Methodological Heterogeneity Research Articles

Systematic Review of Peptide CAQK: Properties, Applications, and Outcomes.

Many central nervous system (CNS) disorders lack approved treatment options. Previous research demonstrated that peptide CAQK can bind to chondroitin sulfate proteoglycans (CSPGs) in the extracellular matrix of the CNS. In vivo studies have investigated CAQK conjugated to nanoparticles containing therapeutic agents with varying methodologies/outcomes. This paper presents the first systematic review assessing its properties, applications, and outcomes secondary to its use. Following PRISMA guidelines, a comprehensive search was performed across multiple databases. Studies utilizing CAQK as a therapeutic agent/homing molecule in animal/human models were selected. Sixteen studies met the inclusion criteria. Mice and rats were the predominant animal models. All studies except one used CAQK to deliver a therapeutic agent. The reviewed studies mostly included models of brain and spinal cord injuries. Most studies had intravenous administration of CAQK. All studies demonstrated various benefits and that CAQK conjugation facilitated localization to target tissues. No studies directly evaluated the effects of CAQK alone. The data are limited by the heterogeneity in study methodologies and the lack of direct comparison between CAQK and conjugated agents. Overall, these findings present CAQK utilization to deliver a therapeutic agent as a promising targeting strategy in the management of disorders where CSPGs are upregulated.

Incidence and prevalence of Lewy body dementia in India: A systematic review

With increasing life expectancy in India, the prevalence of age-related disorders, such as dementia has also increased. Health and social care resources for each state are allocated based on their inhabitants’ age, sex, education, and urban/rural status but not on the dementia subtype, which can significantly influence prognosis, healthcare utilization, and quality of life. Herein, we aimed to systematically review studies investigating the prevalence of the Lewy body dementia (LBD) subtype in India. We conducted a systematic review of EMBASE, MEDLINE, and APA PsychINFO databases on June 22, 2023. Two independent reviewers performed screening and full-text review, with a third reviewer resolving any disputes. Quality was assessed for each extracted paper. Of 1372 identified studies, full-text reviews were conducted on 399 and data were extracted from 4. Two studies included prevalence data on dementia with Lewy bodies (DLB), one on Parkinson’s disease dementia and one on LBD. DLB or LBD has been reported to represent 1.0 – 8.9% of dementia diagnoses. Methodological heterogeneity was characterized by study design, access to biomarkers, diagnostic criteria, and use of cognitive tools. No studies reported incidence data. A paucity of research on LBD epidemiology in India is compounded by methodological heterogeneity, poorly representative cohorts, and varying access to biomarkers. Consensus guidelines may support data harmonization and the creation of multisite consortia, which could redress the under-representation of Central Asian data in epidemiological and genetic LBD studies.

The Effects of Collagen Peptides as a Dietary Supplement on Muscle Damage Recovery and Fatigue Responses: An Integrative Review.

The oral administration of hydrolyzed collagen peptides is a scientifically validated intervention for enhancing skeletal muscle health and performance. This integrative review consolidates the evidence supporting the use of low molecular weight collagen peptides (2000-3500 daltons) for their superior bioavailability and absorption. Our objective was to review the effects of collagen peptide or hydrolyzed collagen supplementation on muscle damage, recovery, and construction related to physical exercise. A bibliographic search was conducted in major English-language databases, including PubMed/Medline, using terms like "Peptides Collagen and Damage" and "collagen peptides AND Soreness Muscle". This review followed PRISMA guidelines, with bias risk assessed via the PEDro scale. The inclusion criteria were (a) randomized clinical trials, (b) randomized studies in humans with a control or placebo group, (c) studies assessing muscle damage or delayed onset muscle soreness via physiological markers or strength performance tests, and (d) studies using hydrolyzed collagen or collagen peptides. Initially, 752 articles were identified. After applying the inclusion and exclusion criteria, including duplicate removal, eight articles with 286 participants were included. Of these, 130 participants received collagen peptide supplementation, while 171 received a placebo or control. This integrative review supports the potential of collagen peptide supplementation to mitigate muscle stress from acute strenuous resistance training. However, due to the methodological heterogeneity among the studies, further clinical trials are needed to clarify the mechanisms underlying muscle improvement with collagen supplementation.

Association of computed tomography-derived body composition and complications after colorectal cancer surgery: A systematic review and meta-analysis.

The prediction of the risk of developing complications after colorectal surgery for colorectal carcinoma remains imprecise. Body composition measurements on a computed tomography (CT) scan can potentially contribute to a better preoperative risk assessment. The aim of this systematic review is to evaluate the evidence for the use of body composition measurements on CT scans to predict short-term complications after colorectal cancer surgery. A literature search (in PubMed, Embase and Web of Science) was performed up to 1 August 2022. Two researchers independently screened the articles, extracted data and assessed the quality of the studies using the Quality in Prognosis Studies tool. The primary outcome measure was the occurrence of complications within 30days after surgery. Meta-analysis was conducted using a random-effects model to synthesize a pooled odds ratio (OR). The study protocol was registered in PROSPERO (CRD42021281010). Forty-five articles with a total of 16537 patients were included. In total, 26 body composition measures were investigated: 8 muscle-related measures, 11 adipose tissue measures, 4 combined muscle and adipose tissue measures, and 3 other measures. These were investigated as potential predictors for more than 50 differently defined postoperative complications. Meta-analysis was only possible for two measurements and showed that higher amounts of visceral fat increase the risk of developing overall complications (OR: 2.52 [1.58-4.00], P<0.0001) and anastomotic leakage (OR: 1.76 [1.17-2.65], P=0.006). A wide variety of body composition measurements on preoperative CT scans have been investigated as a predictive factor for postoperative complications. Visceral fat appeared to be associated with overall complications and anastomotic leakage; however, the association is weak, and its clinical relevance or applicability is questionable. The current evidence is limited by methodological heterogeneity and the risk of bias. To improve comparability of results across studies and improve decision-making, future studies should use standardized methods for measuring body composition on CT scans, outcome definitions and statistical analyses.

Repetitive transcranial magnetic stimulation as a therapy for post-stroke dysphagia: An overview of systematic reviews and meta-analysis

Objective Post-stroke dysphagia is a common swallowing disorder that occurs after a stroke, leading to an increased risk of aspiration pneumonia and malnutrition. There is a pressing need for effective and safe interventions for its rehabilitation. This review aims to answer two key scientific questions: (1) What is the efficacy of repetitive transcranial magnetic stimulation in the rehabilitation of post-stroke dysphagia? (2) Is repetitive transcranial magnetic stimulation a safe intervention for post-stroke dysphagia? Data Sources A comprehensive search was conducted across four electronic databases: PubMed, Cochrane Library, Web of Science, and Embase. The search aimed to identify relevant studies concerning our topic of interest and was completed on 28 May 2024. Review methods In accordance with the PRISMA checklist, a comprehensive search of four databases was conducted, which identified 13 relevant systematic reviews. The inclusion criteria were systematic reviews that evaluated the efficacy and safety of repetitive transcranial magnetic stimulation for post-stroke dysphagia. Exclusion criteria were reviews that did not focus on post-stroke dysphagia or did not evaluate repetitive transcranial magnetic stimulation as a therapeutic intervention. The quality, bias, reporting, and overall evidence quality of these reviews were assessed using validated tools, including the AMSTAR 2 tool for assessing the methodological quality of systematic reviews, the ROBIS tool for assessing the risk of bias, and the GRADE approach for evaluating the overall quality of evidence. This rigorous approach ensures that our review provides a comprehensive and reliable overview of the current state of knowledge on the use of repetitive transcranial magnetic stimulation for post-stroke dysphagia. Results The sample sizes for the individual studies included in the systematic reviews/meta-analyses ranged from 66 to 555. The total number of participants across all studies included in the overall analyses was 752. The evidence was limited by the methodological flaws and heterogeneity of the systematic reviews. The quality of the evidence varied from high to low, with most outcomes having moderate quality. Future research should adopt more rigorous, standardized, and comprehensive designs to confirm the efficacy and safety of repetitive transcranial magnetic stimulation for post-stroke dysphagia. The main reason for downgrading the evidence quality was the small sample size and high heterogeneity of the primary studies. Conclusion This overview synthesized research on repetitive transcranial magnetic stimulation for dysphagia, aiming to inform clinical and policy decisions. However, the current evidence does not conclusively establish the safety and efficacy of repetitive transcranial magnetic stimulation for post-stroke dysphagia rehabilitation. The studies reviewed varied in quality, and many were of poor quality. Therefore, while some studies suggest potential benefits of repetitive transcranial magnetic stimulation, these findings should be interpreted with caution. There is a pressing need for more rigorous, high-quality research to validate the use of repetitive transcranial magnetic stimulation for post-stroke dysphagia rehabilitation. The implications of these findings for clinical practice and policy will be clearer once we have more robust, evidence-based recommendations.

Have interventions aimed at assisting general practitioners in facilitating earlier diagnosis of type 1 diabetes in children been successful in preventing acute complications? A systematic review

BackgroundDiabetic ketoacidosis (DKA) is a life-threatening emergency that can result from delayed diagnosis of type 1 diabetes mellitus (T1DM). Three-quarters of Australian children with a new diagnosis of T1DM visit...

Outcomes for Emergency Presentations of Lung Cancer: A Scoping Review

BackgroundLung cancer is frequently detected during visits to the emergency department (ED). The ED is crucial for identifying likely cases of lung cancer and coordinating the subsequent care for these patients. ObjectivesThis scoping review aims to explore the definitions of emergency presentations (EPs) of lung cancer, along with mortality rates, cancer stage, and treatments for patients diagnosed with lung cancer following an EP. MethodsWe conducted a scoping review of the literature on EPs of lung cancer, identifying 27 relevant articles out of 1,338 initially screened. ResultsMost studies originated from the United Kingdom, collectively reporting over 270,000 EPs of lung cancer. The majority of included studies provided strong evidence. Key findings revealed higher mortality rates among patients diagnosed with lung cancer through emergency presentations, with a significant proportion presenting at advanced stages. Patients with EPs were less likely to undergo surgical removal or receive radiotherapy. Lastly, only 66.7% of the studies defined an EP, with great heterogeneity among EP definitions. Methodological differences precluded meta-analysis. ConclusionDespite methodological heterogeneity, our synthesis indicates that patients presenting acutely with undiagnosed lung cancer often present at advanced stages and experience high mortality rates. These findings underscore the need for further research to develop evidence-based interventions for improving outcomes among ED patients with suspected lung cancer.

How reliable is the distinction between thoracolumbar AO type A3 and A4 fractures? A systematic literature review.

The AOSpine classification divides thoracolumbar burst fractures into A3 and A4 fractures; nevertheless, past research has found inconsistent interobserver reliability in detecting those two fracture patterns. This systematic analysis aims to synthesize data on the reliability of discriminating between A3 and A4 fractures. We searched PubMed, Scopus, and the Web of Science for studies reporting the inter- and intra-observer reliability of detecting thoracolumbar AO A3 and A4 fractures using computed tomography (CT). The search spanned 2013 to 2023 and included both primarily reliability and observational comparative studies. We followed the PRISMA guidelines and used the modified COSMIN checklist to assess the studies' quality. Kappa coefficient (k) values were categorized according to Landis and Koch, from slight to excellent. Of the 396 identified studies, nine met the eligibilitycriteria; all were primarily reliability studies except one observational study. Interobserver k values for A3/A4 fracturesvaried widely among studies (0.19-86). The interobserver reliability was poor in two studies, fair in one study, moderate in four studies, and excellent in two studies. Only two studies reported intra-observer reliability, showing fair and excellent agreement. The included studies revealed significant heterogeneity in study design, sample size, and interpretation methods. Considerable variability exists in interobserver reliability for distinguishing A3 and A4 fractures from slight to excellent agreement. This variability might be attributed to methodological heterogeneity among studies, limitations of reliability analysis, or diagnostic pitfalls in differentiating between A3 and A4. Most observational studies comparing the outcome of A3 and A4 fractures do not report interobserver agreement, and this should be considered when interpreting their results.

Understanding Medical Cannabis: A Simple Guide to CBD and THC

There is an ongoing debate in the literature about the place of cannabinoid therapy in everyday clinical practice. The overview examined systematic reviews and meta-analyses on the use of medical marijuana (MM) in specific or diseases, such as epilepsy, multiple sclerosis, pain, nausea and vomiting during chemotherapy, cachexia, and sleep disorders. We analyzed different cannabinoids like CBD, THC, dronabinol, nabilone, and THC:CBD combinations (Nabiximol) to understand their effects on various medical conditions, dose effectiveness, and side effects. CBD showed promise epilepsy, Nabilone showed a significant reduction in pain and insomnia, Nabiximol has been effective in reducing spasticity, pain, and sleep disturbance in multiple sclerosis patients. Nabilone and dronabinol improve nausea and vomiting due to chemotherapy, but the evidence is low. The results on the effectiveness of MM in the treatment of cachexia and cancer pain are inconclusive. Outcomes suggest that side effects typically were mild to moderate in severity. The type of cannabinoid (including CBD and THC content) and amount of dose, were found to potentially influence the results obtained in the trials, affecting both the effectiveness and the side effects experienced by patients. Young people, elderly, and children are particularly vulnerable and, despite ongoing research in these age groups, we still know too little about whether and in which clinical conditions the use of medical cannabis is justified. The analyzed studies faced limitations due to heterogeneity in methodology, dosages, and outcome measures and highlighting potential controversies in interpreting the results, so further research is needed.

Impact of hospital pharmacy interventions on length of stay in hospitals: a protocol for a systematic review and meta-analysis

Background Length of stay (LOS) is an essential metric for hospital efficiency, patient outcomes and satisfaction. Studies indicate hospital pharmacy interventions positively affect LOS and other outcomes, yet results vary due to study differences. No systematic review or meta-analysis has been conducted on this topic; thus, the aim of this study is to systematically assess the effect of interventions on LOS. Methods This review will conduct a systematic search across MEDLINE, EMBASE, Cochrane Trials, Cochrane Reviews and the Cumulative Index to Nursing and Allied Health Literature to identify pertinent studies. An expert librarian will craft the search strategy, ensuring our review adheres to standard guidelines. We will use Covidence, a specialized systematic review management software, to optimize data management, the selection process and data extraction. A dedicated team of reviewers will independently evaluate titles and abstracts in duplicate, progressing to full-text examination of articles, to determine inclusion in our review and analysis. Data will be extracted by one reviewer, with independent data extraction by a second reviewer in a proportion of papers, and checking for consistency by a third. A template in Covidence will guide extraction of study, setting, participant, intervention and outcome characteristics and findings. The findings will be described narratively, and if possible given the methodological and statistical heterogeneity, meta-analysis will be undertaken. Discussion Considering the inconsistency of previous studies, this systematic review aims to clarify the potential impact of hospital pharmacy interventions on LOS. It will expand and reinforce existing knowledge, and provide detail about which intervention types have the most impact on LOS.

Clinician and health service interventions to reduce the greenhouse gas emissions generated by healthcare: a systematic review

ObjectiveTo synthesise the available evidence on the effects of interventions designed to improve the delivery of healthcare that reduces the greenhouse gas (GHG) emissions of healthcare.DesignSystematic review and structured synthesis.Search...

External ear malformations and cardiac and renal anomalies: A systematic review and meta-analysis.

External Ear Malformations (EEM) continue to be a common malformation seen in the pediatric patient population. This study aims to further elucidate the correlation between EEM and cardiac and renal anomalies. A systematic review and meta-analysis to study the incidence of cardiac and renal anomalies associated with syndromic and isolated (EEM). The literature search spanned multiple databases, including Google Scholar, PubMed, Scopus, Web of Science, and MEDLINE. Studies must be focused on EEM and cardiac and/or renal anomalies. Only articles written in English were included. General study characteristics, number of EEM patients, number of cardiac and renal anomalies and whether cases were syndromic were extracted from the studies. Of 1,058 initial studies, 33 were included for meta-analyses. Mean JBI score for all included studies was 92.06%, indicating acceptable study quality. Interrater reliability was high, with a Cohen kappa score for all studies of 0.94. The resulting pooled prevalence of cardiac abnormalities was 20% [95% CI:13-28%], while renal abnormalities were 13% [95% CI: 7-20%]. The most common anomalies were VSD (3.725%) and renal agenesis (2.04%). The presence of syndrome data across studies was not a significant modifier of prevalence rates. Primary limitation is due to heterogeneity in individual study methodology and reporting standards. These results highlight a higher prevalence of cardiac-related conditions than renal anomalies in patients with both syndromic and non-syndromic EEM in the included studies, underscoring the need for thorough clinical evaluations.

The association between bullying victimization and back pain in young people: a systematic literature review and meta-analysis

Abstract Back pain is a common and recurrent health complaint in adolescence. Psychosocial factors may be associated with the onset and persistence of back pain symptoms. This systematic review aims to determine the association between bullying victimization and back pain in young people. Observational studies that quantified the association between bullying victimization and back pain in participants were included in this systematic review. Estimates of associations and confidence intervals were extracted. A random effects meta-analysis of estimates of association was performed. The quality of evidence was assessed using the Joanna Briggs Institute critical appraisal checklist for analytical cross-sectional studies. Database searches yielded 18,311 citations. Nineteen studies (n = 212,058, 51.4% female) were included in our review. Meta-analysis showed a positive association between bullying victimization and back pain (odds ratio 1.93, confidence interval 1.75-2.13). Subgroup analysis showed no statistically significant effect of sex, age, bullying type, pain type, recall periods, bullying frequency, back pain frequency, risk estimate adjustment, and study critical appraisal rating. All studies were rated at moderate-high risk of bias. Our synthesis of evidence found a weak-moderate association between bullying victimization and back pain in young people. Methodological shortcomings and heterogeneity in the field limit causal inference. Future longitudinal studies are required.

Role of sex and training characteristics on exercise effects on cardiovascular aging: protocol for a systematic review with meta-analysis of randomized trials

BackgroundCardiovascular diseases remain a leading global cause of mortality worldwide especially in older adults. Although it is known that regular exercise reduces cardiovascular diseases incidence, its effects on specific cardiovascular aging parameters considering the influence of sex and different exercise designs are still not fully understood. Therefore, this systematic review and meta-analysis aims to evaluate the effects of different physical exercise protocols on age-related cardiovascular outcomes in older adults.MethodsThis systematic review and meta-analysis will be reported in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Articles will be eligible if they are randomized controlled trials with a primary objective of evaluating the chronic effects of exercise interventions on cardiovascular aging parameters. Search strategy will be performed from the inception to September 30th, 2023, in the following electronic databases: MEDLINE (Ovid), SCOPUS (Elsevier), Embase, Sport Discus (EBSCO), Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science Core Collection (Clarivate Analytics). Data will be extracted and managed through Research Electronic Data Capture (REDCap) software. The Tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX) will be used to assess the methodological quality of included studies. Additionally, the quality of the findings will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) profiler. Meta-analysis based on the random-effects model will be performed (if deemed suitable, considering the methodological and clinical heterogeneity of the studies) to estimate the effects of exercise training on cardiovascular aging variables (i.e., cardiac output; arterial stiffness; stroke volume; endothelial function; and carotid intima-media thickness). Heterogeneity will be assessed with the I2 statistics, while the publication bias will be assessed based on Egger’s test.DiscussionTo the best of our knowledge, this will be the first systematic review and meta-analysis to investigate the impact of sex and training protocols on the cardiovascular aging parameters. Moreover, the findings of this systematic review and meta-analysis will provide evidence for health professionals in the management of elderly patients in order to optimize the exercise prescription to face the cardiovascular alterations related to the aging process, considering the effects of different protocols according to sex.Systematic review registrationPROSPERO CRD42023441015 .

Does orthodontic treatment using fixed appliances cause initial caries lesions?

Systematic review and meta-analysis of randomized clinical trials (RCTs), non-randomized studies of intervention (NRSIs), cohort and cross-sectional studies. The systematic review was registered in advance on PROSPERO, and was conducted following the Cochrane Handbook of Systematic Reviews of Interventions and PRISMA checklist. An electronic search in three databases (PubMed, Scopus, and Embase) was conducted by two authors to evaluate studies published from 1990 until May 2023. The review question was defined in PICOS format as follows: Population (P), subjects with permanent dentition who having/had orthodontic therapy; Exposure (E), orthodontic therapy with fixed orthodontic appliance; Comparison/Control (C), no orthodontic treatment or intervention; Outcome (O), assessing incidence and/or prevalence of initial caries lesions (ICLs) at subject and teeth levels was the primary outcome, whereas evaluating the influence of demographics and treatment-related variables were secondary outcomes; studies (S), randomized clinical trials, non-randomized clinical studies, cohort and cross-sectional studies. Meta-analysis was conducted of three or more included studies had comparable findings. The following factors were calculated for each study; sample size, number of patients with ICLs, number of teeth with ICLs, number of teeth affected per patient, and number of surfaces affected. Statistical heterogeneity of effects among studies was assessed by means of the Cochran's test was used to evaluate the statistical heterogeneity of effects in the included studies. Funnel plot approach was used to assess publication bias, whereas Begg's and Egger's correlation test were used to identify asymmetry. Meta-analysis was conducted using a random effects model owing to high methodological and clinical heterogeneity. A descriptive analysis was presented when the meta-analyses appeared inappropriate. Statistical significance level was set at p < 0.05 for all statistical analyses. 21 studies were included in the qualitative synthesis (systematic review); 11 RCTs; 7 NRSIs, and 3 observation studies. Of the included studies, 19 studies were analyzed in the quantitative synthesis (meta-analysis). In regard to the prevalence rate of ICLs; 57% of patients had ICLs, with a mean of 2.24 lesions per patient and 22% of surfaces were affected. In regard to the incidence rate; 48% of patients developed new ICLs, with a mean of 2.29 new lesions per patient, and 15% of surfaces became affected. Both prevalence and incidence rates were positively associated with the duration of the orthodontic therapy (P = 0.01 and P < 0.01, respectively), illustrating an elevation in the ICLs numbers as the treatment duration (number of months) increases. There was no association between patients' age and ICLs numbers. Orthodontic therapy using fixed appliances can increase the risk of accumulating plaque and developing caries lesion. However, other risk factors may play a role in developing ICLs; thus, controlling for these factors is paramount to better evaluate the true influence of orthodontic therapy on the ICLs development. Implementing caries preventive measures during orthodontic treatment may be needed to minimize the potential risks.

Comparative Evaluation of the Accuracy of Electronic Apex Locator and Digital Radiography for Working Length Determination in Primary Teeth: A Systematic Review.

It is challenging to perform a pulpectomy procedure in primary tooth because of its physiological root resorption and variation in root morphology. Working length measurement is considered to be one of the critical steps, as it determines the extent of obturation and apical seal. To compare the accuracy of electronic apex locator (EAL) and digital radiography (DR) for working length determination in primary teeth. In this systematic review, electronic databases and grey literature were searched from 1st January 2005 to 1st January 2023 for randomized control trial, non- randomized control trial, in vitro studies, ex vivo studies that compared accuracy of EAL and DR in primary teeth. Two reviewers independently identified studies, retrieved data, and assessed risk of bias using the revised and validated MINORS (methodological index for non-randomized studies) criteria. Ten studies were included in qualitative analysis. Seven out of ten studies showed low risk of bias whereas other three studies showed high risk of bias. In view of methodological heterogeneity of the findings, a meta-analysis was not conducted. Available evidence suggests a moderate quality of evidence in this systematic review. Analyzing the ten studies included in this systematic review, the majority of studies showed statistically insignificant difference between EAL and DR. However, EAL was closer to actual WL as compared to DR. Based on the evidence that is currently available; EAL can be considered as an alternative for working length measurement in primary teeth.

Machine learning in paediatric haematological malignancies: a systematic review of prognosis, toxicity and treatment response models.

Machine Learning (ML) has demonstrated potential in enhancing care in adult oncology. However, its application in paediatric haematological malignancies is still emerging, necessitating a comprehensive review of its capabilities and limitations in this area. A literature search was conducted through Ovid. Studies included focused on ML models in paediatric patients with haematological malignancies. Studies were categorised into thematic groups for analysis. Twenty studies, primarily on leukaemia, were included in this review. Studies were organised into thematic categories such as prognoses, treatment responses and toxicity predictions. Prognostic studies showed AUC scores between 0.685 and 0.929, indicating moderate-high predictive accuracy. Treatment response studies demonstrated AUC scores between 0.840 and 0.875, reflecting moderate accuracy. Toxicity prediction studies reported high accuracy with AUC scores from 0.870 to 0.927. Only five studies (25%) performed external validation. Significant heterogeneity was noted in ML tasks, reporting formats, and effect measures across studies, highlighting a lack of standardised reporting and challenges in data comparability. The clinical applicability of these ML models remains limited by the lack of external validation and methodological heterogeneity. Addressing these challenges through standardised reporting and rigorous external validation is needed to translate ML from a promising research tool into a reliable clinical practice component. Key message: Machine Learning (ML) significantly enhances predictive models in paediatric haematological cancers, offering new avenues for personalised treatment strategies. Future research should focus on developing ML models that can integrate with real-time clinical workflows. Addition to literature: Provides a comprehensive overview of current ML applications and trends. It identifies limitations to its applicability, including the limited diversity in datasets, which may affect the generalisability of ML models across different populations. Encourages standardisation and external validation in ML studies, aiming to improve patient outcomes through precision medicine in paediatric haematological oncology.

Effectiveness of High-Intensity Circuit Training on Physical Fitness Among Athletes: A Systematic Review of Randomized-Controlled and Non-Controlled Trials

Background and Aim of the Study: The continuous evolution of sports and athletics necessitates innovative training strategies to optimize athletes’ performance and physical fitness. High-Intensity Circuit Training (HICT) has emerged as a time-efficient method that combines high-intensity exercises with minimal rest, targeting various muscle groups to enhance physical fitness components. Therefore, this systematic review aims to evaluate the effectiveness of HICT on physical fitness components among athletes to provide a clear, evidence-based understanding of HICT’s benefits and limitations. Material and Methods: A comprehensive search strategy was employed, retrieving articles published before September 24, 2023, from databases including the Cochrane Central Register of Controlled Trials, PubMed, and Google Scholar. The selection process followed the PRISMA guidelines, focusing on studies that assessed the impact of HICT on athletes’ physical fitness. The quality of included studies was assessed using the PEDro scale, and data synthesis was conducted to summarize findings on various physical fitness components. Results: The review included 13 studies, highlighting HICT’s positive effects on muscle strength, endurance, flexibility, balance, power, body composition, and cardiovascular endurance. Improvements were noted in neuromuscular efficiency, muscle power, coordination, and cardiovascular fitness, which are crucial for athletic performance. However, the review also identified variability in training adaptations and the need for sport-specific exercises to maximize the benefits of HICT for speed and power enhancements. Conclusions: HICT is a versatile and effective training modality that can significantly improve various aspects of athletes’ physical fitness. Incorporating targeted, sport-specific exercises into HICT programs could further optimize performance enhancements. Despite promising findings, the review acknowledges methodological heterogeneity among studies and calls for further research to refine HICT protocols for athletes.

Data Quality-Driven Improvement in Health Care: Systematic Literature Review.

The promise of real-world evidence and the learning health care system primarily depends on access to high-quality data. Despite widespread awareness of the prevalence and potential impacts of poor data quality (DQ), best practices for its assessment and improvement are unknown. This review aims to investigate how existing research studies define, assess, and improve the quality of structured real-world health care data. A systematic literature search of studies in the English language was implemented in the Embase and PubMed databases to select studies that specifically aimed to measure and improve the quality of structured real-world data within any clinical setting. The time frame for the analysis was from January 1945 to June 2023. We standardized DQ concepts according to the Data Management Association (DAMA) DQ framework to enable comparison between studies. After screening and filtering by 2 independent authors, we identified 39 relevant articles reporting DQ improvement initiatives. The studies were characterized by considerable heterogeneity in settings and approaches to DQ assessment and improvement. Affiliated institutions were from 18 different countries and 18 different health domains. DQ assessment methods were largely manual and targeted completeness and 1 other DQ dimension. Use of DQ frameworks was limited to the Weiskopf and Weng (3/6, 50%) or Kahn harmonized model (3/6, 50%). Use of standardized methodologies to design and implement quality improvement was lacking, but mainly included plan-do-study-act (PDSA) or define-measure-analyze-improve-control (DMAIC) cycles. Most studies reported DQ improvements using multiple interventions, which included either DQ reporting and personalized feedback (24/39, 61%), IT-related solutions (21/39, 54%), training (17/39, 44%), improvements in workflows (5/39, 13%), or data cleaning (3/39, 8%). Most studies reported improvements in DQ through a combination of these interventions. Statistical methods were used to determine significance of treatment effect (22/39, 56% times), but only 1 study implemented a randomized controlled study design. Variability in study designs, approaches to delivering interventions, and reporting DQ changes hindered a robust meta-analysis of treatment effects. There is an urgent need for standardized guidelines in DQ improvement research to enable comparison and effective synthesis of lessons learned. Frameworks such as PDSA learning cycles and the DAMA DQ framework can facilitate this unmet need. In addition, DQ improvement studies can also benefit from prioritizing root cause analysis of DQ issues to ensure the most appropriate intervention is implemented, thereby ensuring long-term, sustainable improvement. Despite the rise in DQ improvement studies in the last decade, significant heterogeneity in methodologies and reporting remains a challenge. Adopting standardized frameworks for DQ assessment, analysis, and improvement can enhance the effectiveness, comparability, and generalizability of DQ improvement initiatives.

Effects of Dietary Nitrate Supplementation on High-Intensity Cycling Sprint Performance in Recreationally Active Adults: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis investigated the influence of dietary nitrate supplementation on performance metrics during cycling sprint exercise according to the PRISMA guidelines. Searches were conducted on MEDLINE, PubMed, ScienceDirect, Scopus, and SPORTDiscus databases up to September 2023. Inclusion criteria were healthy recreationally active men and women who consumed nitrate-rich and nitrate-deficient beetroot juice to assess performance outcomes of mean power, peak power, time-to-peak power, and minimum power during 30-s cycling sprints. Risk of bias was assessed using the Cochrane Risk of Bias 2 and TESTEX tools and funnel plots. A random effects model was performed on six studies and showed that dietary nitrate had significant effects on time-to-peak power (SMD: -0.66, 95% CI: -1.127 to -0.192, p = 0.006) but not on mean power, peak power, or minimum power. Subgroup analysis revealed that an acute low nitrate dose improved time-to-peak power (SMD: -0.977, 95% CI: -1.524 to -0.430, p < 0.001) but not after a multiday moderate nitrate dose (SMD: -0.177, 95% CI: -0.619 to -0.264, p = 0.431). These data suggest that acute nitrate supplementation can benefit time-to-peak power during 30-s cycling sprints, but due to the limited availability of data and heterogeneity in methodology, these results should be interpreted with caution. There was insufficient data on women to analyze sex-based differences. Future studies are required to provide insight on how supplementation regimen and population impact the effects of dietary nitrate for enhancing cycling sprint performance.