Risk Of Bias Assessment Tool For Nonrandomized Studies Research Articles

Effects of Immersive Technology-based Education for Undergraduate Nursing Students: A Systematic Review and Meta-Analysis using the GRADE approach.

The adoption of immersive technology in simulation-based nursing education has grown significantly, offering a solution to resource limitations and enabling safe access to clinical environments. Despite its advantages, there are still diverse reports regarding the effectiveness of immersive technology. It is crucial to verify the effectiveness of immersive technology in nursing education to inform future educational programs. This systematic review aimed to identify the contents of immersive technology-based education for undergraduate nursing students and evaluate the effectiveness of immersive technology compared to traditional teaching methods. A literature search was performed using four databases: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and Web of Science, with the latest search completed on January 19, 2023. The inclusion criteria were as follows: participants were undergraduate nursing students; studies were published in Korean or English; designs included randomized controlled trials (RCTs) or non-randomized studies; and interventions involved virtual reality (VR), augmented reality (AR), mixed reality (MR), or extended reality (XR). Quality assessment was conducted using Version 2 of the Cochrane risk of bias tool (RoB 2) for RCTs and the Risk of Bias Assessment Tool for Non-Randomized Studies (RoBANS). The main outcomes of the included studies were classified according to the New World Kirkpatrick Model (NWKM), ranging from Level 1 (Reaction) to Level 4 (Results). Meta-analysis was conducted using RevMan 5.4 software, and subgroup analysis was conducted due to heterogeneity of the results of meta-analysis. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was adopted for assessing certainty and synthesizing results of the relevant literature. A total of 23 studies were included, with participants numbers ranging from 33 to 289. Nineteen studies adopted VR to simulate various nursing scenarios, including disaster training, resuscitation, health assessments, and home healthcare. Four studies utilized AR technologies. Fifteen studies involved virtual patients in their scenarios. Based on NWKM, the main outcome variables were classified as Level 1 (usability and satisfaction), Level 2 (knowledge, motivation, confidence, performance, attitude, and self-efficacy), and Level 3 (clinical reasoning). Level 4 outcomes were not found in selected studies. Results of the subgroup analysis of meta-analysis showed that immersive technology-based nursing education was more effective than traditional education on knowledge attainment (standard mean difference (SMD)=0.59, 95% confidence interval (CI)=0.28-0.90, P<.001, I2=49%). Additionally, there were significant difference differences between the experimental groups and the control groups in confidence (SMD=0.70, 95% CI= 0.05-1.35, P=.03, I2=82%), and self-efficacy (SMD=0.86, 95% CI= 0.42-1.30; P<.001, I2=63%). These findings support the effectiveness of immersive technology-based education for undergraduate nursing students, despite heterogeneity in methods and interventions. We suggest that long-term cohort studies should be conducted to evaluate the effects of immersive technology-based nursing education on the NWKM Level 4.

Prevalence, severity, and risk factors of cancer-related fatigue among working cancer survivors: a systematic review and meta-analysis.

The aim of this study is to evaluate the prevalence, severity, and risk factors of cancer-related fatigue among currently working cancer survivors. We searched the PubMed, Embase, Scopus, CINAHL, Cochrane Library, and ICHUSHI databases. The risk of bias was evaluated independently using the Risk of Bias Assessment Tool for Non-randomized Studies (RoBANS). A meta-analysis was conducted to determine the prevalence, severity, and related factors associated with cancer-related fatigue among currently working cancer survivors. Our meta-analysis included 18 studies and revealed that 42.2% of currently working cancer survivors experience cancer-related fatigue. The fatigue severity in this group was significantly higher than that in workers without cancer (absolute standardized mean difference (SMD) = 0.67), but lower than that in cancer survivors who had previously worked and were not currently working (absolute SMD = 0.72). Distress was identified as a potential risk factor for cancer-related fatigue in working cancer survivors (partial correlation coefficient = 0.38). The high prevalence of cancer-related fatigue among employed cancer survivors underscores the need for targeted workplace interventions and fatigue management strategies. While the severity of fatigue is less than that seen in non-working survivors, the comparison with the general working population highlights a significant health disparity. The association between distress and fatigue suggests the necessity for a holistic approach to fatigue management that considers both physical and mental factors in working cancer survivors. Our findings highlight the critical need for healthcare professionals and employers to monitor fatigue levels among working cancer survivors and offer appropriate support.

Efficient administration of a combination of nifedipine and sildenafil citrate versus only nifedipine on clinical outcomes in women with threatened preterm labor: a systematic review and meta-analysis

BackgroundPreterm labor (PTL) is a common and serious pregnancy disorder that can cause long-term neurological issues in the infant. There are conflicting studies concerning whether sildenafil citrate (SC) reduces preterm labor complications. Therefore, the meta-analysis aimed to examine the clinical outcomes in women with threatened PTL who received nifedipine plus SC therapy versus only nifedipine.MethodsFor the original articles, six databases were searched using relevant keywords without restriction on time or language until January 13, 2024. The Cochrane risk-of-bias tool for randomized trials (RoB) and the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS) were both used to assess the risk of bias in randomized and non-randomized studies, and GRADE determined the quality of our evidence. Meta-analysis of all data was carried out using Review Manager (RevMan) version 5.1.ResultsSeven studies with mixed quality were included in the meta-analysis. The study found that combining nifedipine and SC resulted in more prolongation of pregnancy (MD = 6.99, 95% CI: 5.32, 8.65, p < 0.00001), a lower rate of delivery in the 1st to 3rd days after hospitalization (RR = 0.62, 95% CI: 0.50, 0.76, p < 0.00001), a higher birth weight (252.48 g vs. nifedipine alone, p = 0.02), and the risk ratio of admission to the neonatal intensive care unit (NICU) was significantly lower (RR = 0.62, 95% CI: 0.50, 0.76, p < 0.00001) compared to nifidepine alone. The evidence was high for prolongation of pregnancy, delivery rate 24–72 h after admission, and NICU admission, but low for newborn birth weight.ConclusionsGiven the effectiveness of SC plus nifedipine in increased prolongation of pregnancy and birth weight, lower delivery in the 1st to 3rd days after hospitalization, and NICU admission, Gynecologists and obstetricians are suggested to consider this strategy for PTL management, although additional article rigor is required to improve the quality of the evidence.

Is test specificity the issue in assessing aerobic fitness and performance of runners? A systematic review.

Various tests have been developed to evaluate aerobic fitness and performance of runners. However, a systematic understanding of which methods are more accurate is necessary to provide coaches and the sports sciences community with useful and confident outcomes. This study aims to summarize the evidence regarding the validity, reliability and sensitivity of tests for measuring aerobic fitness and performance in runners of several background of training. A systematic search was conducted of Web of Science, PubMed and Scopus up to 31st December 2022 according to PRISMA statement guidelines. Studies that reported findings about tests covering maximal aerobic speed, final velocity achieved during the test, average running speed or other method of evaluating the reference speed during the test were included. We evaluated the risk of bias in the included articles using the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS). The tests were categorized into continuous incremental tests, intermittent tests and time-trial test. A total of 23 studies met eligibility criteria. These studies contained three background of training: track and road runners (N.=15), trail runners (N.=7) and inexperienced runners (N.=1). Criterion validity was assessed in 73% of the studies, while only 41% of studies examined convergent validity. The majority of the reviewed studies (87%) ignored test-retest reliability. Test sensitivity was not reported in any study. At least one aerobic fitness and performance test was identified for each types of background of training. However, some methodological aspects were not provided in the included articles. Most studies examined at least one aspect of validity (i.e., criterion or convergent-related validity), whilst few studies investigated test-retest reliability. Researchers and practitioners can use the information provided in this systematic review to select appropriate tests.

Interventions to promote the health and well-being of children under 5s experiencing homelessness in high-income countries: a scoping review

ObjectivesHomelessness among families with children under 5 residing in temporary accommodation is a growing global concern, especially in high-income countries (HICs). Despite significant impacts on health and development, these ‘invisible’...

Match demands of female team sports: a scoping review.

This scoping review aimed to characterize and quantify the external load demands of professional female team sports, in terms of total distance [TD], moderate-speed [MSR] and high-speed running [HSR], sprint, accelerations [ACC], and decelerations [DEC]. A search was conducted in PubMed, Scopus, and Web of Science until 15/04/2023. The Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS) was used. Eighty-six articles were eligible for inclusion in this review, with 40 in soccer, 23 in rugby (6 rugby union, 3 rugby league, and 14 rugby sevens), 8 in field hockey, 8 in basketball, 6 in handball, and 1 in futsal. Soccer is the most investigated sport, and players perform ~9500 m TD, of which ~580 m is performed in HSR, and with a great number of ACC, DEC, and sprints. Rugby league and union players cover a greater distance (~5450 m) when compared to rugby sevens (~1550 m); however, rugby sevens is more demanding in terms of high-intensity actions. Field hockey players perform ~5400 m TD with high-intensity and sprint actions. Women's indoor sports are less studied, and basketball players cover ~5300 m TD, of which 7% is performed in MSR. Handball players perform ~3500 m TD and cover ~423 m in MSR and ~141 m in HSR, and futsal players perform ~5 m × min-1 in HSR and they do a great number of high-intensity activities (HSR, ACC, and DEC). Considering the high physical demands experienced by female athletes, professionals could use the present results for training and return to competition schedules.

Reoperation rate and risk factors of reoperation for ossification of the posterior longitudinal ligament (OPLL): a systematic review and meta-analysis.

Revision surgery for OPLL is undesirable for both patients and physicians. However, the risk factors for reoperation are not clear. Thus, we sought to review the existing literature and determine the factors associated with higher reoperation rates in patients with OPLL. A search was performed using Pubmed, Embase, Web of Sciences, and Ovid to include studies regarding the risk factors of reoperation for OPLL. RoBANS (Risk of Bias Assessment tool for Nonrandomized Studies) was used for risk of bias analysis. Heterogeneity of studies and publication bias was assessed, and sensitivity analysis was performed. Statistical analysis was performed with a p-value < 0.05 using SPSS software (version 23). Twenty studies with 129 reoperated and 2,793 non-reoperated patients were included. The pooled reoperation rate was 5% (95% CI: 4% to 7). The most common cause of reoperation was residual OPLL or OPLL progression (n = 51, 39.53%). An increased risk of additional surgery was found with pre-operative cervical or thoracic angle(Standardized mean difference = -0.44; 95% CI: -0.69 to -0.19; p = 0.0061), post-operative CSF leak (Odds ratio, OR = 4.97; 95% CI: 2.48 to 9.96; p = 0.0005), and graft and/or hardware failure (OR = 192.09; 95% CI: 6.68 to 5521.69; p = 0.0101). Apart from the factors identified in our study, the association of other variables with the risk of second surgery could not be ruled out, owing to the complexity of the relationship and significant bias in the current literature.

Accelerometer-Measured Inpatient Physical Activity and Associated Outcomes After Major Abdominal Surgery: Systematic Review.

It remains unclear how inpatient physical activity after major abdominal surgery affects outcomes. Accelerometer research may provide further evidence for postoperative mobilization. We aimed to summarize the current literature evaluating the impact of accelerometer-measured postoperative physical activity on outcomes after major abdominal surgery. We searched PubMed and Google Scholar in October 2021 to conduct a systematic review. Studies were included if they used accelerometers to measure inpatient physical behaviors immediately after major abdominal surgery, defined as any nonobstetric procedures performed under general anesthesia requiring hospital admission. Studies were eligible only if they evaluated the effects of physical activity on postoperative outcomes such as postoperative complications, return of gastrointestinal function, hospital length of stay, discharge destination, and readmissions. We excluded studies involving participants aged <18 years. Risk of bias was assessed using the risk-of-bias assessment tool for nonrandomized studies (RoBANS) for observational studies and the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) for randomized controlled trials (RCTs). Findings were summarized by qualitative synthesis. We identified 15 studies. Risk of bias was high in 14 (93%) of the 15 studies. Most of the studies (11/15, 73%) had sample sizes of <100. Of the 15 studies, 13 (87%) included the general surgery population, 1 (7%) was a study of patients who had undergone gynecologic surgery, and 1 (7%) included a mixed (abdominal, thoracic, gynecologic, and orthopedic) surgical population. Of the 15 studies, 12 (80%) used consumer-grade accelerometers to measure physical behaviors. Step count was the most commonly reported physical activity outcome (12/15, 80%). In the observational studies (9/15, 60%), increased physical activity during the immediate postoperative period was associated with earlier return of gastrointestinal function, fewer surgical and pulmonary complications, shorter hospital length of stay, and fewer readmissions. In the RCTs (6/15, 40%), only 1 (17%) of the 6 studies demonstrated improved outcomes (shorter time to flatus and hospital length of stay) when a mobility-enhancing intervention was compared with usual care. Notably, mobility-enhancing interventions used in 4 (67%) of the 6 RCTs did not result in increased postoperative physical activity. Although observational studies show strong associations between postoperative physical activity and outcomes after major abdominal surgery, RCTs have not proved the benefit of mobility-enhancing interventions compared with usual care. The overall risk of bias was high, and we could not synthesize specific recommendations for postoperative mobilization. Future research would benefit from improving study design, increasing methodologic rigor, and measuring physical behaviors beyond step counts to understand the impact of postoperative mobilization on outcomes after major abdominal surgery.

Hyponatremia and aging-related diseases: key player or innocent bystander? A systematic review

BackgroundHyponatremia is frequent in older age; whether it is a key player, a surrogate marker, or an innocent bystander in age-related diseases is still unclear.Objective: To understandthe role of hyponatremia in falls, osteoporosis, fractures, and cognitiveimpairment in old patients.MethodEligibility criteria for study inclusions were: written in English, peer-reviewed observational and intervention studies, clinical trial, prospective and retrospective controlled cohort studies, and case-controlled studies without limitations regarding the date of publication.Information sources: Protocol available on the International Prospective Register of Systematic Reviews (PROSPERO, CRD42021218389). MEDLINE, Embase, and PsycINFO were searched. Final search done on August 8, 2021.Risk-of-bias assessment: Risk-of-Bias Assessment tool for Non-randomized Studies (RoBANS) and the Bradford Hill’s criteria for causality.ResultsIncludes studies: One-hundred thirty-five articles retained for the revision.Synthesis of results — Falls: Eleven studies were included. Strong association between hyponatremia and falls in all the studies was found. Osteoporosis and fractures: nineteen articles were included. The association between hyponatremia and osteoporosis is unclear. Cognitive impairment: Five articles were included. No association between hyponatremia and cognitive impairment was found.DiscussionInterpretation: Falls, osteoporosis, and fractures are multifactorial. Hyponatremia is not temporally related with the outcomes; we suggest that hyponatremia may be regarded as a marker of unhealthy aging and a confounder instead of a causal factor or an innocent bystander for falls and fractures. Concerning cognitive impairment, there are no evidence supporting a real role of hyponatremia to be regarded as an innocent bystander in neurodegeneration.

A systematic review and meta-analysis of respiratory dysfunction in Parkinson's disease.

Respiratory dysfunction in Parkinson's disease (PD) is common and associated with increased hospital admission and mortality rates. Central and peripheral mechanisms have been proposed in PD. To date no systematic review identifies the extent and type of respiratory impairments in PD compared with healthy controls. PubMed, EMBASE, CINAHL, Web of Science, Pedro, MEDLINE, Cochrane Library and OpenGrey were searched from inception to December 2021 to identify case-control studies reporting respiratory measures in PD and matched controls. Thirty-nine studies met inclusion criteria, the majority with low risk of bias across Risk of Bias Assessment tool for Non-randomized Studies (RoBANS) domains. Data permitted pooled analysis for 26 distinct respiratory measures. High-to-moderate certainty evidence of impairment in PD was identified for vital capacity (standardised mean difference [SMD] 0.75; 95% CI 0.45-1.05; p < 0.00001; I2 =10%), total chest wall volume (SMD 0.38; 95% CI 0.09-0.68; p=0.01; I2 =0%), maximum inspiratory pressure (SMD 0.91; 95% CI 0.64-1.19; p < 0.00001; I2 =43%) and sniff nasal inspiratory pressure (SMD 0.58; 95% CI 0.30-0.87; p < 0.00001; I2 =0%). Sensitivity analysis provided high-moderate certainty evidence of impairment for forced vital capacity and forced expiratory volume in 1s during medication ON phases and increased respiratory rate during OFF phases. Lower certainty evidence identified impairments in PD for maximum expiratory pressure, tidal volume, maximum voluntary ventilation and peak cough flow. Strong evidence supports a restrictive pattern with inspiratory muscle weakness in PD compared with healthy controls. Limited data for central impairment were identified with inconclusive findings.

Evaluation of Robotic Systems on Cytotoxic Drug Preparation: A Systematic Review and Meta-Analysis.

Background and Objectives: With the increased prevalence of patients with cancer, the demand for preparing cytotoxic drugs was increased by health-system pharmacists. To reduce the workload and contamination of work areas in pharmacies, compounding robots preparing cytotoxic drugs have been introduced, and the use of the robots has been expanded in recent years. As reports on the comprehensive and quantitative evaluation of compounding robots remain lacking, a systematic review and meta-analysis were conducted to provide descriptive and quantitative evaluations of the accuracy of preparing injectable cytotoxic drugs. Materials and Methods: A systematic review and meta-analysis were conducted using published studies up to 2020. To identify eligible studies, PubMed, EMBASE, and Cochrane Library were used. All studies reporting the outcomes relevant to drug-compounding robots such as accuracy, safety, and drug contamination were included. Outcomes from included studies were descriptively summarized. Drug contamination by the robot was quantitatively analyzed using the odds ratio (OR) with a 95% confidence interval (CI). The risk of bias was assessed using the Risk of Bias Assessment tool for Non-randomized Studies (RoBANS). Results: A total of 14 compounding robot studies were eligible for review and 4 studies were included in the meta-analysis. Robotic compounding showed failure rates of 0.9-16.75%, while the accuracy range was set at 5%. Two studies reported that robotic compounding needed more time than manual compounding, two reported that robotic compounding needed less time, and one just reported preparation time without a control group. In a meta-analysis regarding the contamination of the compounding area, manual compounding was associated with lower contamination, although the result was not statistically significant (OR 4.251, 95% CI 0.439-51.772). For the contamination of infusion bags, the robot was associated with lower contamination (OR 0.176, 95% CI 0.084-0.365). Conclusions: Robotic compounding showed better accuracy than manual compounding and, without control groups, showed a high accuracy rate and also reduced the risk of drug contamination and compounding workload. The preparation time of the robot was not consistent because the type of robot and introduced system were different. In conclusion, robotic compounding showed mixed results compared to the manual compounding of drugs, so the system should be introduced considering the risks and benefits of robots.

Comparison of patellar anchor fixation graft and graft through patellar tunnel reconstruction of medial patellofemoral ligament in the treatment of recurrent patellar dislocation: A protocol for a meta-analysis of comparative studies.

Recurrent patellar dislocation (RPD) occurs in people who have their own patellofemoral dysplasia and who have not been properly treated after their first patellar dislocation. For RPD where conservative treatment is ineffective, medial patellofemoral ligament (MPFL) reconstruction is the first choice for surgical treatment, but there are various and controversial ways of MPFL reconstruction and fixation. Initially, more scholars adopted the patellar lateral tunneling (PT) approach to contain and stabilize the graft, but with the newer materials and techniques, some experts adopted the lateral patellar anchor fixation (AF) of the graft, which can avoid the collateral damage caused by the patellar lateral tunneling and can obtain the same definite efficacy. Therefore, a meta-analysis must be performed to provide evidence whether there is a difference between AF and PT reconstruction of the MPFL in the treatment of RPD. We will search, with no time restriction, without any restriction of language and status, the time from the establishment of the database to October 2022, on the following databases: PubMed (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Chinese National Knowledge Infrastructure (CNKI), Wanfang Data (WF), Chinese Scientific Journals Database (VIP), and Chinese databases SinoMed (CBM) electronic databases. The electronic database search will be supplemented by a manual search of the reference lists of included articles. We will apply the risk-of-bias tool of the Cochrane Collaboration for randomized controlled trials to assess the methodological quality. Risk-of-Bias Assessment Tool for Non-randomized Studies was used to evaluate the quality of comparative studies. Statistical analysis will be conducted using RevMan 5.4 software. This systematic review and meta-analysis will evaluate the functional outcomes of the two fixation modalities, AF and PT, in reconstructing MPFL for RPD. The findings of this study will provide a basis for clinical judgment of whether there is a difference between the two forms of AF and PT reconstructed MPFL for RPD.

Dark tourism, the holocaust, and well-being: A systematic review

Dark tourists experience negative and positive feelings in Holocaust places, suggesting emotional ambivalence. The research question of this study is, “is feeling well-being, as a consequence of dark tourism, a way of banalizing the horror?”. The purpose of this study is threefold: to provide an updated systematic literature review (SLR) of dark tourism associated with Holocaust sites and visitors' well-being; to structure the findings into categories that provide a comprehensive overview of the topics; and to identify which topics are not well covered, thus suggesting knowledge gaps. Records to be included should be retrievable articles in peer-reviewed academic journals, books, and book chapters, all focused on the SLR's aims and the research question; other types of publications were outrightly excluded. The search was performed in Web of Science, Scopus, and Google Scholar databases with three keywords and combinations: “dark tourism”, “Holocaust”, and “well-being”. Methodological decisions were based on the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS). This systematic review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. During the process, 144 documents were included, of which 126 were journal articles, 8 were books, and 10 were book chapters. The results point out a hierarchical structure with the main category (Dark tourism - Holocaust - Well-being) and three second-order categories (Dark tourism - Holocaust, Dark tourism - Well-being, and Holocaust - Well-being), from which different subcategories emerge: motivations for visiting places and guiding; ambivalent emotional experience that leads to the transformation of the self; and intergenerational trauma. The gaps identified were the trivialization of horror in Holocaust places; dark tourist profile; motivations and constraints behind visiting dark places; Holocaust survivors and their descendants' well-being; how dark tourism associated with the Holocaust positively or negatively impacts well-being. Major limitations included: lack of randomized allocation; lack of standard outcome definitions; and suboptimal comparison groups. Positive and negative impacts on the well-being of the Holocaust dark tourist were sought, as they are associated with the marketing and management, promotion, digital communication, guiding, or storytelling design of such locations.

Does provision of antenatal care in Southern Asia improve neonatal survival? A systematic review and meta-analysis

BACKGROUNDSouthern Asia has one of the highest burdens of neonatal mortality worldwide (26/1000 live births). Ensuring that women receive antenatal care from a skilled provider may play an important role in reducing this burden. OBJECTIVEThis study aimed to determine whether antenatal care received from a skilled provider could reduce neonatal mortality in Southern Asia by systematically reviewing existing evidence. STUDY DESIGNSeven databases were searched (MEDLINE, Embase, Cochrane Library, CINAHL, PubMed, PsycINFO, and International Bibliography of the Social Sciences [IBSS]). The key words included: “neonatal mortality,” “antenatal care,” and “Southern Asia.” Nonrandomized comparative studies conducted in Southern Asia reporting on neonatal mortality in women who received antenatal care compared with those who did not were included. Two authors carried out the screening and data extraction. The Risk of Bias Assessment tool for Non-randomized Studies (RoBANS) was used to assess quality of studies. Results were reported using a random-effects model based on odds ratios with 95% confidence intervals. RESULTSFour studies were included in a meta-analysis of adjusted results. The pooled odds ratio was 0.46 (95% confidence interval, 0.24 to 0.86) for neonatal deaths among women having at least 1 antenatal care visit during pregnancy compared with women having none. In the final meta-analysis, 16 studies could not be included because of lack of adjustment for confounders, highlighting the need for further higher-quality studies to evaluate the true impact. CONCLUSIONThis review suggests that in Southern Asia, neonates born to women who received antenatal care have a lower risk of death in the neonatal period compared with neonates born to women who did not receive antenatal care. This should encourage health policy to strengthen antenatal care programs in Southern Asia.

Changes in physical activity, dietary and sleeping pattern among the general population in COVID-19: A systematic review protocol.

COVID-19 is a highly infectious respiratory disease caused by a new coronavirus known as SARS-CoV-2. Home confinement and movement restrictions can affect lifestyle changes and may lead to non-communicable diseases (NCD). This systematic review will provide a detailed summary of changing patterns of physical activities, diet and sleep among the general public in COVID-19. PubMed, Google Scholar, EMBASE, Science Direct, and Scopus will be, among eight bibliographic databases, applied and search work will take one month (from January 2021 until February 2021). Key search terms will include common characteristics of physical activity, dietary pattern, sleeping pattern, and COVID-19. The reviewers will fully apply the inclusion and exclusion criteria framed by PICOS as well as the screening form and the PRISMA flow for selecting the papers eligible for this review. Moreover, the reviewers will use a self-developed excel table to extract the required information on dietary pattern changes, physical activities and sleep patterns changes, and the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS) for practicing quality assessment. We will include only observational studies and analyze the extracted information qualitatively and the review output will be based on the eligible studies' outcomes. Changes in physical activity, dietary and sleep patterns are challenging to the public health professionals regarding the risk factors for NCD, and long-term effects might impact the controlling of the NCD. Evidence-based research information is needed regarding the COVID-19 pandemic, and there are a few global data on changes in physical activity, dietary and sleep patterns. Furthermore, innovative public health interventions or implementations are needed to maintain the positive health status of the population in the long run as the consequences of the COVID-19 pandemic. This systematic review is based on a protocol registered with PROSPERO CRD42021232667.

Social media use and mental health during the COVID-19 pandemic in young adults: a meta-analysis of 14 cross-sectional studies

BackgroundPublic isolated due to the early quarantine regarding coronavirus disease 2019 (COVID-19) increasingly used more social media platforms. Contradictory claims regarding the effect of social media use on mental health needs to be resolved. The purpose of the study was to summarise the association between the time spent on social media platform during the COVID-19 quarantine and mental health outcomes (i.e., anxiety and depression).MethodsStudies were screened from the PubMed, Embase, and Cochrane Library databases. Regarding eligibility criteria, studies conducted after the declaration of the pandemic, studies that measured mental health symptoms with validated tools, and studies that presented quantitative results were eligible. The studies after retrieval evaluated the association between time spent on social media platform and mental health outcomes (i.e. anxiety and depression). The pooled estimates of retrieved studies were summarised in odds ratios (ORs). Data analyses included a random-effect model and an assessment of inter-study heterogeneity. Quality assessment was conducted by two independent researchers using the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS). This meta-analysis review was registered in PROSPERO (https://www.crd.york.ac.uk/PROSPERO/, registration No CRD42021260223, 15 June 2021).ResultsFourteen studies were included. The increase in the time spent using social media platforms were associated with anxiety symptoms in overall studies (pooled OR = 1.55, 95% CI: 1.30–1.85), and the heterogeneity between studies was mild (I2 = 26.77%). Similarly, the increase in social media use time was also associated with depressive symptoms (pooled OR = 1.43, 95% CI: 1.30–1.85), and the heterogeneity between studies was moderate (I2 = 67.16%). For sensitivity analysis, the results of analysis including only the “High quality” studies after quality assessment were similar to those of the overall study with low heterogeneity (anxiety: pooled OR = 1.45, 95% CI: 1.21–1.96, I2 = 0.00%; depression: pooled OR = 1.42, 95% CI: 0.69–2.90, I2 = 0.00%).ConclusionsThe analysis demonstrated that the excessive time spent on social media platform was associated with a greater likelihood of having symptoms of anxiety and depression.

INTERLEUKIN AS BIOMARKER OF RECURRENT APHTHOUS STOMATITIS (RAS): A SYSTEMATIC LITERATURE REVIEW

This review aimed to describe the interleukins and interleukin gene polymorphisms related to and recommended as a RAS biomarker. Articles were searched through PubMed, ScienceDirect, and Cochrane Library databases, using the keywords of “Interleukin” AND “Recurrent Aphthous Stomatitis”. The Risk of Bias Assessment tool for Non-randomized Studies (RoBANS) was used, and the writing of this review refers to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. A total of 8 articles met the criteria and showed a low risk of bias assessment. The level of IL-2, IL-6, IL-8, and IL-18 in the acute clinical phase of RAS were higher than in the recovery phase, but IL-10 levels showed decreased. IL-2, IL-6, IL-10 gene polymorphisms were found to be more frequent in RAS patients compared to controls, while IL-12 gene polymorphisms were found to be less associated with RAS pathogenesis. Interleukins at the proteomic level that recommended as a pro-inflammatory biomarker are IL-2, IL-6, IL-8, IL-12, and IL-18, while an anti-inflammatory is IL-10. Only IL-2 can be recommended as a biomarker at the genomic level, as other interleukins still require more investigation.

Effect of simulation-based teaching on nursing skill performance: a systematic review and meta-analysis

Abstract Objective To summarize and produce aggregated evidence on the effect of simulation-based teaching on skill performance in the nursing profession. Simulation is an active learning strategy involving the use of various resources to assimilate the real situation. It enables learners to improve their skills and knowledge in a coordinated environment. Methods Systematic literature search of original research articles was carried out through Google Scholar, Medline, and Cochrane Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Studies conducted on simulation-based teaching and skill performance among nursing students or clinical nursing staff from 2010 to 2019, and published in the English language, were included in this study. Methodological quality was assessed by Joanna Briggs Institute, and the risk of bias was also assessed by Cochrane risk of bias and the risk of bias assessment tool for non-randomized studies (ROBINS-I) checklists. Results Initially, 638 titles were obtained from 3 sources, and 24 original studies with 2209 study participants were taken for the final analysis. Of the total studies, 14 (58.3%) used single group prep post design, 7 (29.1%) used high fidelity simulator (HFS), and 7 (29.1%) used a virtual simulator (VS). Twenty (83.3%) studies reported improved skill performance following simulation-based teaching. Simulation-based teaching improves skill performance among types of groups (single or double), study regions, high fidelity (HF), low fidelity (LF), and standard patient (SP) users. But the effect over virtual and medium fidelity simulators was not statistically significant. Overall, simulation-based teaching improves the skill performance score among the experimental group (d = 1.01, 95% confidence interval [CI] [0.69–1.33], Z = 6.18, P &lt; 0.01, 93.9%). Significant heterogeneity and publication bias were observed during the pooled analysis. Conclusions Simulation did improve skill performance among the intervention groups, but the conclusion is uncertain due to the significant heterogeneity. The large extent of difference among original research has necessitated the development of well-defined assessment methods for skills and standardized simulation set-up for proper assessment of their effects.

Effect of physical activity and exercise on telomere length: Systematic review with meta-analysis.

To compare a physically active lifestyle or structured exercise program to physically inactive lifestyle or control groups on telomere length (TL). We searched PubMed, EMBASE, Cochrane Library, and Open Gray databases up to March 31, 2020. We calculated standardized mean differences (SMD) with 95% confidence intervals (CI) of TL comparing physically active to physically inactive individuals and exercise intervention to control groups. Risk of bias was judged using the Risk of Bias Assessment tool for Non-randomized Studies (RoBANS) for physical activity (PA) studies and the Cochrane risk-of-bias (RoB2) for exercise intervention studies. Certainty of evidence was judged using Grading of Recommendations Assessment, Development and Evaluation (GRADE). We included 30 studies (24 assessing the effects of PA and 6 assessing the effects of exercise interventions) comprising 7418 individuals. Physically active individuals had longer telomeres (SMD=0.70, 95% CI 0.12-1.28, very-low certainty), especially in middle-aged individuals (SMD=0.90, 95% CI 0.08-1.72, very-low certainty) and when considering only athletes (SMD=0.54, 95% CI 0.18-0.90, very-low certainty). Trim-and-fill analyses revealed that most of the pooled effects were overestimated. Exercise interventions did not yield any significant effect on TL. There is very-low certainty that physically active individuals have longer telomeres with a moderate effect, but this effect is probably overestimated.

MO935HEALTH RELATED QUALITY OF LIFE AFTER KIDNEY TRANSPLANTATION: A SYSTEMATIC REVIEW

Abstract Background and Aims Health-related quality of life (HRQOL) is becoming an increasingly important outcome in kidney transplantation besides graft function and patient survival. It is of clinical interest to understand whether kidney transplant recipients (KTRs) experience better HRQOL after the invasive procedure and to what extent they can restore HRQOL. To the best of our knowledge, the last relevant systematic review and meta-analysis, which compared HRQOL in KTRs to patients on dialysis, only included eligible publications before 2005. With the considerable improvement in nephrology care and the exponential increase in studies focusing on HRQOL in the past two decades, an updated overview of the current literature is needed. Moreover, to gain a comprehensive picture of HRQOL in KTRs, it is also necessary to include relevant comparison groups such as the general population and healthy controls to understand to which extent HRQOL can be restored to a “pre-CKD” level. To describe HRQOL in KTRs, this systematic review summarizes the published literature to date that compared HRQOL of KTRs with other relevant populations (i.e. patients receiving dialysis, patients on the waiting list for kidney transplantation, patients with chronic kidney disease [CKD] not receiving dialysis, the general population, and healthy controls) and themselves before kidney transplantation. To avoid potential bias, we include studies using different HRQOL questionnaires. Method A thorough literature search was conducted in PubMed, EMBASE, Web of Science, and COCHRANE Library. Studies were included when published between January 2000 and October 2020, and when comparing HRQOL in adult KTRs to the relevant populations. The quality of included studies was assessed using the Risk Of Bias Assessment tool for Non-randomized Studies (RoBANS). Prespecified study characteristics and HRQOL scores were extracted. Due to substantial clinical and methodological heterogeneity, results were summarized in a narrative manner without pooled estimates. Results 44 studies comprising 6929 KTRs were included in this systematic review. The mean age of KTRs in all studies ranged from 29 to 72 years old, and only two studies were conducted in an elderly cohort (≥ 65 years). The majority of studies (93%) reported a higher percentage of male KTRs (median 62%; range 43% to 86%). The average time of HRQOL-measurements after kidney transplantation ranged from 1 to 234 months after the operation. 50% of the studies had a cross-sectional design; 32% had a prospective, and 18% had a retrospective design; and 55% of the studies were single-center studies. While taken into account study heterogeneity, KTRs reported a higher HRQOL after kidney transplantation compared to pre-transplantation and compared to patients receiving dialysis with or without being on the waiting list, especially in disease-specific domains (i.e. burden of kidney disease, effect of kidney disease, and symptoms). Additionally, KTRs had comparable to marginally higher HRQOL compared to patients with CKD stage 3-5. When compared to healthy controls or the general population, KTRs reported similar HRQOL in the first one or two years after kidney transplantation, and lower physical HRQOL and lower to comparable mental HRQOL with an average post-transplant time longer than two years. Conclusion Patients generally report better HRQOL after successful kidney transplantation compared to themselves before the operation and patients receiving dialysis with or without waiting for kidney transplantation, but HRQOL of KTRs does not return to “pre-CKD” HRQOL levels. Future studies investigating risk factors for impaired HRQOL are needed to maximize the long-term benefit of kidney transplantation.