Methodological Quality Research Articles

Comparative analysis of dynamic external fixation, static external fixation, and internal fixation in interphalangeal joint fractures: outcomes, complications, and clinical implications

Background and objectiveProximal interphalangeal joint (PIPJ) fractures present significant therapeutic challenges in hand surgery. This systematic review evaluated the comparative efficacy of dynamic external fixation against traditional treatment modalities, integrating machine learning analysis to enhance outcome prediction and treatment selection.MethodsWe systematically reviewed 43 clinical studies published between January 2014 and January 2024, including 26 dynamic external fixations, 6 traditional internal fixations, and 11 static external fixations. Studies were included if they reported quantitative outcomes of PIPJ fracture treatment, had a minimum follow-up of 4 weeks, and included at least 20 patients. Case series with fewer than 5 patients and non-English publications without available translations were excluded. The analysis focused on four key outcomes: range of motion (ROM), recovery time, complication rates, and functional results. We developed a neural network model to predict treatment outcomes, achieving 89.7% accuracy (95% CI 87.3–92.1%). Methodological quality was assessed using the Newcastle–Ottawa Scale and Cochrane Risk of Bias tool.ResultsDynamic external fixation demonstrated superior outcomes across multiple domains. ROM analysis revealed a median of 86.12° (range: 70°–95°) for dynamic fixation compared to 72.30° (range: 56°–88°) for traditional approaches (mean difference: 13.82°, 95% CI 10.24–17.40°). Dynamic fixation significantly reduced recovery duration (9.68 weeks vs. 20.47 weeks, p < 0.001). Complication profiles favored dynamic fixation, with pin tract infection rates of 2.4% versus 3.8% for traditional fixation. Functional assessment using the Ishida scoring system showed favorable outcomes in the dynamic fixation group, with a mean score of 85.3 points and 78% of cases achieving scores above 80 points.DiscussionThis comprehensive systematic review provides evidence supporting the efficacy of dynamic external fixation for PIPJ fracture treatment. The findings demonstrate improved functional outcomes, accelerated rehabilitation, and reduced complication rates. The integration of machine learning analysis shows promise for optimizing patient-specific treatment selection. Further validation through large-scale, multicenter randomized controlled trials with extended follow-up periods is warranted.

Effectiveness of Probiotics, Prebiotics, and Symbiotic Supplementation in Cystic Fibrosis Patients: A Systematic Review and Meta-Analysis of Clinical Trials

Background and Objectives: Cystic fibrosis (CF), caused by CFTR gene mutations, primarily affects the respiratory and gastrointestinal systems. Microbiota modulation through probiotics, prebiotics, or synbiotics may help restore microbial diversity and reduce inflammation. This study aimed to evaluate their efficacy in CF. Materials and Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) published between 2000 and 2024 was conducted in Cochrane, ScienceDirect, Web of Science, LILAC, BMC, PubMed, and SCOPUS following PRISMA guidelines. Methodological quality was assessed using the Jadad scale, and RevMan 5.4® estimated effects on pulmonary function (FEV1), exacerbations, hospitalizations, quality of life, and inflammatory markers. Results: Thirteen RCTs (n = 552), mostly in pediatric populations, were included. Most examined probiotics (e.g., Lactobacillus rhamnosus GG, L. reuteri), while four used synbiotics. Several studies reported reduced fecal calprotectin and proinflammatory interleukins (e.g., IL-6, IL-8), suggesting an anti-inflammatory effect. However, no significant differences were observed regarding hospitalizations or quality of life. Additionally, none of the studies documented serious adverse events associated with the intervention. The meta-analysis showed no significant decrease in exacerbations (RR = 0.81; 95% CI = 0.48–1.37; p = 0.43) or improvements in FEV1 (MD = 4.7; 95% CI = −5.4 to 14.8; p = 0.37), even in subgroup analyses. Sensitivity analyses did not modify the effect of the intervention on pulmonary function or exacerbation frequency, supporting the robustness of the findings. Conclusions: Current evidence suggests that probiotics or synbiotics yield inconsistent clinical benefits in CF, although some reduction in inflammatory markers may occur. Larger, multicenter RCTs with longer follow-up are needed for clearer conclusions. Until more definitive evidence is available, these supplements should be considered experimental adjuncts rather than standard interventions for CF management.

20 Evaluating the Post-operative Outcomes of Progressive Tension Suturing Compared to Drains in Abdominoplasty Surgery: A Systematic Review and Meta-Analysis

Abstract Closed suction drains are placed to prevent seroma formation after abdominoplasty, but evidence of their effectiveness is limited, and they may increase infection risk and patient discomfort. Previous meta-analyses comparing progressive tension suturing (PTS) to drainage (D) in abdominoplasty have been methodologically weak and small in sample size. In this study we aimed to conduct the first robust systematic review comparing PTS and D outcomes in abdominoplasty. Data were pooled with a random effects Mantel–Haenszel model. Risk of bias was assessed with Cochrane’s risk-of-bias tool and the ROBINS-I tool for randomized controlled trials and observational studies, respectively. The GRADE system evaluated methodological quality. PTS significantly reduced postoperative seroma rates (relative risk [RR] 0.34; 95% CI 0.15-0.76; P = .001) and reoperation rates (RR = 0.56; 95% CI 0.03-9.77; P =0.05) compared to drains, with no significant differences in hematomas, infections, or dehiscence. We included 24 studies with 750 patients, including 2 randomized controlled trials, and was found to be methodologically superior by AMSTAR-2 criteria. Subgroup analysis indicated that combining liposuction with PTS significantly reduced seromas (RR 0.18; 95%CI 0.00-7.39; P &amp;lt; .00001), infections (RR 0.16; 95% CI 0.03-0.86; P = 0.03), and dehiscence (RR 0.11; 95% CI 0.01-1.01; P = .05). This robust meta-analysis showed PTS was superior to drains in reducing seroma and reoperation rates, with no difference for hematomas or infections. Combining liposuction with PTS may be superior to placing drains. Larger, high-quality studies are needed to further assess the safety and efficacy of drainless abdominoplasty.

Periodontitis and Platelets Status: A Systematic Review With Meta-Analysis and Trial Sequential Analysis.

Circulating platelets are essential in hemostasis, thrombosis, and immune responses. Modifications in platelet function may impact immunological reactions to dental biofilm and cardiovascular health. Understanding changes in platelet status and activity in patients with periodontitis is still a subject of investigation. This study aimed to synthesize evidence from observational studies that investigated platelet status and activity in patients with and without periodontitis. MEDLINE-PubMed, EMBASE, and Cochrane-CENTRAL Library databases were searched up to November 2024. Primary outcomes included platelet count (PC) and mean platelet volume (MPV). Secondary outcomes encompassed any other biomarker relevant to platelet status and activity. Methodological quality was evaluated using the Newcastle-Ottawa scale, and heterogeneity was analyzed. Descriptive analysis of outcomes and meta-analysis, incorporating trial sequential analysis of PC and MPV, were conducted. The body of evidence was graded by utilizing the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). 3621 unique records were identified, resulting in 23 eligible studies with 22 variables evaluating the platelet status. Fourteen studies exhibited a low risk of bias, and 9 exhibited moderate risk of bias. PC in patients with periodontitis was significantly higher compared to individuals without periodontitis (Mean Difference (MD) = 23.55 ×109/L, 95% CI [7.68; 39.43]). There was no statistically significant difference between the groups for MPV (MD = 0.16 fL, 95% CI [-0.49; 0.82]). Trial sequential analysis indicated a conclusive meta-analysis of PC and highlighted the need for additional data on MPV from future trials. The certainty is moderate for slightly higher PC in patients with periodontitis compared to individuals without it and low for no difference in MPV between the two groups. The evidence is not robust to claim a clear difference in other platelet activation biomarkers between the two groups. International Prospective Register of Systematic Reviews (PROSPERO) by number: CRD42023439051.

Are school-based behavioural interventions an effective strategy for improving physical activity and sedentary behaviour in children and adolescents? A meta-analysis

ObjectiveThis systematic evaluation and meta-analysis [PROSPERO CRD42024598218] was conducted in order to summarise the effectiveness of a body of school-based behavioural interventions on physical activity (PA) and sedentary behaviour in children and adolescents.MethodsWe conducted a systematic search of the literature up to November 2024 using PubMed, Web of Science and SCOPUS. The methodological quality of the included literature was assessed using the Cochrane Risk Assessment Tool.ResultsOf the 6,071 search records initially identified, 26 studies were considered eligible for systematic evaluation and meta-analysis. School-based behavioural interventions were effective in increasing moderate-intensity physical activity [standardised mean difference (SMD), 0.18 (95% CI, 0.04–0.31), p = 0.01]. School-based behavioural interventions failed to reduce ST (sedentary time) [−0.04 (95% CI, −0.08 to −0.01), p = 0.12] and failed to improve low-intensity PA (LPA) [0.18 (95% CI, −0.07–0.44), p = 0.16]. Subgroup analyses showed that school-based behavioural interventions were more effective in improving moderate-intensity PA in children and adolescents who were in school [0.46 (95% CI, 0.20–0.72), p = 0.02]. School-based behavioral interventions do not differentiate moderate-intensity physical activity among children and adolescents of different ages, [0.18 (95% CI, 0.05–0.31), p = 0.1], nor do they make a difference in moderate-intensity physical activity among children and adolescents in different regions [0.18 (95% CI, 0.04–0.31), p = 0.12].ConclusionSchool-based behavioural interventions are effective in increasing moderate-intensity PA among children and adolescents, particularly those who were in school.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/recorddashboard, PROSPERO [CRD42024598218].

Effects of transcranial direct current stimulation (tDCS) on motor function among people with stroke: evidence mapping

ObjectiveTo present, organize, and assess the methodological quality of the current research related to tDCS on motor function after a stroke and to identify gaps and clinical implications using an evidence mapping approach.MethodsSix electronic databases (PubMed, Embase, Cochrane Library, Web of Science, CINAHL, PEDro), gray literature, and reference lists of articles were searched from inception until October 2023. The Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) checklist and PEDro scale were used to assess the methodology quality of systematic reviews (SRs) and randomized controlled trials (RCTs).ResultsA total of 172 articles met the inclusion criteria from 5759 records, including 46 SRs and 126 RCTs. Related studies came from 29 countries around the world, and China has performed the most, with 12 SRs and 21 RCTs. More than half of SRs (65.22%) were evaluated with low or critically low quality, while 78.58% of RCTs have shown excellent or good quality. A total of 26 SRs and 93 RCTs have reported outcomes on upper limb motor function with kinds of tDCS, and 15 SRs and 44 RCTs have focused on lower extremity function. Studies with safety concerns have reported no or mild adverse events.ConclusionsThis study systematically identified gaps and indicated that tDCS is a kind of potential and safe intervention. Given potential concerns on the clinical application, more high-quality research with large sample size and kinds of objectives is needed in the future.

Safety and efficacy of proton pump inhibitors in preterm infants with gastroesophageal reflux disease.

Although physiological reflux is seen in nearly all newborns to varying degrees, symptoms can be severe and cause gastroesophageal reflux disease (GERD). In preterm infants, one symptom that is often attributed to GERD is apnea and associated cardiorespiratory events, such as bradycardia and oxygen desaturation. Although the relationship between GERD and apnea, bradycardia, and desaturation events remains a subject of ongoing investigation, trials of agents that reduce gastric acidity, such as proton pump inhibitors (PPI), have been conducted to assess the effect of these agents on GERD. To assess the benefits and harms of PPIs for the treatment of preterm infants with diagnosed or suspected GERD. We searched CENTRAL, MEDLINE, Embase, two trial registries, and Epistemonikos in October 2023. We checked reference lists of included studies, and studies and systematic reviews in which the subject matter was related to the intervention or population examined in this review. We included randomized controlled trials, quasi-randomized controlled trials, cross-over trials, and cluster-randomized trials that assessed the use of PPIs (including esomeprazole, lansoprazole, omeprazole, pantoprazole, or rabeprazole) alone or in combination. Infants had to receive treatment for a minimum of three days. We considered the following comparisons: (1) PPIs versus no treatment, (2) PPI versus positioning changes (elevated head of bed or prone positioning), (3) PPI versus dietary changes (thickened feeds). We excluded studies examining alginates and histamine receptor blockers. Studies including other non-pharmacological interventions for GERD were included if these interventions were available to infants in all study groups. Two review authors independently identified eligible trials, reviewed the methodological quality of each trial, and extracted data on prespecified outcomes. Data were compared and differences resolved. We used standard methods of Cochrane Neonatal to synthesize data using relative risk (RR), risk difference (RD), and mean difference (MD). After screening 1217 articles, only two studies, enrolling a total of 62 infants, met our criteria. Both studies compared the use of PPIs to no treatment (placebo). One study included ten infants with a mean gestational age of 36.1 ± 0.7 weeks, who were treated with seven days of PPI or placebo, and then crossed over to the other study arm for seven days, with gastric pH monitoring performed at the end of each week. The other study included 52 infants with a mean gestational age of 31 weeks, who were randomized to a PPI or placebo for 14 days, with various outcomes measured at baseline and after 14 days. Both studies were judged to be at low risk of bias. Only one study (N = 52) reported the primary outcome, cardiorespiratory events. The evidence is very uncertain about the effect of PPIs on cardiorespiratory events (MD 6.14 lower, 95% CI 44.51 lower to 32.23 higher). The evidence is very uncertain for the reported secondary outcome measures, including apnea at the end of treatment (MD 0.30 lower, 95% CI 0.93 lower to 0.33 higher), bradycardia at the end of treatment (MD 1.89 higher, 95% CI 1.11 lower to 4.89 higher), desaturation at the end of treatment (MD 7.72 lower, 95% CI 45.86 lower to 30.42 higher), choking at the end of the treatment (MD 0.96 higher, 95% CI 1.88 lower to 3.80 higher), irritability at the end of treatment (MD 0.02 higher, 95% CI 11 lower to 10.96 higher), and vomiting at the end of treatment (MD 0.34 higher, 95% CI 3.15 lower to 3.83 higher). The study was prematurely discontinued due to poor enrollment. One study (N = 10) reported a marked reduction in the percentage of time spent with esophageal acid exposure, with pH < 4. However, there was no effect on the frequency of symptoms. The study sample precludes the ability to extrapolate any significant data. Neither study reported data on length of stay or parental satisfaction. There were insufficient data to perform a meta-analysis. No trials addressed the issue of PPI versus positioning changes, or PPI versus dietary changes (thickened feeds). Although widely used, there are insufficient data regarding the benefits and harms of proton pump inhibitors in preterm infants with gastroesophageal reflux disease. The most limiting factor was the paucity of studies on preterm infants. Even the studies that were included in this review were not limited to preterm infants. Hence, further studies are needed to address the safety and efficacy of proton pump inhibitors for the treatment of diagnosed or suspected gastroesophageal reflux disease in preterm neonates.

Examining the Association between Heat Exposure and Crime in Cities across theUnited States: A Scoping Review.

Growing evidence suggests exposure to high temperatures may result in increased urban crime, a known driver of health and health inequity. Theoretical explanations have been developed to describe the heat-crime relationship without consensus yet achieved among experts. This scoping review aims to summarize evidence of heat-crime associations in U.S. cities. Further examination of empirical and translational inconsistencies in this literature will ensure future studies of urban heat-crime relationships in the U.S., and their policy impacts are informed by a thorough understanding of existing evidence. We performed a comprehensive literature search of empirical studies on heat-crime relationships in U.S. cities published between January 2000 and August 2023. The included studies were qualitatively synthesized based on operationalized exposures, outcomes, covariates, methodologies, theoretical framing, and policy implications. In total, 46 studies were included in this review. Most studies (93%) reported significant, positive associations between urban heat exposure and both violent and non-violent crime outcomes. The shape and strength of these associations varied based on operational definitions of urban heat exposures, crime outcomes, and relevant covariates in employed methods. We also found inconsistencies in the theoretical explanations and policy implications reported across studies. Climate-driven extreme heat events are projected to increase in frequency and severity. Our findings underscore the urgency of refining the understanding and translation of the complex relationship between urban heat and crime. In this review, we highlight opportunities to improve the methodological quality and responsible policy translation of future research in U.S. cities, which has implications for research globally.

Efficacy of neuromodulation and rehabilitation approaches on pain relief in patients with spinal cord injury: a systematic review and meta-analysis.

Spinal cord injury (SCI) is a debilitating neurological condition that causes physical dependency, psychological distress, and financial burden. Pain is a common consequence of SCI, significantly impacting quality of life. Effective pain management in SCI is challenging and requires multifaceted approaches. Among rehabilitation methods, non-invasive brain stimulation techniques such as repetitive transcranial magnetic stimulation (rTMS), theta burst stimulation (TBS), transcranial direct current stimulation (tDCS), transcutaneous electrical nerve stimulation (TENS), and virtual reality (VR) have been explored. This study aims to evaluate the efficacy of rehabilitation and non-invasive brain stimulation techniques on pain relief in SCI patients. A systematic review of the literature was conducted using PubMed, Scopus, and ScienceDirect with the formula ("spinal cord injury") AND ("pain"). Risk of bias was assessed using the Cochrane Risk of Bias Tool. Sixteen studies involving 319 patients were included. Patients in the control groups received: rTMS in seven trials, tDCS in seven trials, TBS in one trial, and TENS combined with VR in one trial. The trials analyzed were of poor methodological quality, characterized by small sample sizes, weak power analyses, varying clinical scores, and non-comparable follow-up periods. No major complications or serious adverse events were reported. Results were inconsistent, with no solid evidence supporting the superiority of rehabilitation techniques over comparator treatments. However, the favorable safety profile and positive outcomes in some measures suggest potential benefits for pain management and quality of life. Further studies are necessary to better understand SCI-related pain and optimize treatment strategies.

Effectiveness of FIFA injury prevention programs in reducing ankle injuries among football players: a systematic review

Background Ankle injuries are some of the most common injuries among footballers and can prevent players from participating in sport. The Fédération Internationale de Football Association (FIFA) developed FIFA injury prevention programs to reduce overall football injuries, but their effectiveness on a particular joint, such as the ankle, was not assessed. Therefore, this project aims to investigate if these FIFA injury prevention programs are particularly effective in reducing ankle injuries. Method A systematic review was conducted with the following criteria for study selection: Randomized controlled trials (RTCs) comparing the FIFA programs (FIFA 11 the old version and FIFA 11+) with the usual training for the teams. Other studies that included the number or percentage of ankle injuries as an outcome. Sample: Male and female footballers aged between 13 and 40 years old and without any restriction on particular skill levels. The Physiotherapy Evidence Database scale (PEDro) was used to assess the methodological quality of the included studies. Results The search strategy identified five RCTs that used the FIFA programs. The included studies had a good-to-excellent methodological quality according to the PEDro scale (ranging from 5 to 7 out of 10). The pooled data from all the included studies indicated that the FIFA 11 and FIFA 11+ programs were effective in reducing the ankle injury rate by 14%, while pooled results from the studies that used the FIFA 11+ program significantly reduced ankle injury rate by 32%. However, the FIFA 11 program was not effective in reducing the ankle injury rate. Conclusion The FIFA programs, and especially the FIFA 11+ program, appear to be more effective than the usual training in preventing ankle injuries among footballers.

Estrategias digitales y técnicas de cambio de comportamiento para la prevención de infecciones de transmisión sexual: protocolo para una revisión de revisiones sistemáticas

Introduction Sexually transmitted infections (STIs) are a leading cause of premature mortality, with unsafe sex as a predominant risk factor. Changing risky sexual behaviors and adopting healthy habits is key to preventing STIs, including HIV, essential for public health. Technological advances in digital interventions have revealed significant opportunities, and systematic reviews have evaluated their effectiveness. These digital interventions, using technologies such as mobile phones, apps, and wearable devices, have shown great potential to reduce STIs, particularly among young people, who are a key population for their implementation. Objective This protocol aims to describe in advance a systematic review intended to gather, evaluate, and synthesize the available evidence on digital behavior change interventions for STI prevention. In particular, it seeks to identify the most effective behavior change techniques to guide the design of evidence-based interventions that contribute to reducing STIs. Methods This protocol outlines a review of systematic reviews. The methodological quality of the included reviews will be assessed using the AMSTAR-2 tool, following the PRISMA-P guidelines. Comprehensive searches will be conducted in Cochrane, PubMed, Epistemonikos, and PsycINFO. The inclusion criteria will focus on systematic reviews evaluating the effect of digital behavior change interventions for STI prevention, covering technologies such as mobile phones, apps, and websites. Data extraction will identify key components using the Behavior Change Techniques Taxonomy version 1 (BCTTv1). The protocol is registered in PROSPERO (CRD42023485887). Expected results This review is expected to provide theoretical insights into behavior change in STI prevention through digital interventions, identifying the most effective techniques. These findings will help design scalable, evidence-based interventions, aimed especially at youth, and guide policymakers in implementing more effective strategies to reduce STI transmission around the world.

Mental Health Professionals’ Attitudes Towards Virtual Reality Therapies: A Systematic Review

Abstract Virtual reality (VR) therapies show promise in mental health treatment, yet their adoption in clinical practice remains limited. Understanding mental health professionals’ attitudes is crucial for successful implementation. A systematic search was conducted by the first author with support from a librarian in eight databases (PubMed [1966], PsycINFO [1967], Web of Science [1900], Scopus [1966], Medline [1946], Global Health [1973], Embase [1974], and PsycExtra [1908]), Google Scholar, and ProQuest Dissertation and Theses Global until May 9th 2024. Twenty studies (2010–2024) from Europe (n = 11), North America (n = 5), Oceania (n = 3), and Asia (n = 1), comprising 1300 mental health professionals, meeting inclusion criteria were analyzed, including qualitative, quantitative, and mixed-methods research. The methodological quality of the included studies was moderate to high, but some limitations in sampling strategies. Data were synthesized using narrative synthesis. Results indicated that while only 3% of mental health professionals reported using VR in clinical settings, they predominantly held positive attitudes towards VR therapies but identified numerous barriers. Key facilitators included VR’s accessibility, safety and controllability (the therapist’s ability to customize stimulus according to patients’ needs), and increased patient engagement. Key barriers encompassed technical limitations, high cost, treatment suitability concerns, potential side effects, workload, and time investment. The findings highlight the need for targeted training programs, improved technological infrastructure, and clearer guidelines to support VR therapies in mental health practice. Future research could focus on ways to address these limitations and using facilitators to enhance VR adoption.

Postoperative Hemorrhage in Patients with Aneurysms Associated with Arteriovenous Malformations. A Systematic Review and Meta-Analysis.

Postoperative Hemorrhage in Patients with Aneurysms Associated with Arteriovenous Malformations. A Systematic Review and Meta-Analysis.

Approaches to Training Speech-Language Pathologists to Work With People With Aphasia: A Systematic Review.

The aim of this systematic review was to analyze the published research on training approaches for preparing current and future speech-language pathologists (SLPs) to work effectively with people with aphasia (PWA). The review addresses key questions regarding the described training approaches, their key features, research quality, and efficacy. The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with International Prospective Register of Systematic Reviews (CRD42024453742). The literature search spanned nine databases. Eligibility criteria included peer-reviewed publications in English that reported on training programs involving current or future SLPs working with PWA. Studies were assessed for research quality using the American Speech-Language-Hearing Association's (ASHA's) levels of evidence framework. Narrative synthesis was used to identify key features in the training programs. A total of 920 citations were identified, with 50 studies meeting the inclusion criteria for analysis. Included studies represented a broad range of training approaches, research designs, and research quality. The 50 studies fell into ASHA levels of evidence Ib, IIa, IIb, III, and IV. Statistical meta-analysis was not possible because of variability in research design and outcome measures, but the studies revealed statistically significant findings relevant to the question of what makes training effective for preparing clinicians to work with people with aphasia. The current literature related to training of clinicians to work with PWA is heterogeneous in approach, outcome metrics, and methodological quality. There is evidence supporting several recommendations for training clinicians including integrating direct interactions with PWA during training, combining didactic and experiential learning, and incorporating reflective practices. Overall, the review highlights the need for well-described evidence-based training standards for speech-language pathology students working with PWA. Future research should aim to develop and validate comprehensive training guidelines to improve care quality for individuals with aphasia.

Cutaneous manifestations of Fabry disease: A systematic review.

Fabry disease (FD) is a rare X-linked lysosomal storage disorder resulting in potential debilitating accumulation of glycosphingolipids in organs such as skin, nerves, heart, kidneys, lungs, and the central nervous system. Skin is easily investigated and can guide clinicians to diagnose FD, minimizing delay of enzyme substitution therapy. This systematic review followed the PICO and PRISMA guidelines. Using Web of Science, PubMed, and Embase, a total of 968 studies were retrieved by January 1, 2024. All clinical studies describing the skin characteristics and abnormalities of FD patients were included. After inclusion of articles, the methodological quality was assessed using the QUADAS-2 critical appraisal checklist. Twenty-three studies were included. Different skin manifestations were described in FD patients. Fifteen studies described angiokeratomas, five studied telangiectasias, 13 studied sweat abnormalities (anhidrosis/hypohidrosis/hyperhidrosis), nine described lymphoedema, and two reported hair abnormalities. Sweat abnormalities were the most common skin manifestation, affecting 57.6% of patients with FD; angiokeratomas were observed in 51.5% of patients. A high prevalence (16.5%) of lymphoedema was seen in a large study (n = 5487). Skin involvement appeared age-dependent and increased with age. Quality assessment showed high or unclear risk of bias in 19/23 studies. We summarized data on skin manifestations in 10 757 FD patients. The pathogenesis of sweat abnormalities and the occurrence of cutaneous vascular lesions, such as angiokeratomas and telangiectasias, in only half of FD patients remains poorly understood. Enzyme replacement therapy generally did not reduce skin manifestations in FD patients. Direct comparisons between studies were challenging due to variations in reported outcomes.

Service-level interventions to reduce waiting time in outpatient and community health settings may be sustained: a systematic review

AimThe primary aim of this systematic review of the literature was to determine whether interventions to reduce waiting time in outpatient and community health services can be sustained. The secondary...

Corticosteroids in pediatric retropharyngeal and parapharyngeal abscesses: a systematic review.

By synthesizing and analyzing existing research data, this study evaluates the clinical efficacy and safety of corticosteroids in the treatment of pediatric retropharyngeal abscess (RPA) and parapharyngeal abscess (PPA). Two authors independently searched PubMed, EMBASE, Cochrane Library, and Web of Science, for studies relating to corticosteroids-assisted antibiotic therapy for pediatric RPA and PPA. Literature was meticulously screened against predefined inclusion and exclusion criteria, and relevant data were extracted. Meta-analysis and systematic review methodologies were employed to synthesize and analyze existing research comprehensively, evaluating clinical efficacy and safety. Five studies were included (2 retrospective case series, 3 retrospective cohort studies), involving a total of 2560 subjects. The cohort studies demonstrated robust methodological quality. Meta-analysis results indicated significantly lower surgical drainage rates in the steroid group (OR = 0.28; 95% CI: 0.23-0.34; p < 0.01) and reduced hospitalization duration (OR=-0.14; 95% CI: -0.23 to -0.06; p < 0.01) compared to the non-steroid group. Systematic evaluation revealed lower hospitalization costs in the steroid group. Predominantly, studies favored intravenous dexamethasone (82.76%). No adverse reactions to corticosteroids were reported. Current evidence suggests a beneficial role for corticosteroids in the treatment of pediatric RPA and PPA, emphasizing their importance in symptom improvement, decreased surgical intervention, shortened hospital stays, and reduced hospital costs. However, caution is warranted regarding potential side effects, particularly with long-term use. Future research should further elucidate specific dosages, durations, and optimal types of glucocorticoid therapy to better guide clinical practice.

Comparing the effectiveness of dual-task and single-task training on walking function in stroke recovery: A systematic review and meta-analysis.

Stroke is a prevalent neurological disease with high morbidity and disability. Single-task walking training has limitations, and dual-task walking training has emerged. Yet, research on the relative effectiveness of dual- and single-task training for stroke patients' walking function is inconclusive. This study aims to systematically compare the efficacy of dual-task with single-task training interventions on improving walking function among stroke survivors. A comprehensive search of electronic databases was conducted to identify randomized controlled trials investigating the application of dual-task training on walking function in stroke patients. Two reviewers independently screened the references, selected relevant studies, extracted data, and assessed the risk of bias. The primary outcome measures related to walking function included step speed, step length, stride length, step frequency, Berg balance scale (BBS), and timed up and go (TUG) test. The Cochrane risk of bias tool was used for methodological quality assessment of the included literature. Statistical analysis was performed using RevMan 5.4 software. Furthermore, the quality of evidence of the outcome measures was evaluated using the GRADEPro software. A total of 17 studies were enrolled in this systematic review and meta-analysis. The results revealed that dual-task training exhibited significantly superior efficacy compared to single-task training in enhancing step speed, step length, stride length, step frequency, and BBS score (P < .05). However, no significant difference was observed in the TUG test (P = .100). Compared with traditional single-task training, dual-task training could be more effective in improving walking function among stroke patients, especially with regard to temporal and spatial parameters such as step length and speed, stride frequency and BBS score, but the effect on enhancing TUG test still remains unclear. These findings would help clinicians to formulate a more rational stroke rehabilitation strategy.

Reliability and Validity of Laboratory and Field Cardiorespiratory Exercise Tests for Wheelchair Users: A Systematic Review

Background: cardiorespiratory fitness is one of the most important components of physical fitness. In this paper, we set out to identify cardiopulmonary tests evaluated for measurement properties in wheelchair users and determine which are reliable and valid for this population. Methods: Articles were collected from PubMed, Scopus, SPORTDiscus, and Web of Science. The initial search was conducted in October 2022 and updated in July 2023 for recent publications. From 1257 screened studies, 42 met the criteria: (a) participants were wheelchair users, (b) tests measured cardiorespiratory fitness, (c) test reliability or validity was reported, (d) articles were original, and (e) full text was in English. Two independent researchers extracted participant details (number, gender, age, disability) and test information, with a third researcher resolving disagreements. Statistical analyses of test reliability and validity were documented. Results: Methodological quality was assessed using the COSMIN checklist. Evidence levels for reliability and validity were established. Moderate evidence was found for reliability in one field test, and for validity in two lab and two field tests. Conclusions: While most tests show good reliability and validity, sample sizes are small, limiting conclusions. Further research is needed to strengthen the evidence and identify the most suitable tests for wheelchair users. Researchers are encouraged to replicate validation studies to support future testing.

Injury profile in badminton players of Asian countries: A systematic review and meta-analysis

Background and Aims Badminton is a globally acknowledged non-contact racquet sport that requires agility, strategic insight, and precise execution. It is important to note that a considerable number of elite badminton players across different formats originate from Asia. Consequently, it is essential to analyze the epidemiological patterns of injuries to formulate effective injury prevention strategies. The review aimed to study the epidemiological pattern of badminton injuries and describe injury contexts and characteristics in countries of the Asian Region. Materials and Methods PubMed, Scopus, and Embase were searched using words related to badminton and injury. Badminton players of Asian countries from the recreational to international levels who play in all formats of the game were included in the study. There was no restriction on the age of the badminton players. Methodological quality was independently evaluated by two authors using the Joanna Briggs Institute (JBI) critical appraisal instruments. Results Following a thorough screening based on established inclusion and exclusion criteria, eight studies were incorporated into the review. These studies provided data concerning 1265 badminton players ranging from adolescents to adults. In total, 2284 injuries were examined. The aggregated data indicated that the majority of these injuries affected the lower limbs and were predominantly classified as overuse injuries. Conclusion The injury data presented in this review serves as a valuable resource for the development of injury-prevention programs, aimed at mitigating the incidence of injuries and thereby enhancing player availability. A significant concern highlighted in the review is the need for standardization in injury reporting formats and documentation, which is essential for achieving these objectives effectively.