Marine life under plastic threat: A systematic review of systematic reviews.

Intellectual disability (ID) and psychiatric disorders are common comorbidities of epilepsy, yet there is a paucity of rigorous research evaluating the frequency and features of this experience. This systematic review seeks to evaluate the methodological strengths and limitations of extant literature, with the aim of providing a practical framework for future research to better understand this complex comorbidity. Searches of EMBASE, MEDLINE, Web of Science, CINAHL and PsycINFO scanned January 2000 to June 2024. Eligibility criteria included peer-reviewed studies in English, participants over 16years old with ID and epilepsy, and reporting psychiatric symptoms or disorders. Methodological quality was rated with a traffic light system. Nineteen studies were included. Methodological evaluation revealed most studies recruited from representative settings such as epilepsy services or national ID databases. Most studies included variability in ID severity. While a majority of studies used ID-appropriate psychiatric measures, only 12% directly included the person with ID in this assessment and they were seldom involved in the research consent process. While more than half of studies reported antiseizure medication use, there was limited evaluation of ASM dose relationships with psychiatric presentations. A framework for future research is proposed that focuses on ensuring representative samples, interdisciplinary research to improve diagnosis of psychiatric conditions in this population, and greater inclusion of people with epilepsy and ID in the research process so that researchers can better understand their needs and vulnerabilities so as to improve clinical translation.

Patient experiences of radiation-induced menopause in cervical cancer: A scoping review.

Hormonal Modulation of Keratoconus: A Systematic Review and Screening Strategy for At-Risk Populations.

This scoping review aimed to systematically map and synthesize existing evidence on strategies designed to enhance mental health and resilience among nurses, spanning individual, organizational, educational, and policy-level interventions. Following Arksey and O'Malley's framework, refined by Levac et al., and guided by PRISMA-ScR standards, a comprehensive search was conducted across five electronic databases and gray literature sources. Eligible studies included empirical research and policy documents published in English between 2015 and 2025. Data were extracted using an Excel-based template, and methodological quality was appraised with the Mixed Methods Appraisal Tool (MMAT). Narrative and thematic synthesis were employed to categorize strategies into key domains. The synthesis identified four overarching themes: (1) individual-focused strategies such as mindfulness, cognitive-behavioral approaches, and resilience training; (2) organizational strategies including supportive leadership, workload adjustments, and structured peer support; (3) educational and training interventions such as resilience curricula, simulation-based training, and mentorship; and (4) policy and system-level strategies encompassing occupational health protections, welfare programs, and regulatory frameworks. These multilevel approaches demonstrated varying degrees of effectiveness, but sustainability and integration into routine practice remained inconsistent. Building a resilient nursing workforce requires integrated, multilevel strategies. Resilience should be reframed as a shared responsibility across individuals, organizations, and systems to safeguard nurse well-being, improve patient outcomes, and ensure the sustainability of healthcare services.

Can baseline features predict a reduction in pain and disability following neck-specific exercise in people with chronic non-specific neck pain?: A systematic review.

Effects of respiratory muscle training on respiratory function, exercise capacity and quality of life in people with multiple sclerosis: a systematic review and meta-analysis.

This study investigated trends in oral microbiota composition (index test) that could indicate potential candidates to identify children at risk for dental caries development compared with visual/tactile examination (reference test). MEDLINE/PubMed, Web of Science, Embase, Scopus, Lilacs, SciELO, and Google Scholar databases were searched up to September 2025. Methodological quality was assessed by Newcastle-Ottawa Scale and QUADAS-2. Qualitative synthesis was performed using all included studies. Thirteen studies that assessed the oral microbiota composition through high-throughput sequencing platforms were included comprising 740 caries-free participants at the baseline. Alloprevotella spp. and Megasphaera spp. were exclusively highly abundant in children who developed caries, whereas Peptostreptococcus spp. was exclusively highly abundant in caries-free children. The diagnostic value of the oral microbiota composition showed specificity, sensitivity, accuracy, and area under the receiver operating characteristics curve ranging from 0.6 to 1.0, 0.75 to 0.90, 0.73 to 0.93, and from 0.51 to 0.94, respectively. High risk of bias was found for the index test. The available evidence does not support the use of oral microbiota composition as a screening test to identify children at risk for caries development. Studies conducted at the species level are likely to provide results with greater sensitivity and specificity, improving risk assessment and understanding of caries-associated microbiota (PROSPERO CRD42023495648).

Frequencies of transcutaneous electrical nerve stimulation and interferential current for chronic low back pain: a network meta-analysis.

Isoflavones (ISFs) are plant-derived compounds, found mainly in legumes and most abundantly soy, with oestrogenic properties. These ISFs have been investigated for their potential to influence cognitive function, particularly in aging populations. Our review aimed to assess the overall landscape of dietary soy or isoflavone intervention effect on cognitive functions and to determine the statistical significance of their effects on specific cognitive domains. A systematic literature search was conducted across major databases (PubMed, Scopus, Web of Science) to identify relevant studies (n = 37). The RCTs were then subjected to a meta-analysis where data was available (n = 16). In terms of risk of bias and methodological quality, the vast majority (n = 27) scored positively with the remainder receiving neutral ratings (n = 9). The meta-analysis pooled effect size for composite cognitive function was significant, 0.25 [0.04, 0.45], whilst domain-specific meta-analyses revealed a significant positive effect on memory, with a pooled effect size of 0.33 [0.04, 0.62]. The effects on executive function, psychomotor speed and processing speed were not significant. The findings in the systematic review consisted of two studies showing negative significance, fifteen studies showed positive significant outcomes, seven showing bidirectional significant outcomes and the remaining thirteen studies showing no significance. The meta-analytic portion provides statistical evidence that isoflavone supplementation can significantly influence specific domains of cognitive function, particularly memory. While the overall composite effect was modest, the domain-specific findings suggest that isoflavones may be a beneficial dietary intervention for targeted cognitive improvements, namely memory outcomes.

Family-centred care interventions in paediatric intensive care units: a scoping review.

Healthy aging is a major public health priority, particularly for women, who have a longer life expectancy and a high prevalence of conditions associated with frailty, sarcopenia, and loss of functional independence. Therefore, the objective of this systematic review and meta-analysis was to evaluate the effects of functional exercise on physical and psychosocial outcomes in women over 60 years of age. A systematic review and meta-analysis was conducted following PRISMA guidelines. Searches were performed in PubMed, Scopus, Web of Science, and Cochrane Library up to September 2025. Only randomized controlled trials involving women aged 60 years and older who participated in functional exercise interventions were included. Methodological quality was assessed with the PEDro scale, and pooled analyses were conducted using standardized mean differences (SMD) with 95% confidence intervals. Seventeen randomized controlled trials with a total of 968 participants met the inclusion criteria. Meta-analyses showed that functional exercise significantly improved physical capacities, including functionality (SMD = 0.81; 95% CI = 0.62 to 0.99), strength (SMD = 0.51; 95% CI = 0.11 to 0.91), and power (SMD = 0.28; 95% CI = 0.10 to 0.46). Additional evidence suggested improvements in psychosocial outcomes and reductions in proinflammatory cytokines, although results were more heterogeneous. The overall methodological quality of the included studies was moderate to high. Functional exercise may be a beneficial strategy to enhance physical and psychosocial capacities in women over 60 years of age. It may also contribute to modulating inflammatory and immunosenescence-related responses; however, the evidence remains limited and should be interpreted with caution. Further high-quality studies are needed to support its integration into healthy aging and preventive care programs.

Computerized adaptive testing for assessing substance use and substance use disorder: A systematic review.

Neurorehabilitation in physiotherapy depends on experience-dependent neuroplasticity; however, conventional clinical outcomes may lack sensitivity to capture dynamic neural adaptations underlying recovery. Brain entropy and complexity measures derived from EEG and neuroimaging have emerged as potential biomarkers of neural adaptability. To map and synthesize evidence on brain entropy and complexity as biomarkers of neuroplasticity in neurorehabilitation, with relevance to physiotherapy practice. A scoping review was conducted following PRISMA-ScR guidelines. PubMed, Scopus, and Web of Science were searched up to August 2025 for studies reporting quantitative entropy or complexity measures in neurological populations undergoing rehabilitation or task-based assessment. Eight studies were included. Interventional studies in stroke and brain injury populations reported moderate to large within-group neural effects, with increases in entropy or complexity accompanying functional improvement following task-oriented, robotic, or brain-computer interface-based rehabilitation. Studies of higher methodological quality demonstrated more consistent entropy-outcome associations, whereas lower-quality observational studies showed greater variability. Degenerative neurological conditions are characterized by reduced neural complexity. Brain entropy and complexity measures are sensitive indicators of neuroplastic change and may complement clinical outcomes in physiotherapy. Although not yet ready for routine clinical decision-making, these biomarkers show promise for monitoring intervention response and guiding personalized rehabilitation, pending methodological standardization and longitudinal validation.

Regional citrate anticoagulation (RCA) is increasingly utilized for therapeutic plasma exchange (TPE). Currently, many clinical studies have focused on the safety and efficacy of RCA in TPE. However, due to the complex application and the lack of a uniform standard of RCA, the results of these researches, especially citrate-related metabolic complications, varied greatly in different studies. The purpose of this meta-analysis is to assess the safety and efficacy of RCA in TPE. We performed a comprehensive search on PubMed, Embase, and the Cochrane Library database from the inception to August 26, 2024. Studies regarding the application of RCA in TPE were included to assess the efficacy and safety of RCA in TPE. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale and the Jadad scale. Meta-analysis was performed using Stata software (version 15.1). There were 13 eligible studies included, involving 4268 RCA-TPE sessions. The pooled rate of extracorporeal circuit clotting, bleeding, citrate accumulation, hypocalcemia, hypernatremia, hypomagnesemia, and metabolic alkalosis was 5.3% (95% CI [2.4-9.2]), 2.0% (95% CI [0.2-5.0]), 1.8% (95% CI [0.0-6.7]), 17.9% (95% CI [2.3-42.5]), 1.7% (95% CI [0.0-5.1]), 45.6% (95% CI [25.9-66.0]), and 14.8% (95% CI [0.5-41.3]), respectively. Subgroup analysis of hypocalcemia and metabolic alkalosis in the membrane therapeutic plasma exchange (mTPE) was 42.1% (95% CI [2.5-89.7]) and 32.4% (95% CI [25.3-39.9]), respectively. Compared to before treatment, the serum sodium and bicarbonate significantly increased, and serum calcium decreased significantly after RCA-TPE treatment. There was no difference in platelet (PLT), prothrombin time (PT), activated partial thromboplastin time (APTT), the ratio of total calcium to ionized calcium, total calcium, pH, and base excess (BE) before and after treatment. Subgroup analyses demonstrated that pH and BE in mTPE, and APTT and PT in double filtration plasmapheresis (DFPP) were significantly increased after treatment. Regional citrate anticoagulation might be effective in TPE treatments. However, the incidence of hypomagnesemia, hypocalcemia, and metabolic alkalosis is relatively high. Close monitoring and timely adjustment are needed during the process of RCA-TPE treatment to avoid these complications.

Nurse-led interventions targeting post-intensive care syndrome domains in adult intensive care unit survivors: A systematic review.

Predictors of Volume Reduction Rate Following Microwave Ablation for Benign Thyroid Nodules: A Systematic Review and Meta-Analysis.

A systematic search of PubMed and EMBASE was conducted using terms such as "pelvic insufficiency fractures", "radiotherapy" and "gynecological cancers". Citations of relevant studies were also screened. Eligible studies included gynecolgical patients treated with pelvic RT, and reporting risk factors for RRIFs. Key data, including study characteristics, incidence rates, fracture definitions, imaging and dosimetry methods and statistical approaches were extracted. The Transparent Reporting of a multivariable prediction modelfor Individual Prognosis Or Diagnosis (TRIPOD) checklist was used to assess the methodological quality of the included studies. 28 studies met the inclusion criteria. RRIF incidence ranged from 1.7% to 37.4%. Commonly reported risk factors included advanced age, postmenopausal status, higher RT doses, low body weight, pre-existing osteoporosis, and concurrent chemotherapy. Imaging protocols, fracture definitions, and timing of detection varied widely. Statistical limitations, including reliance on univariable analyses, small sample sizes, and inconsistent baseline assessments, were common and limit reliable interpretation of risk factors. Anatomical targets for dose evaluation varied, with few studies correcting for biologically effective dose. Only one study developed a predictive model for RRIFs, which demonstrated moderate performance but lacked validation. Bone health assessments were inconsistently performed. Interdisciplinary approaches to improve fracture risk prediction, reduce treatment-related toxicity, and guide clinical decision-making.

Parents' perception of family-centered care in the pediatric intensive care unit: a systematic review of qualitative studies.

Sediments are key environmental compartments that accumulate and release chemical contaminants, leading to chronic exposure of benthic communities. The freshwater oligochaete Lumbriculus variegatus is the only sediment-dwelling species recommended for sediment risk assessment under OECD guidelines, but it is used far less frequently than Chironomus sp. To analyse why it is underused, we systematically reviewed 303 ecotoxicological studies with L. variegatus published since the development of OECD Guideline 225 in 2007, identifying 91 studies that met predefined inclusion criteria and methodological quality standards. Only 12 % of chronic sediment studies (≥28 days) strictly followed OECD 225 without deviations, while 51 % did not refer to the guideline at all. Conventional endpoints (mortality, growth, reproduction) were assessed in 91 % of studies. However, life-stage differentiation was rarely applied, and 27 % of chronic studies failed to meet the reproduction criterion in controls. Overall, 44 % of studies extended OECD 225 by including additional endpoints. Behavioural endpoints (feeding, locomotion, sediment avoidance, bioturbation) were used in 30 % of studies and were frequently more sensitive than conventional measures. Thirty-four comparative studies between L. variegatus and at least one other standard sediment species (Chironomus sp., Hyalella azteca, or Tubifex tubifex) showed that none of the species was generally much more sensitive than the oligochaete. Our review identifies substantial gaps in standardisation, endpoint selection, and experimental design in L. variegatus studies. We recommend revising OECD 225 to incorporate additional sublethal endpoints, update the reproduction criterion and synchronisation time, and differentiate life stages in growth and reproduction assessments. These improvements would enhance the ecological relevance and regulatory applicability of L. variegatus in sediment ecotoxicology.