Risk Of Bias In Non-randomized Studies Of Interventions Research Articles

Efficacy of Interventions Intended to Increase Lung Cancer Screening Rates: A Systematic Review and Meta-analysis.

Few eligible patients in the United States participate in lung cancer screening (LCS) with low-dose computed tomography (LDCT). What is the efficacy of interventions to increase LCS participation? We performed a systematic review following a prespecified protocol registered in PROSPERO (CRD42021283984). In June/July of 2021, we searched Ovid MEDLINE, Embase, Cochrane, CENTRAL, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and Epistemonikos from 1946 to October 2021 to identify studies evaluating interventions to increase LCS participation. Thirteen of 2761 studies met inclusion criteria for data extraction. Of these, six had results available (five RCTs and one prospective observational study). The studies had predominantly White and non-Hispanic participants. An intention-to-treat analysis was used to calculate each study's relative risk (RR) to increase LCS. Effect sizes were pooled using a random-effects model with a subgroup analysis for multi- versus single-step interventions. Risk of bias was evaluated with the revised Cochrane risk-of-bias tool (RoB 2) and risk of bias in non-randomized studies of interventions (ROBINS-I). Overall, the proportion of screening LDCTs performed did not improve in the intervention group relative to the comparator group (RR [95% CI] of 1.30 [0.74, 2.29]), and meta-analysis indicated high heterogeneity of studies (I2 = 91%). Subgroup analysis suggests that interventions targeting multiple barriers may increase LCS participation (RR [95% CI] for multistep vs single-step; 2.68 [1.77, 4.05] vs 0.99 [0.89, 1.10], P < 0.01). Quality assessment revealed that three of five RCTs showed some concerns or high risk of bias. Evidence on efficacy of interventions to increase LCS participation is limited due to a small number of prospective studies performed in non-diverse populations with critical risk of bias. Further, overall, studied interventions did not improve lung cancer screening participation, though interventions targeting multiple barriers may have some benefit.

Conducting observational analyses with the target trial emulation approach: a methodological systematic review

ObjectivesTarget trial emulation is an approach that is increasingly used to improve transparency in observational studies and help mitigate biases. For studies declaring that they emulated a target trial, we...

Prophylactic antibiotics for manual removal of retained placenta in vaginal birth.

Retained placenta is a potentially life-threatening condition because of its association with postpartum haemorrhage. Manual removal of the placenta increases the likelihood of infectious complications of the uterine cavity. So, prophylactic antibiotics are recommended by some experts, and commonly administered to reduce these risks. However, the evidence supporting this decision is limited. This review aims to assess the effectiveness of prophylactic antibiotics for manual removal of retained placenta after vaginal birth. To compare the effectiveness and adverse effects of routine prophylactic antibiotics for the manual removal of placenta after vaginal birth. To identify appropriate prophylactic antibiotic regimens. For this update, we searched CENTRAL, MEDLINE, Embase, CINAHL, and two trials registries, in addition to screening the reference lists of retrieved studies and systematic reviews. The last search was 14 May 2024. All randomised controlled trials and non-randomised studies comparing prophylactic antibiotics to no treatment or to another prophylactic antibiotic to prevent postpartum endometritis after manual removal of placenta after vaginal birth. The critical outcome in our review was postpartum endometritis. Other important outcomes were puerperal morbidity, perineal infection, duration of hospital stay, sepsis, any infection, blood loss, postpartum haemorrhage, secondary postpartum haemorrhage, readmission to hospital, adverse effects of the drugs, women's satisfaction, and neonatal outcomes, such as jaundice, sepsis, neonatal intensive care unit admission, et cetera. The risk of bias was assessed at the outcome level. We used the Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) tool to assess the risk of bias in non-randomised studies. We carried out statistical analysis using Review Manager. We used a fixed-effect meta-analysis to synthesise the results, and GRADE to assess the certainty of the evidence. We included four retrospective cohort studies with a total of 974 participants. Studies were conducted in Germany, Bulgaria, Norway, and Israel, between 1983 and 2017. Prophylactic antibiotics versus no antibiotics was the only comparison in our analysis. Postpartum endometritis We do not know whether prophylactic antibiotics have an impact on postpartum endometritis (risk ratio (RR) 0.94, 95% confidence interval (CI) 0.48 to 1.85; 4 studies, 974 participants; very low-certainty evidence). Postpartum haemorrhage The evidence suggests that prophylactic antibiotics may result in little to no difference in postpartum haemorrhage (RR 1.00, 95% CI 0.78 to 1.29; 1 study, 325 participants; low-certainty evidence). Neonatal intensive care unit admission (NICU) The evidence suggests that prophylactic antibiotics may result in little to no difference in NICU admission of the neonate (RR 0.86, 95% CI 0.29 to 2.61; 1 study, 353 participants; low-certainty evidence). There were no data available for other important outcomes, including puerperal morbidity, perineal infection, duration of hospital stay, sepsis, any infection, blood loss, secondary postpartum haemorrhage, readmission to hospital, adverse effects of drugs, women's satisfaction, or neonatal outcomes of jaundice or sepsis. There is very uncertain evidence supporting the use of prophylactic antibiotics for manual removal of placenta for preventing postpartum endometritis. The evidence suggests that prophylactic antibiotics result in little to no difference in postpartum haemorrhage or admission to a neonatal intensive care unit. There were no available data on other important outcomes. Multicentre, randomised controlled trials comparing antibiotic prophylaxis and placebo or no antibiotic, or one antibiotic and another, for manual removal of placenta in vaginal birth are needed to provide more robust evidence. This systematic review received support from the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP). Protocol and previous versions are available at https://10.1002/14651858.CD004904.pub3.

Current real world health data of telemedicine for heart failure with reduced ejection fraction: a systematic review and meta-analysis

Abstract Background Telemedicine has improved adherence to heart failure (HF) treatment, however it has not yet been tailored specifically to address HF with reduced ejection fraction (HFrEF). Our objective is to undertake a comprehensive systematic review and meta-analysis of existing research studies that focus on telemedicine in HFrEF. Methods We conducted an extensive literature review encompassing trials which included outpatients with HFrEF who underwent telemedicine compared with usual care. We exclude any studies without ejection fraction data. Three bibliographic databases from PubMed, ScienceDirect, and Cochrane Library were utilized in our search from January 1999 to May 2023. The endpoints of interest included all-cause mortality, cardiovascular-related mortality, all-cause hospitalization, and HF-related hospitalization. The Cochrane risk-of-bias (RoB) and the risk of bias in non-randomized studies – of interventions (ROBINS-I) were used for non-randomized or observational studies. To quantitatively analyze the collective findings, a pooled odds ratio (OR) was computed for each outcome. Results Out of the initial pool of 4,947 articles, we narrowed down our analysis to 27 studies, Results showed that telemedicine significantly reduced all-cause mortality (OR: 0.65; 95% CI 0.54 – 0.78; p&lt;0.00001), cardiovascular-related mortality (OR 0.68, 95% CI 0.58 – 0.80, p &lt; 0.00001), and HF-related hospitalization based on number of events (OR 0.77, 95% CI 0.64 – 0.94, p = 0.009) as well as number of patients (OR 0.78, 95% CI 0.69 – 0.87, p &lt; 0.0001). Conclusion Telemedicine was shown significantly beneficial in decreasing mortality and hospitalization in HFrEF patients. Future research should focus on standardizing effective telemedicine practices due to the existing variability in methods and clinical situation of the patients. PROSPERO: CRD42023471222 registerd on October 21, 2023

Seizure outcomes in patients with brain metastases and epilepsy: A systematic review on the efficacy of antitumor treatment and antiseizure medication

Abstract Background Epilepsy is a common symptom in patients with brain metastases (BMs), and because of the rising incidence of BMs, adequate seizure management is warranted. We conducted a systematic review on seizure outcomes after antitumor treatment and antiseizure medication (ASM) in patients with BMs from solid tumors and epilepsy. Methods A literature search was performed in six databases up to February 2024. Extracted outcomes were rates for (1) seizure freedom; (2) ≥50% seizure reduction; and (3) treatment failure (for ASM only). Weighted averages (WAs) were calculated for outcomes after surgery at 6 months follow-up. Quality assessment of the included studies was performed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Results We retrieved 2244 references, of which 16 studies were eligible for inclusion. Eight studies were at critical, and 8 studies at serious risk of bias. The WA of seizure freedom rates at 6 months after surgical resection was 64% (based on 3 studies at serious risk of bias, n=151 patients). Results on ASM efficacy and tolerability were unreliable, as all eligible studies for these outcomes were at critical risk of bias. Conclusions Limited available evidence from heterogeneous study populations demonstrated that in the majority of patients with epilepsy due to BMs, seizure freedom 6 months after surgical resection may be reached. No substantial evidence on ASM efficacy and tolerability in patients with epilepsy due to BMs is available. High-quality cohort studies are warranted to expand the evidence on seizure outcomes after antitumor and ASM treatment.

Heat Generation and Pain Assessment in Piezosurgery Versus Conventional Drilling for Implant Placement: A Systematic Review.

The development of new technologies in implant dentistry has led to the introduction of piezosurgery, which utilizes ultrasonic vibrations for micrometric and selective bone cutting. It is hypothesized to reduce trauma to bone tissue, thereby potentially improving the healing process compared to traditional drilling methods. This systematic review examines the differences in heat generation and pain perception between piezosurgery and conventional drilling techniques for dental implant placement. An extensive review of literature was performed using various databases, includingPubMed via MEDLINE, EBSCO, and Google Scholar. Out of an initial pool of 2,279 articles, nine studies met the predefined inclusion criteria and were included in the final analysis following title and abstract screening and subsequent full-text evaluation. The quality of the selected studies was rigorously assessed using the Risk of Bias (RoB 2.0), Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I), and Quality Assessment Tool for In Vitro Studies (QUIN) tools. Data pertaining to thermal effects and postoperative pain associated with piezosurgery relative to conventional drilling protocols were collected. The results indicated a significant reduction in postoperative pain with piezosurgery; however, the technique was associated with higher intraoperative temperatures during osteotomy. These findings provide valuable insights into the potential benefits and limitations of piezosurgery in dental implant procedures.

Exploring the Influence of the Edmonton Symptom Assessment System Implementation in Palliative Care Patients: A Systematic Review.

One of the most essential elements of providing high-quality palliative care is good symptom control, which is guided through an assessment of the evolution of the patient's level of distress over time. The Edmonton Symptom Assessment System (ESAS) was created to measure diverse symptoms in palliative care patients. It is a user-friendly, validated, and reliable multi-item instrument. Globally, ESAS is extensively used to direct dailyclinical careand foster communication across multidisciplinary teams, ensuring coordinated patient management, facilitating referrals to specialized programs, and evaluating the quality of care. In this systematic review, we aim to evaluate the influence of using ESAS on symptom assessment and control among palliative care patients and settings. We have employed both manual and electronic search strategies among databases to determine relevant studies. This systematic review included original studies published between 2013 and 2023 that implemented theESASas part of palliative care for adult patients with terminal illness or advanced disease. Studies recruiting pediatric patients, case reports with limited sample sizes and no descriptive statistics, and nonhuman or laboratory studies were excluded.The ROBINS-I (Risk Of Bias In Non-randomized Studies-of Interventions) tool was used to assess the quality of the included studies, which assessed the methodological quality and potential risk of bias in non-randomized clinical studies. We included eight studies that recruited a total of 3184 patients. Fatigue followed by pain were the symptoms with the highest score on ESAS among all the studies, while the lowest score was recorded for nausea and dyspnea in most of the studies. ESAS scores showed improvement in the follow-up visits. Two of the included studies reported satisfaction with the utilization of the ESAS tool. As stated in our results, it can improvethe overall quality of life for patients receiving palliative care by assisting healthcare professionals, family members, and caregivers in methodically assessing and treating symptoms over time. By fostering better communication among care teams and involving caregivers in the process, the use of ESAS promotes a morepatient-centered approach to care, ensuring that both the patient's needs and the perspectives of their loved ones are considered.

Contemporary use of 3D printed jigs and guides for osteotomies around the knee: a systematic review

Background. With improved accessibility of imaging and additive manufacturing, custom targeting guides and jigs are now widely accepted across many areas of orthopaedics. During orthopedic surgery, patient-specific guides assist in the accurate drilling and cutting of bone in conjunction with meticulous pre-operative planning. Given their increased uptake, it is important to define the lessons learned from recent clinical experience, and to document the reported benefits when using this technology intra-operatively. The aim of this review is to evaluate the potential benefits of patient-specific guides for osteotomies about the knee, and to clarify what evidence currently exists to support their use. Methods. A systematic review of PubMed, Embase, and Web of Science was performed for studies investigating the use of intra-operative patient-specific guides for realignment osteotomies about the knee. Randomised controlled trials, non-randomised studies, observational studies, case series, and case reports, as well as in vitro studies, were included. Screening was conducted with the Covidence software, and risk of bias was assessed with the Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I) tool. Results. A total of 38 studies satisfied the inclusion criteria: 21 of these included patient-specific instrumentation (PSI) for high tibial osteotomy, 6 with distal femoral osteotomy, 4 — for combined tibial/femoral rotational corrective osteotomies, 4 — in double-level osteotomies, and 6 — for intra-articular osteotomies. The main outcomes reported were accuracy of surgical correction, typically with reference to pre-operative plans, and execution accuracy based on radiographic measurements. Other common outcomes were operative time, intra-operative fluoroscopy, and operative costs. Many studies were observational in nature, with no control groups available for suitable comparison. Conclusions. For corrective osteotomies about the knee, the literature suggests PSI has very strong potential to improve accuracy in achieving pre-operative targets. This was reported for both opening and closing wedge osteotomies of the femur, and for high tibial osteotomy. Some contradictory results have been reported for high tibial osteotomy, based on limited evidence from small studies that in many instances lacked controls for comparative analysis. Additional controlled trials are necessary to confirm the benefits of PSI for osteotomies about the knee, considering it has not yet been conclusively validated. The literature currently available indicates PSI can improve the accuracy of corrective osteotomies about the knee.

Managing the work stress of inpatient nurses during the COVID-19 pandemic: a systematic review of organizational interventions

BackgroundDuring the coronavirus disease 2019 (COVID-19) pandemic, inpatient nurses faced various work stressors. Little is known about organizational interventions that can mitigate the negative consequences of pandemic-related stressors.ObjectiveThe aim was to provide a synopsis of the literature concerning the types and outcomes of organizational interventions performed during the COVID-19 pandemic that directly (re)organized the work structures of inpatient nurses to address pandemic-related work stressors or to increase nurses’ ability to cope.MethodsWithin this preregistered systematic literature review, we searched four databases (PubMed, PsycINFO, PsycARTICLES, CINAHL) and two preprint databases (MedRxiv, PsyArXiv) for interventional studies of organizational interventions published between 01/2020 and 03/2023 (k = 990 records). We included 12 primary studies after title-abstract and full-text screening. A synthesis of results without meta-analysis was conducted. Risk of bias was assessed with the Cochrane risk-of-bias tool for randomized trials – version 2 (RoB-2) and Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tool.ResultsAll interventions were implemented in hospitals. The reasons given for implementation included pandemic-related work stressors such as a high workload, understaffing, and a lack of medical resources. To respond to the various work stressors, half of the studies took a multilevel approach combining organizational and person-oriented interventions (k = 6). Most studies (k = 8) took a secondary prevention approach, focusing on the organization of rest breaks (k = 5). With respect to outcomes, the studies examined nurse-related stress and resilience, turnover intention, job satisfaction, and other factors. Risk-of-bias analyses revealed that conclusions about the effectiveness of the interventions are limited due to confounding factors and self-selection.ConclusionsThe identified interventions provide a basis for future research to draw conclusions on the effectiveness of organizational interventions during pandemics. The promotion of adequate work breaks could be useful if the work stressors associated with strain and negative consequences cannot be changed directly. However, the same stressors (e.g., high workload) can hinder nurses from participating in offered interventions. This emphasizes the importance of directly addressing inpatient nurses’ work stressors.RegistrationProspero-ID CRD42023364807 (March 2023).

The Battle of Endoscopic Bariatric Therapies for Obesity: Endoscopic Sleeve Gastroplasty Versus Endoscopically Inserted Intragastric Balloon—A Pairwise Meta-Analysis of Comparative Studies and a Call for Randomized Controlled Trials

Background: Endoscopic sleeve gastroplasty (ESG) represents the latest primary endoscopic intervention for managing obesity. Both ESG and intragastric balloons (IGBs) have demonstrated effectiveness and safety for weight loss. However, there is a paucity of high-quality evidence supporting the superiority of one over the other, and no pairwise meta-analysis of comparative studies has been published to date. Our aim was to conduct a pairwise meta-analysis of comparative studies directly comparing ESG and IGB. Methods: We systematically conducted a literature search on PubMed and Google Scholar following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our search used specific search terms. The Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) Tool was used to evaluate the quality of the included studies. Data were analyzed using Review Manager (RevMan) 5.4.1 software with a random-effects model. The statistical method used was the Mantel-Haenszel method. For dichotomous data, the effect size was represented using odds ratio (OR), while mean difference (MD) was utilized as the effect size for continuous data. Results: After screening 967 records, a total of 9 studies met the inclusion criteria for this meta-analysis (5302 patients). The quality assessment categorized 5 studies as having a moderate risk of bias, while 3 studies were classified as having a low risk of bias. Sufficient information was not available for one study to ascertain its overall quality. A statistically significant increase in total weight loss percentage (TWL%) at 1 and 6 months was observed with ESG compared with IGB. In addition, a statistically insignificant decrease in the incidence of adverse events and readmissions was observed with ESG. Furthermore, a statistically significant decrease in the incidence of reintervention was observed with ESG. Conclusions: While this study suggests a higher TWL% associated with ESG compared with IGB, drawing definitive conclusions is challenging due to limitations identified during a comprehensive quality assessment of the available literature. We advocate for randomized controlled trials (RCTs) directly comparing the newer IGB (with a 12-mo placement duration) with ESG. However, this study consistently reveals higher rates of early reintervention (re-endoscopy) within the IGB group, primarily necessitated by the removal or adjustment of the IGB due to intolerance. Given the additional intervention required at 6 or 12 months to remove the temporarily placed IGB, this trend may imply that IGB is less economically viable than ESG. Cost-effectiveness analyses comparing ESG and IGB are warranted to provide valuable scientific insights.

Comparing the effectiveness and safety of videolaryngoscopy and direct laryngoscopy for endotracheal intubation in the paediatric emergency department: a systematic review and meta-analysis.

Endotracheal intubation is an uncommon procedure for children in the emergency department but can be technically difficult and cause significant adverse effects. Videolaryngoscopy (VL) offers improved first-pass success rates over direct laryngoscopy (DL) for both adults and children undergoing elective surgery. This systematic review was designed to evaluate current evidence regarding how the effectiveness and safety of VL compares to DL for intubation of children in emergency departments. Four databases (MEDLINE, Embase, CENTRAL and Web of Science) were searched on 11th May 2023 for studies comparing first-pass success of VL and DL for children undergoing intubation in the emergency department. Studies including adult patients or where intubation occurred outside of the emergency department were excluded. Quality assessment of included studies was carried out using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. Meta-analysis was undertaken for first-pass success and adverse event rate. Ten studies met the inclusion criteria representing 5,586 intubations. All included studies were observational. Significantly greater first-pass success rate was demonstrated with VL compared to DL (OR 1.64, 95% CI [1.21-2.21], p = 0.001). There was no significant difference in risk of adverse events between VL and DL (OR 0.79, 95% CI [0.52-1.20], p = 0.27). The overall risk of bias was moderate to serious for all included studies. VL can offer improved first-pass success rates over DL for children intubated in the emergency department. However, the quality of current evidence is low and further randomised studies are required to clarify which patient groups may benefit most from use of VL. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=415039, Identifier CRD42023415039.

Neonatal and maternal outcomes of mRNA versus Non-mRNA COVID-19 vaccines in pregnant patients: a systematic review and meta-analysis.

To compare the effectiveness and safety of non-mRNA versus mRNA COVID-19 vaccines on pregnant women and their newborns in a systematic review with meta-analysis. We searched PubMed, Embase, and Cochrane Central in May 2023. The search strategy yielded 4451 results, 16 studies were fully reviewed. We selected case-control studies analysing non-mRNA versus mRNA vaccines. Data collection and analysis: we assessed the risk of bias using the Cochrane Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. Standardised mean differences were pooled using random-effect models. We identified 8 prospective and retrospective studies with a total of 32,153 patients. Non-mRNA vaccines were associated with a higher incidence of fever (OR 2.67; 95% CI 2.08-3.43; p<0.001), and a lower incidence of fetal or neonatal death (OR 0.16; 95% CI 0.08-0.33; p<0.001). In subgroup analyses, the Jansen vaccine (Ad26.COV2.S) was found to have a higher rate of premature labor/delivery (OR 4.48; 95% CI 1.45-13.83; p=0.009) and missed/spontaneous abortion (OR 1.90; 95% CI 1.09-3.30; p=0.02), as compared with the Pfizer (BNT162b2) vaccine. non-mRNA vaccines are associated with a lower incidence of fetal or neonatal death among pregnant women who receive a Covid19 vaccine, although at an increased rate of pyrexia compared with mRNA vaccines. Other studies are required for better assessment. CRD42023421814.

Role of Spinal Surgery Drainage Techniques in Postoperative Outcomes: Insights From a Comprehensive Literature Review.

Postoperative management often demands the introduction of several strategies in an attempt to minimize complication rates. One of the routine strategies includes the use of spinal drains, which have been questioned for their efficacy in improving postoperative outcomes. However, its role in postoperative outcomes is still debated. In general, this elucidation of an extensive literature review supports the synthesis of current evidence regarding the role of spinal drains in infection rates, hematoma formation, and overall patient recovery. A comprehensive search of PubMed from 2000 to 2024 was performed, focusing on studies investigating the use of spinal drains in spinal surgeries and their associated postoperative outcomes. It followed the guidelines outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The inclusion criteria were studies related to spinal surgeries, excluding case reports, reviews, and editorials, and limited to articles published in English. Quality assessment was performed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. A total of 19 studies were included, with different designs and varied sample sizes. The sample size was from 25 to 2,446 patients. Findings on infection rates were mixed; while one group of studies showed no significant differences in patients with and without drains, another group showed a reduced rate of reoperation for surgical site infections in patients with drains. In general, hematoma formation rates were reported to be the same across groups, while a few studies indicated that drains were more effective in managing wound exudates compared to no drains. Recovery outcomes indicated that patients who had a wound drain were more likely to stay in the hospital longer, although an improvement was noticed with time-driven wound drain removal, which resulted in shorter hospital stays and earlier ambulation. The use of spinal drains in postoperative spinal surgery presents both benefits and drawbacks. Spinal drains can assist in the management of wound exudates, and earlier detection of infection complications increases hospital stays and complications. Indeed, whether to use spinal drains or not should be an individual decision, weighing the potential benefits and risks. Future studies need to be done in order to establish clear guidelines for the use of drainage systems in various spinal surgical cases.

Resective epilepsy surgery and its impact on depression in adults: a systematic review, meta-analysis, and implications for future research

BackgroundHow epilepsy surgery influences the bidirectional relationship of epilepsy and depression remains poorly defined.MethodFor a better understanding of this question, we conducted a systematic review and meta-analysis of risk ratio...

A Systematic Review of the Effect of Gene-Lifestyle Interactions on Metabolic-Disease-Related Traits in South Asian Populations.

Recent data from the South Asian subregion have raised concern about the dramatic increase in the prevalence of metabolic diseases, which are influenced by genetic and lifestyle factors. The aim of this systematic review was to summarize the contemporary evidence for the effect of gene-lifestyle interactions on metabolic outcomes in this population. PubMed, Web of Science, and SCOPUS databases were searched up until March 2023 for observational and intervention studies investigating the interaction between genetic variants and lifestyle factors such as diet and physical activity on obesity and type 2 diabetes traits. Of the 14 783 publications extracted, 15 were deemed eligible for inclusion in this study. Data extraction was carried out independently by 3 investigators. The quality of the included studies was assessed using the Appraisal Tool for Cross-Sectional Studies (AXIS), the Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I), and the methodological quality score for nutrigenetics studies. Using a narrative synthesis approach, the findings were presented in textual and tabular format. Together, studies from India (n = 8), Pakistan (n = 3), Sri Lanka (n = 1), and the South Asian diaspora in Singapore and Canada (n = 3) reported 543 gene-lifestyle interactions, of which 132 (∼24%) were statistically significant. These results were related to the effects of the interaction of genetic factors with physical inactivity, poor sleep habits, smoking, and dietary intake of carbohydrates, protein, and fat on the risk of metabolic disease in this population. The findings of this systematic review provide evidence of gene-lifestyle interactions impacting metabolic traits within the South Asian population. However, the lack of replication and correction for multiple testing and the small sample size of the included studies may limit the conclusiveness of the evidence. Note, this paper is part of the Nutrition Reviews Special Collection on Precision Nutrition. PROSPERO registration No. CRD42023402408.

Do bisphosphonates and RANKL inhibitors alter the progression of coronary artery calcification? A systematic review

ObjectivesTo determine whether bisphosphonates and NF-κB ligand (RANKL) inhibitors delay coronary artery calcification (CAC).DesignA systematic review was conducted.Data sourcesMEDLINE, EMBASE and CENTRAL.Eligibility criteriaLongitudinal studies investigating CAC progression in adults (>18...

Association between different levels of suppressed viral load and the risk of sexual transmission of HIV among serodiscordant couples on antiretroviral therapy: a protocol for a two-step systematic review and individual participant data meta-analysis

IntroductionHIV is a major global public health issue. The risk of sexual transmission of HIV in serodiscordant couples when the partner living with HIV maintains a suppressed viral load of...

Inheritance patterns of lower urinary tract symptoms in adults: a systematic review.

To compile and evaluate the heritability and inheritance patterns of lower urinary tract symptoms (LUTS) in adult cohorts. Searches of five databases (PubMed, Embase, APA PsycInfo, Global Health, and OVID Medline) commenced on 6 July 2024, resulting in 736 articles retrieved after deduplication. Studies evaluating heritability patterns, gene frequencies, and familial aggregation of symptoms were included for review. Screening and predefined eligibility criteria produced 34 studies for final review. A descriptive analysis of synthesised data was performed, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Cochrane Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) tool and the Johanna Briggs Institute checklist were used to evaluate these studies. Ten of the 34 studies (29%) described general LUTS, 14 (41%) described symptoms due to benign prostatic enlargement (BPE), nine (26%) described urinary incontinence (UI; urge UI [UUI], stress UI [SUI] and mixed UI [MUI]), four (12%) described nocturia alone, two (6%) described overactive bladder (OAB), and four (13%) described other specific symptoms (frequency, postvoid residual urine volume). BPE symptoms, UI (MUI and UUI), nocturia alone, and frequency alone were associated with genetic predisposition, whilst OAB and SUI had more modest inheritance. The pathogenetic and pharmacological mechanisms fundamental to LUTS manifestation are highly heterogeneous. Further work is required to evaluate the inheritance patterns of LUTS more extensively.

The efficacy of intravitreal anti-VEGF for radiation maculopathy: a systematic review and meta-analysis.

Anti-vascular endothelial growth factor (VEGF) therapy is the primary approach for managing radiation maculopathy. However, a noticeable gap exists in meta-analyses evaluating the efficacy of anti-VEGF therapy specifically in the context of radiation maculopathy. We conducted a review of comparative studies on anti-VEGF treatment up to October 2023. References were sourced from PubMed, EMBASE, and the Cochrane Library. The Cochrane Risk of Bias tool assessed the quality of randomized controlled trials (RCTs), while the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool evaluated non-RCTs. Thirteen articles originating from eleven trials involving 2,525 eyes of 2408 patients were included. Four trials with 2226 eyes examined the effect of preventive anti-VEGF. Four trials with 189 eyes assessed the effect of anti-VEGF for preexisting maculopathy, and three trials with 110 eyes compared different anti-VEGF treatment modalities. In the preventive anti-VEGF treatment meta-analysis over a 24-month follow-up, the anti-VEGF group exhibited significantly fewer cases of radiation maculopathy (OR: 0.40; 95% CI: 0.25, 0.66, P= .0003, I2 =45%). For the meta-analysis of anti-VEGF treatment for pre-existing radiation maculopathy over a 6-month follow-up, the anti-VEGF group showed improved visual acuity (SMD: -1.13, 95% CI: -1.69 to -0.56, P < .0000, I2 = 47%) and decreased central macular thickness (SMD: -0.59, 95% CI: -1.13 to -0.05, P = 0.03, I2 = 62%). Prophylactic anti-VEGF effectively prevents radiation maculopathy and is also beneficial in treating pre-existing radiation maculopathy. Intensive treatment initially provides early benefits, but the efficacy diminishes after transitioning to a treat-and-extend regimen.

2197 Effectiveness of horticultural therapy on the psychosocial and physical function of older adults with normal cognitive function.

Abstract Introduction Horticultural therapy (HT) is not uncommonly used as non-pharmacological therapy for patients with dementia. However, less is known about its effects on older adults with normal cognition. This systematic review and meta-analysis syntheses available evidence to evaluate the effects of HT on psychosocial and physical function in cognitively intact older adults. Method A systematic search in 9 electronic databases for experimental and quasi-experimental studies was performed between January 1, 2001, and July 19, 2021. Studies involving participants above 60 years old with normal cognition, analysing psychosocial and physical effects of HT, were included. Cochrane Risk of Bias 2 (RoB2) tool and Risk of Bias in Non-randomised Studies- of Interventions (ROBINS-I) were used to assess risk of bias. Meta-analysis was conducted using Stata software. Cochran’s Q test and I2 were used to explore statistical heterogeneity. Narrative synthesis was conducted for trials unsuitable for quantitative pooling. Results Nineteen articles (2191 participants) were included. Meta-analyses found that HT showed moderate-large effects on psychosocial outcomes, with improved self- efficacy (Hedges’ g = 0.49, 95%Confidence Interval: 0.07,0.91, 3 trials, I2:0.00%) and self-esteem (g = 1.01, 95%CI:0.33,1.68, 2 trials, I2:0.00%), and decreased depressive symptoms (g = −3.33, 95%CI:-6.29,-0.37, 4 trials, I2:98.51%). Narrative synthesis suggested benefits in Health-related Quality of Life. Regarding physical effects, HT improved exercise duration and intensity (g = 1.37, 95%CI:0.92,1.82, 2 trials, I2:0.00%). Effects on anxiety, social engagement and fitness did not achieve statistically significance. Conclusion The findings support the potential role of HT in promoting psychosocial and physical function among older adults with intact cognition. Given high statistical heterogeneity, more work is needed to explore the effect of possible moderators on treatment effects.