrative synthesis approach was used. Results: A total of 33 primary studies were included in this narrative review, of which 10 were reviews (5 systematic reviews), 1 was an RCT, and 22 were non-RCTs. A total of 11 were from the UK, 10 studies were from the USA, and 5 were from Canada. Femoroacetabular impingement (FAI) was investigated in a total of 23 studies, followed by hip micro-instability in 7 studies, dysplasia in 5 studies, and gluteal and hamstring tears in 4 studies. The RCT had a low risk of bias. Of the 22 non-RCTs, 16 had a low risk of bias, 5 had a moderate risk of bias, and 1 had a high risk of bias. All systematic reviews were of moderate quality. Conclusions: Hip arthroscopy is an effective treatment for FAI with promising early outcomes, especially when combined with closed capsular repair and appropriate rehabilitation. Surgeons should tailor their approach to capsular management to optimize recovery, as closed capsular repair may enhance functional outcomes. Additionally, preoperative tools like the HAR Index can help identify patients at higher risk of requiring hip arthroplasty after surgery. The conclusions of the included primary studies align with current general recommendations and contribute valuable insights to the field of hip orthopedics.

Bloodletting at the ear apex for acute stroke: A systematic review and meta-analysis of randomized controlled trials.

Stroke is a major cause of death and disability worldwide. Despite innovative developments in acute stroke treatment techniques in modern society, many stroke survivors still experience complications, leading to a demand for complementary and alternative medicines, including traditional medicine. Bloodletting at the ear apex (BLEA) is a nonpharmacological intervention used for various diseases, including acute stroke, in traditional medicine in East Asian countries, including China and Korea. This study aimed to evaluate the clinical efficacy of BLEA for acute stroke recovery. We searched PubMed, Embase, CENTRAL, AMED, CNKI, KoreaMed, ScienceOn, and OASIS databases for randomized controlled trials (RCTs) evaluating the effect of BLEA on acute stroke recovery. We systematically reviewed the literature published in academic journals up to September 8, 2024 and synthesized the data extracted from the final selected literature. The results of the meta-analysis are presented as mean differences (MDs) with 95% confidence intervals (CIs). The Cochrane Risk of Bias 2 tool and GRADE methodology were used for quality assessment. Six RCTs with 530 participants were included in this meta-analysis. In patients with acute stroke receiving conventional Western medical treatment, the addition of BLEA significantly improved neurological deficits assessed by the National Institute of Stroke Scale (MD, -2.83; 95% CIs, -4.48 to -1.17), consciousness impairment measured by the Glasgow Coma Scale (MD, 2.75. 95% CIs, 1.72 to 3.78), and motor function assessed by the Fugl-Meyer Assessment (MD, 5.31. 95% CIs, 3.04 to 7.58). It also significantly reduced the length of hospital stay (MD, -7.39; 95% CIs. -8.85 to -5.93). BLEA may be a promising intervention that provides additional benefits to patients with acute stroke receiving standard western medical care. However, the supporting evidence comes from a few small studies with a high risk of bias and low reporting quality. Future studies with appropriate population sizes and more rigorous methodology are warranted.

Systematic review of prognostic models for predicting recurrence and survival in patients with treated oropharyngeal cancer

ObjectivesThis systematic review aims to evaluate externally validated models for individualised prediction of recurrence or survival in adults treated with curative intent for oropharyngeal cancer.DesignSystematic review.SettingHospital care.MethodsSystematic searches were conducted...

Impact of Tele-Pulmonary Rehabilitation in Patientswith Chronic Obstructive Disease: A Systematic Review and Network Meta-Analysis.

Introduction: Pulmonary rehabilitation (PR) is essential for long-term management of chronic obstructive pulmonary disease (COPD). However, evidence regarding the effectiveness of various PR delivered via telemedicine (tele-pulmonary rehabilitation [tele-PR]) is lacking. This study aims to assess the comparative effects of different tele-PR types on clinical outcomes in patients with COPD. Methods: The following databases were searched: PubMed, EMBASE, CENTRAL, CINAHL, and EBSCO Open Dissertations from inception to May 2023. We included randomized controlled trials, quasi-experimental, and cohort studies investigating the effects of tele-PR on exercise capacity. The Cochrane Effective Practice and Organization of Care Group risk of bias was used to assess the quality of included studies. Data were analyzed using STATA 17.0 with a random-effects model. Tele-PR comparisons were ranked using surface under the cumulative ranking (SUCRA). Results: Seven studies (n = 815) encompassing five tele-PR types were included in the network meta-analysis. Two studies were justified as having a high risk of bias. There were no significant differences among different types of tele-PR and face-to-face PR, in terms of improving the 6-minute walk test. However, the hierarchy estimation suggested that tele-coaching by virtual agents more often than three sessions per week is more likely to be better than other tele-PRs (SUCRA 95.4%). Discussion: While uncertainty persists regarding the optimal tele-PR delivery model, our study suggests that tele-PR was not different from face-to-face PR. However, limited studies and evidence of low-quality underscore the need for well-designed clinical trials to yield more robust comparative evidence.

Prevalence of Sarcopenic Obesity in Elderly Population: A Meta-Analysis

Background: Sarcopenic obesity (SO) is characterized by the simultaneous presence of both obesity and sarcopenia in the same individual, and it is associated with adverse health outcomes such as falls, hospitalization, functional disability, and mortality. This study aimed to provide a comprehensive analysis of the prevalence of SO in the elderly population through a systematic review and meta-analysis of the scientific literature. Methods: A systematic search was conducted in the PubMed, Embase, Web of Science, and LILACS databases for observational studies published up to July 2023 on the prevalence of SO in individuals aged 65 years or older. Data were collected from the selected and included articles, including general study information, demographic characteristics of the samples, methods, and results. The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS) criteria. A random-effects model was applied for the quantitative synthesis (meta-analysis) of combined prevalence data, and the I-squared index (I²) was used to assess heterogeneity. Publication bias was evaluated using a funnel plot and Egger’s test. Results: A total of 37 articles meeting the eligibility criteria were selected and included in this meta-analysis. Heterogeneity among the studies was observed, along with evidence of publication bias. Most studies were classified as having a high risk of bias. The pooled prevalence of SO in the elderly was 10% (95% CI: 8%−12%; I²: 99.10%, p&lt;0.001). A similar result was observed after stratification by sex, with a prevalence of 10% in both men (95% CI: 8%−12%; I²: 97.46%, p&lt;0.001) and women (95% CI: 8%−12%; I²: 98.72%, p&lt;0.001). Subgroup and sensitivity analyses revealed that the study setting, criteria used for the diagnosis of obesity, and the risk of bias in the studies were potential factors contributing to the heterogeneity in the prevalence of SO in the elderly. Conclusions: This meta-analysis indicated a significant prevalence of SO among the elderly population, with no difference by sex, highlighting SO as a substantial health problem in this population. These findings underscore the importance of interventions to reduce the occurrence of SO in the elderly.

Identifying Barriers and Facilitators to Active Travel Infrastructure Usage Amongst Under-Represented Population Groups in the United Kingdom: A Rapid Systematic Review

Utilising active travel has the potential to positively impact health. Research shows that certain members of society may be less likely to undertake active travel than others, particularly individuals belonging to marginalised population groups such as ethnic minorities and people with disabilities. The aim of this rapid systematic review was to assess the barriers and facilitators to active travel amongst marginalised groups in the United Kingdom. Electronic databases were searched from inception to October 2022. All primary study designs were deemed eligible for inclusion if they investigated either barriers or facilitators to active travel amongst a marginalised population group within the UK. Twelve studies met inclusion criteria encompassing participants from an ethnic minority background, physical disability or a learning disability. Safety concerns were identified as a barrier for each group. Infrastructural barriers were apparent for people with a physical disability. Bike ownership or lack of bike-riding knowledge was a barrier for ethnic minorities. Facilitators identified were provision of recourses in the form of bicycles and training for ethnic minorities, while improved independence and perceived health benefits facilitated active travel amongst people with disabilities. Overall, the included studies were deemed to be of a high risk of bias. There is a lack of high-quality research in this area in the UK context, and future studies should aim to identify ways to improve access to active travel for ethnic minorities, people with disabilities, in addition to other marginalised groups who are currently not represented in the existing literature.

A Systematic Review Investigating the Impact of Dual Use of E-Cigarettes and Conventional Cigarettes on Smoking Cessation

BackgroundDual use (DU) of conventional cigarettes (CC) and e-cigarettes (EC) has emerged as a common pattern among youth and adult populations. This review aims to investigate whether dual use can promote smoking cessation.MethodsA systematic search was conducted in accordance with PRISMA guidelines, and all longitudinal studies reporting transitions between DU, exclusive e-cigarette use and exclusive conventional cigarette use were included. Two independent reviewers screened and read all records. Use status transitions among dual users were compared to transitions among exclusive e-cigarette users and exclusive CC smokers.ResultsForty-six records (sixteen original studies) were identified. Of sixteen included studies, eight could be pooled for meta-analysis. The studies showed great heterogeneity, and many presented moderate to high risks of bias. Most dual users who changed state transitioned to cigarette smoking. Baseline dual users were less likely to report a transition into complete abstinence compared to exclusive CC smokers and exclusive EC users. About one-fifth of dual users remained in the same use status after &gt;16–24 months, exposing them to DU for a prolonged time. After &gt;24–48 months, 8% of DU maintained DU.ConclusionCurrent evidence suggests that DU is not a first step toward smoking cessation, with most DUs continuing cigarette consumption either through persistent DU or exclusive CC smoking. Relatively fewer dual users transitioned into complete nicotine abstinence compared to exclusive CC and exclusive EC users. The concerns raised about limitations of current evidence highlight the need for more research focussed on use status transitions among dual users.

The Effect of Combined Strength, Plyometric, and Sprint Training on Repeated Sprint Ability in Team-Sport Athletes: A Systematic Review and Meta-Analysis.

Repeated sprint ability (RSA) is crucial for success in team sports, and involves both neuromuscular and metabolic factors. While single-mode training (SGL; e.g., sprint training) and combined training (CT; e.g., sprint + plyometric) can improve RSA, whether CT offers additional benefits compared to SGL or active controls maintaining routine training (CON) remains uncertain in team-sport athletes. This study evaluates the effect of CT versus SGL and CON on the RSA of team-sport athletes. A comprehensive search was conducted in five electronic databases. Thirteen studies involving 394 males and 28 females, aged 14 to 26 years, were included. The random effects model for meta-analyses revealed greater improvement in RSA mean after CT compared to SGL (Hedge's g effect size [g] = -0.46; 95 % confidence interval [CI]: -0.82, -0.10; p < 0.01) and CON (g = -1.39; 95% CI: -2.09, -0.70; p < 0.01). CT also improved RSA best compared to CON (g = -1.17; 95% CI: -1.58, -0.76; p < 0.01). The GRADE analyses revealed low- to very-low certainty of evidence in all meta-analyses. Subgroup analysis revealed that plyometric + sprint training yielded greater RSA mean (g = -1.46) and RSA best (g = -1.35) improvement than plyometric + resistance + sprint training and resistance + sprint training. The effects of CT on RSA did not differ according to age (≥ 18 vs. < 18), sports (e.g., soccer vs. basketball vs. handball), or RSA test type (linear sprint vs. sprint with change-of-direction). Studies showed an overall high risk of bias (ROB 2). In conclusion, CT may be improving team-sport athletes' RSA more effectively than SGL (small effect size) and CON (large effect size), particularly when CT involves plyometric + sprint training.

Dry needling for orofacial pain: a systematic review and meta-analysis of randomized clinical trials.

Orofacial pain (OFP) is an ache in the front part of the head and typically has musculoskeletal, dental, neural, or sinogenic origin. Dry needling (DN) is the insertion of a solid sterile fine needle through the skin aimed at deactivating the myofascial trigger points has extensively been studied in randomized clinical trials (RCTs). This systematic review was aimed at evaluating the evidence base for the effectiveness of DN for OFP. We searched Medline, Cochrane Central, and Web of Science (from their respective inceptions to February 2024) for RCTs evaluating the effectiveness of DN in patients with OFP. Studies with individuals suffering from cervicogenic or tension type headaches as well as observational studies were excluded. Primary outcomes were pain intensity and severity; secondary outcomes were disability, quality of life, and adverse effects. The review adhered to the methods described by in the Cochrane Handbook. Twenty-four RCTs with a total of 1,318 patients suffering from OFP were included. Most had an unclear or high risk of bias, and the quality of the evidence ranged from very low to low for all comparisons and outcomes. A meta-analysis suggested that, compared with usual care alone, DN + usual care had no effect on pain intensity (visual analogue scale) (standardized mean difference = -1.89, 95% confidence intervals -5.81 to 2.02, very low certainty evidence) at follow-ups of up to 6 weeks. There is little reliable evidence for the effectiveness of DN in reducing OFP. Future, larger, more rigorous studies might reduce the existing uncertainties.

Relationship between Shoulder Pain, Trunk and Lower Limb Pain in Overhead Athletes: A Systematic Review with Meta-analysis.

Forty-nine percent of overhead athletes suffer from shoulder pain. Throwing movements require the participation of all components of the kinetic chain to reduce risk for shoulder overuse. Thus, limited lower limb range of motion or weakness has been identified as a risk factor for shoulder pain in overhead athletes. This systematic review aims to evaluate the association between shoulder, trunk, and lower limb pain in overhead athletes. Systematic Review and Meta-analysis. A systematic review was conducted in the PubMed/MEDLINE, Science Direct and CENTRAL/Cochrane databases for observational studies. Search terms included sports-related terms (e.g., 'overhead', 'baseball', 'volleyball', 'handball') and injury-related terms (e.g., 'injury history', 'shoulder pain', 'lower limb pain', 'hip pain', 'knee pain', 'ankle pain', 'foot pain', 'trunk pain'). Studies were considered for review if they met the following criteria: inclusion of overhead athletes, investigation of injury or pain in shoulder and lower limb or trunk, had data related to or could calculate the calculation of odds ratio (OR) or relative risk (RR), available in French or English. The ROBINS-E tool was used to assess the methodological quality of each article. The data were pooled in a random-effects meta-analysis, using odds ratios to estimate the strength of the association between shoulder pain and pain at other locations. Seven articles were included. Five of them were at moderate risk of bias and two were at high risk of bias. Shoulder pain was associated with low back pain (OR=5.51), hip pain (OR=4.32), knee pain (OR=3.03) and ankle/foot pain (OR=2.84). This systematic review highlighted, with very low to low certainty, a significant association between shoulder pain and trunk/lower limb pain or injuries. Level 3.

Day-case knee and hip replacement.

Day-case knee and hip replacement, in which patients are discharged on the day of surgery, has been gaining popularity during the last two decades, and particularly since the COVID-19 pandemic. This systematic review presents the evidence comparing day-case to inpatient-stay surgery. A systematic literature search was performed of MEDLINE, Embase, and grey literature databases to include all studies which compare day-case with inpatient knee and hip replacement. Meta-analyses were performed where appropriate using a random effects model. The protocol was registered prospectively (PROSPERO CRD42023392811). A total of 38 studies were included, with a total of 83,888 day-case procedures. The studies were predominantly from the USA and Canada, observational, and with a high risk of bias. Day-case patients were a mean of 2.08 years younger (95% CI 1.05 to 3.12), were more likely to be male (odds ratio (OR) 1.3 (95% CI 1.19 to 1.41)), and had a lower mean BMI and American Society of Anesthesiologists grades compared with inpatients. Overall, day-case surgery was associated with significantly lower odds of readmission (OR 0.83 (95% CI 0.73 to 0.96); p = 0.009), subsequent emergency department attendance (OR 0.62 (95% CI 0.48 to 0.79); p < 0.001), and complications (OR 0.7 (95% CI 0.55 to 0.89) p = 0.004), than inpatient surgery. There were no significant differences in the rates of reoperation or mortality. The overall rate of successful same-day discharge for day-case surgery was 85% (95% CI 81 to 88). Patient-reported outcome measures and cost-effectiveness were either equal or favoured day-case. Within the limitations of the literature, in particular the substantial risk of selection bias, the outcomes following day-case knee and hip replacement appear not to be inferior to those following an inpatient stay. The evidence is more robust for unicompartmental knee replacement (UKR) than for total knee replacement (TKR) or total hip replacement (THR). The rate of successful same-day discharge is highest in UKR, followed by TKR and comparatively lower in THR.