Standardized Mean Difference Research Articles

Assessing the impact of telemedicine interventions on systolic and diastolic blood pressure reduction: A systematic review and meta-analysis

Background Hypertension, characterized by high blood pressure, poses a significant risk for cardiovascular diseases, stroke, and heart attack. Managing it is particularly challenging in areas with limited healthcare access and for patients who cannot attend regular in-person visits. Telemedicine interventions offer a promising solution by improving patient adherence and facilitating timely treatment adjustments. This study aims to systematically evaluate the impact of these telemedicine interventions on reducing systolic and diastolic blood pressure. Methods A comprehensive search of PubMed, Scopus, and Web of Science was conducted to identify relevant studies. Two independent reviewers screened and selected eligible articles, extracting key data using a standardized form. The quality of the included studies was assessed with the Mixed Methods Appraisal Tool (MMAT). A random effects model was used to combine the results, with treatment effects measured using standardized mean differences (Hedges's g). Consistency of findings was evaluated through statistical tests, including the Q test and I² statistic, to assess heterogeneity. Data analysis was conducted using Stata statistical software version 17.0. Results Of the 2700 articles retrieved, 35 studies were selected for inclusion in the analysis. Using a random-effects model, the overall effect size was Hedges's g = −0.22 (95% CI: −0.30 to −0.15; p-value < 0.001), indicating a small but meaningful reduction in blood pressure (systolic and diastolic). Telemedicine interventions had a greater impact on systolic blood pressure (Hedges's g = −0.27, 95% CI: −0.39 to −0.15; p-value < 0.001) compared to diastolic blood pressure (Hedges's g = −0.17, 95% CI: −0.26 to −0.07; p-value < 0.001), though both reductions were clinically relevant. Conclusion This study demonstrates that telemedicine interventions significantly reduce both systolic and diastolic blood pressure, with a more pronounced effect on systolic pressure. The overall effect size indicates a small but meaningful improvement in hypertension management. These findings highlight the potential of telemedicine as an effective strategy for enhancing patient outcomes in hypertension care.

Efficacy of Action Observation Therapy on Gait, Balance and Mobility Impairments: A Systematic Review and Meta‐Analysis

ABSTRACTBackground and purposeAction Observation Therapy (AOT) has been proposed to improve gait, balance and mobility in subjects with neurological and musculoskeletal disorders. The current review aimed to investigate AOT effects in subjects with gait, balance and mobility impairments.MethodsA systematic literature search was performed using PubMed/MEDLINE, EMBASE and Scopus databases from inception until May 2023. Randomized controlled trials investigating effects of AOT on gait, balance and mobility in subjects with any type of clinical condition were included. Two reviewers performed data extraction and methodological quality assessment using the revised Cochrane risk of bias tool for randomized trials. The overall effects were reported as mean difference (MD) or standardized mean difference (SMD) with 95% confidence interval (CI).ResultsThirty‐one studies were included. Low evidence supported AOT to enhance walking speed (SMD: 0.40; 95% CI: 0.17, 0.62; I2 = 0%), stride length (SMD: 0.35; 95% CI 0.05, 0.66; I2 = 0%) and single limb support duration (MD: 4.1%; 95% CI: 1.0, 7.2, I2 = 0%) after stroke. Low evidence supported AOT to improve walking distance (MD: 56.8 m; 95% CI; 39.2, 74.4 m) and dynamic (SMD: 0.40; 95% CI: 0.04, 0.76; I2 = 0%) and static (SMD: 0.69; 95% CI: 0.32, 1.05; I2 = 0%) balance, while very low evidence supported AOT to enhance mobility (MD: −1.48 s; 95% CI; −2.2, −0.8 s; I2 = 0%) after stroke. Moderate evidence supported AOT to improve dynamic balance in subjects with Parkinson's disease (SMD: 0.44; 95% CI: 0.09, 0.79; I2 = 28%), while low evidence supported AOT to enhance dynamic balance (SMD: 0.61; 95% CI: 0.15, 1.08; I2 = 27%) and mobility (MD: −2.08 s; 95% CI; −3.5, −0.6 s; I2 = 0%) in patients with orthopedic conditions.ConclusionAOT improved gait, balance and mobility after stroke, dynamic balance in patients with Parkinson's disease and dynamic balance and mobility in patients with orthopedic conditions. However, evidence certainty was generally low and further high‐quality studies are needed.Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews (n. CRD42021240626)

Systematic review and meta-analysis assessing the status of carotid intima–media thickness and lipid profiles in type 2 diabetes mellitus

ObjectivesCarotid intima–media thickness (CIMT) is a measurement for subclinical atherosclerosis and has been associated with overall cardiovascular diseases, especially in type 2 diabetes mellitus (T2DM). We aimed to assess the...

FLAIR vascular hyperintensity is associated with functional outcome in patients with ischemic stroke receiving endovascular treatment: a meta-analysis

BackgroundFluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) might be useful for predicting and functional outcome in ischemic stroke patients after endovascular thrombectomy (EVT), but its clinical benefit remains controversial. Thus, this study aimed to evaluate the association of FVH on prognosis in ischemic stroke patients who received EVT.MethodsPubMed, Embase, Cochrane Library, Web of Science, and Wanfang databases were searched for potentially eligible studies published up to March 2024. Pooled standard mean difference (SMD), risk ratios (RR) with 95% confidence intervals (CI) were employed to assess the association of FVH on prognosis in ischemic stroke patients who received EVT. All statistical analyses were conducted using STATA 12.0 software.ResultsA total of 10 studies were included in our study. The results indicated that higher FVH score were associated with better prognosis (SMD: 0.80, 95% CI 0.63–0.97). Moreover, the presence of FVH was significant associated with better functional outcome in ischemic stroke patients who received EVT (RR: 0.68, 95% CI, 0.58–0.79).ConclusionThe current meta-analysis suggests that FVH is related the prognosis of ischemic stroke patients after EVT.

Spiritual therapy’s impact on death anxiety in Iran: A systematic review and meta-analysis

Recently, spirituality-based interventions for modulating death anxiety in both unhealthy and healthy individuals have increased. However, the effectiveness of this treatment approach in reducing death anxiety remains controversial. Thus, this systematic review and meta-analysis aimed to clarify the impact of spiritual therapy interventions on death anxiety in Iran. We searched for all randomised and controlled trials related to the research topic in national and international databases, including Web of Science, PubMed, Scopus, Wiley, Taylor & Francis, ScienceDirect, SID, Civilica, IranDoc and Noormags. Fifteen studies with 772 participants that were found relevant and fulfilled the defined exclusion and inclusion criteria were included in the analyses. Stata 17 software was used to analyse the data. The results showed a significant difference between the average death anxiety scores in the experimental and control groups after receiving spiritual therapy (standardised mean difference = –5.97, 95% confidence interval: –9.51, –2.44). In addition, the results of the Q and I2 tests indicated significant heterogeneity among the studies (p < 0.001; Q = 411.45; I2 = 99.50%). Thus, although the findings show that interventions based on spiritual therapy can reduce death anxiety, the high heterogeneity and publication bias of some trials limit the validity and generalisability of their effects. The findings of this meta-analysis will help in elucidating the effectiveness of spiritual therapy and open new horizons for this therapeutic approach for psychologists, counsellors and educational planners, thereby creating a relative consensus between advocates and critics of therapeutic spirituality.

Beneficial effects of non‐pharmacological interventions for post‐stroke pain: A meta‐analysis

AbstractPurposePain is a frequent post‐stroke health concern, and several non‐pharmacological interventions are commonly employed to manage it. However, few reviews have examined the effectiveness of such interventions, making it difficult to draw conclusions about their usefulness. Furthermore, subgroup analysis based on post‐stroke pain level or intervention characteristics is rarely performed. This study aimed to investigate the effectiveness of non‐pharmacological interventions and evaluate the significant factors associated with post‐stroke pain through subgroup analysis.DesignSystematic review and meta‐analysis.MethodsRelevant studies were obtained from seven databases, from their commencement up to March 2024, as well as from the gray literature. The PICOS approach was used to evaluate the eligibility criteria of the studies. The RoB‐2 tool was used to determine the risk of bias in each randomized trial. Pooled estimations of standardized mean difference and heterogeneity (quantified with I2) were obtained using a random‐effects model. The stability of the pooled result was then assessed using the leave‐one‐out approach. STATA 17.0 was used to run the meta‐analysis.FindingsNon‐pharmacological interventions were effective in reducing pain immediately after intervention (pooled SMDs: −0.79; 95% confidence interval [CI]: −1.06 to −0.53; p < 0.001). The approach involving acupuncture, aquatic therapy, or laser therapy and rehabilitation training was effective for post‐stroke hemiplegic shoulder pain. A pooled analysis of non‐pharmacological interventions showed that both less than 4 weeks and more than 4 weeks of interventions were effective in alleviating pain in stroke patients.ConclusionNon‐pharmacological approaches appear to be beneficial for reducing post‐stroke pain. The outcomes based on the modalities merit further research.Clinical relevanceFurther studies are needed to determine the effects of different modalities on pain intensity following a stroke. Furthermore, to avoid overestimation of intervention efficacy, future randomized trials should consider blinding approaches to the interventions delivered.

Acupuncture for uremic pruritus: A systematic review and meta-analysis protocol

Background Uremic pruritus (UP) or chronic kidney disease-associated pruritus (CKD-aP) is one of the most intractable dermatologic symptom in patients with chronic kidney disease. Several randomized controlled trials (RCTs) have been conducted to investigate the antipruritic effects of acupuncture on UP/CKD-aP and suggested a significant therapeutic effect, while the evidence supporting the application of acupuncture is limited. Objectives This study will assess the efficacy and safety of acupuncture for patients with UP/CKD-aP. Methods Data Sources: RCTs will be searched in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science, the Chinese Biomedical Literature Database, the China National Knowledge Infrastructure, Wanfang Database, VIP Database, the WHO International Clinical Trials Registry Platform portal and www.ClinicalTrials.gov from inception to 31st August 2024. Study eligibility criteria: RCTs in English and Chinese conducted on UP/CKD-aP patients will be included. Participants: Adult patients diagnosed with UP/CKD-aP will be included. Interventions: All acupuncture interventions in the management of UP/CKD-aP will be included, compared with no treatment, placebo or sham acupuncture, or other treatment agents. Outcome measures: The primary outcome will be the change in the severity of itching evaluated by validated scales. Study appraisal and svnthesis methods: If necessary, a meta-analysis will be performed for the pooled therapeutic effect by Review Manager 5.3, or a qualitative descriptive analysis will be presented. The data will be transformed into the risk ratio (RR) for binary data and the mean difference (MD) or standardized MD for continuous data for analysis. Results This review will update evidence of RCTs evaluating acupuncture for UP/CKD-aP. Limitations Anticipated challenges contain the methodological and clinical heterogeneity in terms of evaluation tools and acupuncture interventions within included studies. Conclusion and implications It will benefit patients and impact health-care decision-making regarding the models of care that are feasible for patients. Trial registration PROSPERO CRD42021257001.

Peripartum allopregnanolone blood concentrations and depressive symptoms: a systematic review and individual participant data meta-analysis

AbstractNeuroactive steroids including allopregnanolone are implicated in the pathophysiology of peripartum depressive symptoms (PDS). We performed a systematic review searching PubMed/Embase/PsychInfo/Cinhail through 08/2023 (updated in 07/2024), and conducted a random-effects meta-analysis of studies comparing allopregnanolone blood concentrations in women with versus without PDS at various timepoints during the 2nd and 3rd trimester and the postpartum period, calculating standardized mean differences (SMDs) and 95% confidence intervals (CIs). Meta-regression and subgroup analyses included age, diagnoses of affective disorders before pregnancy, antidepressant treatment, analytical methods, and sample type. Study quality was assessed using the Newcastle-Ottawa-scale. The study protocol was registered on PROSPERO (registration number CRD42022354495). We retrieved 13 studies with 2509 women (n = 849 with PDS). Allopregnanolone concentrations did not differ between women with versus without PDS at any timepoint (p > 0.05). Allopregnanolone concentrations assessed during pregnancy did not differ for women with versus without PDS at postpartum follow-up (p > 0.05). Subgroup analyses indicated higher allopregnanolone concentrations in women with versus without PDS at gestational weeks 21–24 and 25–28 (SMD = 1.07, 95% CI = 0.04, 2.11 and SMD = 0.92, 95% CI = 0.26, 1.59 respectively). Moreover, we reported differences between studies using mass-spectrometry combined with chromatography versus immunoassays at gestational weeks 25–28 (p = 0.01) and plasma versus serum samples at gestational weeks 21–24 (p = 0.005). Study quality was rated as poor, good, and fair for two, one and ten studies respectively. PDS were not associated with differences for allopregnanolone concentrations. The use of heterogenous peripartum time points, study cohorts, depression symptom measures and analytical methods has hampered progress in elucidating neuroactive steroid signaling linked to PDS.

The impact of early childhood education and care‐based interventions on child physical activity, anthropometrics, fundamental movement skills, cognitive functioning, and social–emotional wellbeing: A systematic review and meta‐analysis

SummaryThis review assessed the effectiveness of ECEC‐based interventions to improve child physical activity, and intervention impact on child weight‐based anthropometrics, fundamental movement skills (FMS), cognitive functioning, and social–emotional wellbeing. Adverse effects and costs were assessed. Finch et al's 2014 systematic review was updated. Electronic databases were searched 10 September 2014 to 27 October 2022. Included studies were randomized controlled trials of ECEC interventions targeting physical activity among children aged 0–6 years. The methodological quality of studies was assessed using Cochrane's Risk of Bias tool v2. Standardized mean differences (SMD) were calculated for each outcome with meta‐analysis undertaken; otherwise, findings were described narratively. Fifty‐three studies were included. ECEC‐based interventions were found to significantly improve child physical activity (SMD 0.193, 95% confidence interval [CI] 0.09 to 0.3; p < 0.001) and FMS (SMD 0.544, 95% CI 0.1 to 0.98; p = 0.015), compared to control. Small positive, but non‐significant, effects were found for weight‐based anthropometrics, cognitive functioning, and social–emotional wellbeing. Few studies reported adverse effects (n = 10), and no studies reported formal economic analyses. While ECEC‐based interventions can significantly improve child physical activity and FMS, further evidence of their impact on cognitive functioning, social–emotional wellbeing, and the cost‐effectiveness of such interventions is required to inform policy and practice.

Exercise Interventions and Intelligence in Children and Adolescents: A Meta-Analysis.

Mixed evidence exists on whether physical exercise interventions influence intelligence measures in children and adolescents. To determine the effect of exercise interventions on intelligence in children and adolescents. Relevant articles were identified in PubMed, Web of Science, PsycINFO, and Scopus (until February 22, 2024). Randomized controlled trials assessing the effects of exercise interventions on intelligence in youth (≤19 years). A random-effects meta-analysis was performed for intelligence measures reported in ≥3 studies. Subanalyses examined the moderating effect of variables such as participants' intelligence quotient (IQ), age, or intervention duration. Fourteen randomized controlled trials (n = 3203 participants; age range = 5-14 years) were included. Exercise interventions significantly improved general intelligence compared with control groups (standardized mean difference = 0.54, 95% confidence interval [CI] = 0.11-0.97, P = .01), which corresponded to a mean improvement in the IQ score of 4.0 points (95% CI = 1.44-6.64, P = .01). Significant benefits of exercise interventions were also observed for fluid intelligence (standard mean difference = 0.20, 95% CI = 0.06-0.34, P = .006). Crystallized intelligence could not be meta-analyzed because of a lack of studies. Subanalyses revealed similar benefits in participants with low/borderline versus normal IQ, children versus adolescents, and interventions with different durations. The heterogeneity observed in the characteristics of the exercise interventions and the populations included can be a potential confounding factor. Exercise interventions are associated with improvements in intelligence (including both general and fluid intelligence) in youth.

Comparison of nonimplantable electrical stimulation in women with urinary incontinence: a systematic review and network meta-analysis of randomized controlled trials.

This study examined the effectiveness of various electrical stimulation methods in alleviating symptoms and enhancing the quality of life for women with urinary incontinence. We conducted a systematic search of PubMed, Cochrane Library, PEDro, EMBASE, and ClinicalTrials.gov from inception to August 2024. Randomized controlled trials (RCTs) that meet following criteria were included, urinary continence in women, using various electric stimulation treatments and evaluated outcomes related to symptoms, quality of life. Thirty RCTs were subjected to risk of bias assessment, certainty of evidence, and network meta-analysis. Statistical analysis was performed using a random-effects model, with continuous variables expressed as standardized mean difference (SMD) and 95% confidence interval (CI). Percutaneous tibial stimulation (SMD - 1.86, 95% CI - 2.77 to - 0.96) and intravaginal stimulation (SMD - 0.97, 95% CI - 1.55 to - 0.38) significantly reduced symptom severity. Additionally, percutaneous tibial, intravaginal, transcutaneous tibial, and trans-sacral stimulations improved quality of life. Percutaneous tibial stimulation was the most effective, followed by intravaginal stimulation. Despite moderate to low confidence in the evidence, large-scale RCTs are needed to evaluate long-term benefits of these treatment.

Effect of low-intensity muscle strength training on postoperative rehabilitation and adverse events in patients with knee osteoarthritis over 55 years of age: a meta-analysis

BackgroundThis study aimed to study the effect of low-intensity muscle strength training on postoperative rehabilitation of patients with knee osteoarthritis over 55 years of age and the incidence of adverse events by a meta-analysis.MethodsWe searched China National Knowledge Infrastructure (CNKI), WanFang, China Science and Technology Journal Database (VIP), PubMed, Web of science, and Embase databases for articles on the effect of low-intensity muscle strength training on the recovery of patients with knee arthritis. And meta-analysis combined effect was performed in R 4.2.2 software. Quantitative analysis and risk of bias were assessed by Begg’s and Eegger’s test.ResultsMeta-analysis showed that the effect of low-intensity muscle strength training on postoperative knee range of motion in patients with knee arthritis was mean difference (MD) = 5.20, 95% CI=[4.00, 6.40], τ2 = 0.43, P = 0.34; the effect on postoperative muscle strength was standard mean difference (SMD) = 1.24, 95% CI=[0.86, 1.61], τ2 = 0.07, P < 0.01; the effect on postoperative knee joint score was MD = 5.88, 95%CI=[2.09, 9.67], τ2 = 16.60, P < 0.01; the effect on postoperative knee visual analogue scale (VAS) score was MD=-1.12, 95%CI =[-1.43, -0.81], τ2 = 0.09, P < 0.001; the effect on the incidence of adverse events was RR = 0.85, 95%CI= [0.52 1.39], τ2 = 0.79, P = 0.04.ConclusionLow-intensity muscle strength training can improve the muscle strength of the affected limb and knee joint score, reduce the VAS score and the incidence of adverse events in patients with knee osteoarthritis over 55 years of age after surgery, but it has no effect on the postoperative knee range of motion, so it can be considered as appropriate in clinical selection.

Nurse Burnout and Patient Safety, Satisfaction, and Quality of Care

Occupational burnout syndrome is characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment and is prevalent among nurses. Although previous meta-analyses have explored the correlates of nurse burnout, none have estimated their association with health care quality and safety and patient morbidity and mortality. To evaluate the magnitude and moderators of the association between nurse burnout and patient safety, patient satisfaction, and quality of care. The Web of Science, Scopus, MEDLINE, Embase, PsycINFO, CINAHL, and ProQuest databases were searched from January 1, 1994, to February 29, 2024. Two reviewers independently identified studies that reported a quantifiable association between nurse burnout and any of the outcomes of patient safety, patient satisfaction, or quality of health care. The PRISMA 2020 guideline was followed. Two reviewers independently extracted the standardized mean difference (SMD) (Cohen d) estimates for a random-effects meta-analysis. Subgroup analyses and meta-regressions were conducted using prespecified variables. Any measure of patient safety, patient satisfaction, or quality of health care previously associated with nurse burnout. A total of 85 studies (81 cross-sectional and 4 longitudinal) involving 288 581 nurses from 32 countries (mean [SD] age, 33.9 (2.1) years; 82.7% female; mean [SD] burnout prevalence rate with study-specific ascertainments, 30.7% [9.7%]) were included. Nurse burnout was associated with a lower safety climate or culture (SMD, -0.68; 95% CI, -0.83 to -0.54), lower safety grade (SMD, -0.53; 95% CI, -0.72 to -0.34), and more frequent nosocomial infections (SMD, -0.20; 95% CI, -0.36 to -0.04), patient falls (SMD, -0.12; 95% CI, -0.22 to -0.03), medication errors (SMD, -0.30; 95% CI, -0.48 to -0.11), adverse events or patient safety incidents (SMD, -0.42; 95% CI, -0.76 to -0.07), and missed care or care left undone (SMD, -0.58; 95% CI, -0.91 to -0.26) but not with the frequency of pressure ulcers. Nurse burnout was also associated with lower patient satisfaction ratings (SMD, -0.51; 95% CI, -0.86 to -0.17) but not with the frequencies of patient complaints or patient abuse. Finally, nurse burnout was associated with lower nurse-assessed quality of care (SMD, -0.44; 95% CI, -0.57 to -0.30) but not with standardized mortality rate. The associations were consistent across nurses' age, sex, work experience, and geography and persistent over time. For patient safety outcomes, the association was smaller for the low personal accomplishment subcomponent of burnout than for emotional exhaustion or depersonalization, as well as for nurses with a college education. In this systematic review and meta-analysis, nurse burnout was found to be associated with lower health care quality and safety and lower patient satisfaction. This association was consistent across nurse and study characteristics.

Several components of postural control are affected by benign paroxysmal positional vertigo but improve after particle-repositioning maneuvers: A systematic review and meta-analysis.

Benign Paroxysmal Positional Vertigo is a vestibular disorder causing vertigo and imbalance. This systematic review and meta-analysis aims to explore the impact of benign paroxysmal positioning vertigo and repositioning maneuvers on postural control. In September 2024, PubMed, Web of Science, Scopus and reference lists of included studies were systematically searched. Articles comparing measures of postural control between patients and controls, and/or pre- and posttreatment were considered relevant. Study selection, data extraction and identification of risk of bias were done by two researchers. If possible, meta-analysis was performed with Review Manager version 5.4.1 and standardized mean differences were calculated with a random-effects model. Twenty-one of the 37 included studies were useful for meta-analyses. Meta-analyses revealed that benign paroxysmal positional vertigo negatively affects perception of verticality (p < .001; SMD = 0.73; 95% CI = [0.39;1.08]) and sensory orientation (p < .001; SMD = -1.66; 95% CI = [-2.08, -1.23]). The perception of verticality (p < .001; SMD = 0.99; 95% CI = [0.76;1.21]) and sensory orientation (p < .001; SMD = -0.77; 95% CI = [-1.11, -0.44]) improved after treatment with repositioning maneuvers. Results of systematic review indicate stability in gait was impaired, vertigo but improve after repositioning maneuvers. Limits of stability were impaired in older patients, but did not improved after repositioning maneuvers. Benign paroxysmal positioning vertigo affects several underlying components of postural control. Repositioning maneuvers can significantly improve the related postural control impairments. This may partly explain the increased odds of falling in these patients, and the positive treatment effect of repositioning maneuvers on falls and fear of falling.

Association between nickel exposure and diabetes risk: an updated meta-analysis of observational studies

ObjectiveThe results of epidemiological studies on the association between nickel exposure and diabetes remain controversial. Therefore, an update meta-analysis was conducted to examine the association between urinary nickel levels and diabetes risk, and to focus on whether there is an association between blood nickel levels and diabetes risk.MethodsRelevant studies were comprehensively searched from PubMed, Web of Science, and Wanfang databases from their inception to July 2024. The random-effects model was utilized to determine pooled Standard Mean Difference (SMD) and 95% confidence intervals (CIs), with stratified and sensitivity analyses also performed. Heterogeneity between studies was assessed using I2 statistic, while publication bias was evaluated using Egger's and Begg's tests. The quality of the included studies was assessed using the Newcastle-Ottawa Scale.ResultsA total of 19 studies involving 46,071 participants were included in this meta-analysis. The random-effects model indicated that the pooled SMD for nickel exposure levels in diabetic patients and non-diabetic controls were 0.16 (95% CI 0.07–0.2) for urine and 0.03 (95% CI −0.20 to 0.27) for blood, respectively.ConclusionIt was discovered that diabetes risk was positively correlated with urinary nickel levels, whereas there was no significant correlation with blood nickel levels. Furthermore, it appeared that the association between nickel exposure and diabetes risk differ in individuals with diabetes compared to those with pre-diabetes, and that the direction of the correlation may even be reversed. In conclusion, more high-quality prospective studies are needed in order to validate these findings in future research endeavors.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO, registration number: CRD42024534139.

Characteristics of optical coherence tomography in patients with iron deficiency anemia : a systematic review and meta-analysis.

The primary objective of this systematic review and meta-analysis was to assess the association between iron deficiency anemia (IDA) and retinal changes via optical coherence tomography (OCT). The search was conducted in MEDLINE, Scopus, Embase, Web of Science, and Google Scholar until February 1, 2024. Two independent researchers included the articles based on the inclusion and exclusion criteria. Data regarding the study design, patient characteristics, number of patients with and without IDA, mean and SD of the retinal nerve fiber layer (RNFL), C/D ratio, foveal avascular zone (FAZ) area and perimeter, foveal density and superficial and deep capillary plexus (SCP and DCP) vascular density (VD) were collected. STATA version 17.0 was used to compute pooled measures of the standardized mean difference. I2 and chi-square tests were used to assess heterogeneity between studies. We found 1378 nonduplicate studies, 35 of which were potentially relevant. 19 articles met the inclusion criteria and were included in the review. The meta-analysis confirmed that there was a statistically significant association between IDA and RNFL thickness reduction (SMD = -0.76, 95% CI: -1.09 to -0.44 ; p-value = 0.001, I2 = 86.88%), FAZ area (SMD =-0.35, 95% CI: -0.67 to -0.02; p value = 0.04, I2 = 59.76%) and SCP VD (SMD = -1.12, 95% CI: -1.85 to -0.39; p-value = 0.001, I2 = 83.15%). The associations between IDA and the C/D ratio (SMD = 0.07, 95% CI: -0.13 to 0.28; p value = 0.49, I2 = 0.0%) and DCP VD (SMD = -0.30, 95% CI: -0.89 to 0.29; ,p-value = 0.32 ,I2 = 77.20%) were not significant. There was no considerable publication bias. The results of this meta-analysis demonstrated that, compared with healthy controls, individuals with IDA presented a thinner RNFL, a smaller FAZ, and lower SCP and DCP vascular densities. However, further studies are needed to reach more conclusive results.

Virtual Reality-Based Therapy Can Enhance Balance and Muscular Endurance in Children and Adolescents with Down Syndrome: A Systematic Review with a Meta-Analysis

Physical exercises are crucial for enhancing postural balance and muscle strength in children and adolescents with Down syndrome (DS). Virtual reality-based therapy (VRBT), which utilizes exergames, can favor performing physical activity. The aim of this review was to assess the effectiveness of VRBT in improving balance and muscular endurance in children and adolescents with DS. Since inception up to August 2024, we screened in PubMed Medline, SCOPUS, WOS, CINAHL, and PEDro studies that assessed the effectiveness of VRBT, compared to conventional therapy (CT) or usual care (UC), in improving balance and muscular endurance in DS. Methodological quality was assessed using the PEDro scale. Effect size in meta-analyses was calculated with the Cohen’s standardized mean difference (SMD) and its 95% confidence interval (95% CI). Nine studies providing data from 424 participants with good methodological quality (PEDro: 6.3 ± 1.2 points) were included. Our meta-analysis showed that VRBT is more effective than controls in increasing function (SMD = 1.22; 95% CI 0.64 to 1.81; p &lt; 0.001), dynamic balance (SMD = −2.2; 95% CI −3.1 to −1.25; p &lt; 0.001), and muscular endurance (SMD = 1.37; 95% CI 0.58 to 2.2; p &lt; 0.001). This is the first meta-analysis to exclusively focus on children and adolescents with DS, demonstrating the effectiveness of VRBT in enhancing balance and muscular endurance.

A simulation-based bias analysis to assess the impact of unmeasured confounding when designing nonrandomized database studies.

Unmeasured confounding is often raised as a source of potential bias during the design of nonrandomized studies, but quantifying such concerns is challenging. We developed a simulation-based approach to assess the potential impact of unmeasured confounding during the study design stage. The approach involved generation of hypothetical individual-level cohorts using realistic parameters, including a binary treatment (prevalence 25%), a time-to-event outcome (incidence 5%), 13 measured covariates, a binary unmeasured confounder (u1; 10%), and a binary measured "proxy" variable (p1) correlated with u1. Strengths of unmeasured confounding and correlations between u1 and p1 were varied in simulation scenarios. Treatment effects were estimated with (1) no adjustment, (2) adjustment for measured confounders (level 1), and (3) adjustment for measured confounders and their proxy (level 2). We computed absolute standardized mean differences in u1 and p1 and relative bias with each level of adjustment. Across all scenarios, level 2 adjustment led to improvement in the balance of u1, but this improvement was highly dependent on the correlation between u1 and p1. Level 2 adjustments also had lower relative bias than level 1 adjustments (in strong u1 scenarios: relative bias of 9.2%, 12.2%, and 13.5% at correlations of 0.7, 0.5, and 0.3, respectively, vs 16.4%, 15.8%, and 15.0% for level 1). An approach using simulated individual-level data is useful to explicitly convey the potential for bias due to unmeasured confounding while designing nonrandomized studies, and can be helpful in informing design choices. This article is part of a Special Collection on Pharmacoepidemiology.

Attention and executive delays in early childhood: a meta-analysis of neurodevelopmental conditions.

The objective of this review was to evaluate attention and executive function performance in children with neurodevelopmental conditions across the first 5 years of life, compared to neurotypical peers. MEDLINE, EMBASE, and PsycINFO databases were searched until June 30, 2023, and studies comparing attention or executive function between children with (or at risk for) neurodevelopmental conditions and neurotypical (or low risk) peers, 0 to 5 years old, were included. Of the 4338 studies identified, 111 studies with 12292 participants were included in the meta-analysis. The qualitative analysis of brain development included 5 studies. Primary outcomes were the standardised mean difference (Hedges' g) in attention and executive function between groups. Meta-regressions examined moderating effects of age, biological sex, diagnosis, and measure type. Children with neurodevelopmental conditions showed small delays in attention (n = 49 studies, k = 251 outcomes, g = 0.36, 95% CI 0.23-0.48, p < 0.001) and moderate delays in executive function (n = 64 studies, k = 368 outcomes, g = 0.64,95% CI 0.53-0.76, p < 0.001). Attention and executive function delays could not be identified in the first year (equivalence tests, p < 0.001), small to moderate delays were found in toddlerhood and moderate delays by preschool. Delays identified were largely transdiagnostic, although there was some evidence of diagnosis-specific delays for attention and moderation by measure type (informant rating vs performance-based vs physiological). Qualitative analysis described how delays were underpinned by a divergence of brain development in medial prefrontal regions. These findings highlight the potential of using attention and executive measures to detect delay and to intervene in neurodevelopmental conditions early in life.

Efficacy and Safety of Lumateperone for Bipolar Depression and Schizophrenia: A Systematic Review and Meta-Analysis.

This study aimed to evaluate the efficacy and safety of lumateperone in treating bipolar disorder and schizophrenia. A comprehensive literature search was conducted across multiple databases and websites from inception to July 16, 2024, to identify both published and unpublished randomized controlled trials (RCTs). Meta-analyses were performed using random-effects or fixed-effects models depending on statistical heterogeneity. Relative risks (RRs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs) were used to summarize the effects. Out of 931 records screened, seven RCTs (four focusing on bipolar depression and three on schizophrenia) were eligible for inclusion. Lumateperone was efficacious in reducing depressive symptoms in bipolar depression (SMDs = -0.36, 95% CI: -0.59 to -0.13). In treating schizophrenia, lumateperone exhibited a lower combined SMD of -0.14 (95% CI: -0.27 to 0, P = 0.051, I² = 49.6%), showing no significant difference from the placebo group, although the p-value approached significance. The lumateperone group showed significantly higher response rates compared to placebo in both bipolar depression (RRs = 1.27, 95% CI: 1.07 to 1.51) and schizophrenia (RRs = 1.44, 95% CI: 1.12 to 1.86). Common treatment-emergent adverse events included somnolence, dry mouth, dizziness, nausea, and headache (RRs = 1.30 to 3.29). Importantly, lumateperone did not significantly increase extrapyramidal symptoms (EPS, RRs = 1.46, 95% CI: 0.84 to 2.53). Lumateperone is effective in treating bipolar depression but does not significantly reduce symptom severity in schizophrenia. It has a favorable safety and tolerability profile. However, caution is warranted in interpreting these findings due to the limited number of studies included.