Title Screening Research Articles

The burden of lung cancer attributable to ambient PM2.5 exposure: a systematic literature review

Abstract Background Lung cancer is recognized as one of the most common causes of cancer morbidity and mortality worldwide and is the second cause of death with highest years of life lost in highly developed regions. Ambient exposure to particulate matter (PM2.5) is the leading global environmental risk factor. Long-term exposure to PM2.5 is associated with several health outcomes, including lung cancer, ischemic heart disease, and chronic obstructive pulmonary disease. Aim To review and estimate the impact attributable to PM2.5 exposure due to lung cancer. Methods A systematic review and a meta-analysis were conducted to determine whether long-term exposure to PM2.5 increases the risk of lung cancer and to derive exposure-response relationships between PM2.5 and lung cancer. The literature search was performed in databases (i.e., Pubmed/Scopus) and studies published from January 1, 2010 onwards were considered. Studies describing the association between long-term exposure to the pollutant under research and the incidence, prevalence, and mortality of lung cancer, considering a relative measure of association were included, with no restriction in geographical area. Results In the literature review, 2215 articles were considered for the first step of data synthesis, all articles were screened, considering the screening of titles (first step), abstracts (second step) and full-text (third step) considering the inclusion criteria. In a second step the data was extracted from the included articles (n = 129) and considering the variables related to the characteristics of the study and the study population, exposure, and outcome measurement, and details of risk of bias assessment. Conclusions These findings provide data to synthesize effect size estimates using a Meta-Regression - Bayesian, Ensemble, Regularized, Trimmed (MR-BRT) model, important to provide evidence data on the impact of air pollution on human health, which is crucial for decision-making. Key messages • Long-term exposure to PM2.5 increases lung cancer risk so the estimating of the impact of the exposure is an urgent need to provide evidence-based data for air quality improvement. • Meta-analysis aims to establish a relation between PM2.5 exposure and the burden of lung cancer.

Xenon and Argon as Neuroprotective Treatments for Perinatal Hypoxic-Ischemic Brain Injury: A Preclinical Systematic Review and Meta-Analysis.

Xenon and argon are currently being evaluated as potential neuroprotective treatments for acquired brain injuries. Xenon has been evaluated clinically as a treatment for brain ischemia with equivocal results in small trials, but argon has not yet undergone clinical evaluation. Several preclinical studies have investigated xenon or argon as treatments in animal models of perinatal hypoxic-ischemic encephalopathy (HIE). A systematic review of MEDLINE and Embase databases was performed. After screening of titles, abstracts, and full text, data were extracted from included studies. A pairwise meta-analysis of neuroprotective efficacy was performed using a random effects model. Heterogeneity was investigated using subgroup analysis, funnel plot asymmetry, and Egger's regression. The protocol was prospectively registered on PROSPERO (CRD42022301986). A total of 21 studies met the inclusion criteria. The data extracted included measurements from 1591 animals, involving models of HIE in mice, rats, and pigs. The meta-analysis found that both xenon and argon had significant (P < .0001) neuroprotective efficacies. The summary estimate for xenon was 39.7% (95% confidence interval [CI], 28.3%-51.1%) and for argon it was 70.3% (95% CI, 59.0%-81.7%). The summary effect for argon was significantly (P < .001) greater than that of xenon. Our results provide evidence supporting further investigation of xenon and argon as neuroprotective treatments for HIE.

An integrative systematic review on interventions to improve layperson's ability to identify trustworthy digital health information.

Health information on the Internet has a ubiquitous influence on health consumers' behaviour. Searching and evaluating online health information poses a real challenge for many health consumers. To our knowledge, our systematic review paper is the first to explore the interventions targeting lay people to improve their e-health literacy skills. Our paper aims to explore interventions to improve laypeople ability to identify trustworthy online health information. The search was conducted on Ovid Medline, Embase, Cochrane database, Academic Search Complete, and APA psych info. Publications were selected by screening title, abstract, and full text, then manual review of reference lists of selected publications. Data was extracted from eligible studies on an excel sheet about the types of interventions, the outcomes of the interventions and whether they are effective, and the barriers and facilitators for using the interventions by consumers. A mixed-methods appraisal tool was used to appraise evidence from quantitative, qualitative, and mixed-methods studies. Whittemore and Knafl's integrative review approach was used as a guidance for narrative synthesis. The total number of included studies is twelve. Media literacy interventions are the most common type of interventions. Few studies measured the effect of the interventions on patient health outcomes. All the procedural and navigation/ evaluation skills-building interventions are significantly effective. Computer/internet illiteracy and the absence of guidance/facilitators are significant barriers to web-based intervention use. Few interventions are distinguished by its implementation in a context tailored to consumers, using a human-centred design approach, and delivery through multiple health stakeholders' partnership. There is potential for further research to understand how to improve consumers health information use focusing on collaborative learning, using human-centred approaches, and addressing the social determinants of health.

30 Access to Autism Spectrum Disorder services for marginalized families in Canada: A scoping review

Abstract Background In Canada, despite universal healthcare, immigrant and racially marginalized families face unique barriers when accessing Autism Spectrum Disorder (ASD) services for their children. Exploring these experiences is critical to inform the federal government’s efforts to create a national autism strategy that serves children and families with ASD in Canada. Objectives We conducted a scoping review of immigrant, refugee, and racially marginalized families’ access to, utilization, and experiences with ASD services in Canada. Design/Methods The Joanna Briggs Institute scoping review methodology was used. A literature search in MEDLINE, EMBASE, CINAHL, APA PsycINFO, Scopus, and Web of Science was conducted in August 2023. English and French-language qualitative studies describing the experiences of marginalized families in Canada with accessing and/or using ASD services for their child &amp;lt;18 years were included. To assess eligibility of search results, title, abstract, and full-text screening were conducted independently by two reviewers. For included studies, two reviewers extracted data and appraised articles using the Critical Appraisal Skills Programme qualitative checklist. Results There were 4,489 search results. After de-duplication, 3,804 studies remained. Of these studies, 12 met inclusion criteria – representing 320 immigrant caregivers living in Ontario (n=167), Quebec (n=151), and British Columbia (n=2). Caregivers immigrated from Africa (n=55), Latin America (n=43), Europe (n=25), Asia (n=13), North America (n=11), the Middle East (n=4), and unreported (n=169). Of note, no studies focused on refugees. Common barriers when accessing ASD services were related to: difficulties navigating the health system (wait times, limited resources in the public system, high costs for private services, lack of collaboration between school and healthcare providers), challenges interacting with service providers (feeling unheard, discrimination, lack of continuity of care), and cultural differences (regarding ASD, language barriers, social isolation). In contrast, families identified supportive healthcare and school personnel, provision of culturally-specific multilingual resources, and parent-led peer support networks as key facilitators to ASD service access and use. Conclusion These results highlight gaps in existing research, especially around the experiences of refugee families. Our findings reiterate the importance of greater caregiver involvement in informing evidence-based recommendations to improve Canadian service provision, policy, and research. This national focus is especially relevant, given that 23% of Canadians in the most recent 2021 census are landed immigrants – representing the highest proportion of immigrants in Canada to date and emphasizing the growing need for culturally competent care.

Use of Biomarkers in Nutrition Intervention Studies of Children: A Scoping Review

Obesity in youth is an increasingly prevalent public health concern worldwide. Lifestyle interventions aim to help participants establish healthy habits and reduce obesity-related disease risk by targeting physical activity and dietary habits. Most studies assess weight loss, but biomarkers may enable more rapid and comprehensive assessment of intervention success. This scoping review aims to synthesize the published literature on which biomarkers are assessed during interventions for pediatric obesity to inform future use. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search of five databases conducted in February 2022 returned 1579 unique and relevant articles published between 2006 and 2021. After screening titles, abstracts, and full text, four reviewers determined that 43 studies met eligibility requirements. Quality screening was conducted, and 97.7% of papers were of fair or good quality. Of the 43 studies, 47% reported measures of adipose-related signaling molecules inclusive of adipokines, 74% included insulin-related biomarkers, 63% reported lipid-related biomarkers, 40% reported proinflammatory cytokine biomarkers, 12% reported measures of skin and/or plasma carotenoids, 40% measured blood pressure, and 21% included liver enzymes. Sixty-seven percent of studies measured biomarkers in whole blood, 40% measured biomarkers in plasma, 56% measured biomarkers in serum, and 2% measured biomarkers in urine. This work summarizes the current use of biomarkers in lifestyle intervention studies enrolling children. These biomarkers could be clinically relevant for pediatric weight management interventions.

Waist circumference as a parameter in school-based interventions to prevent overweight and obesity - a systematic review and meta-analysis

BackgroundPreventing childhood obesity remains an important public health issue worldwide. Since visceral fat in particular is understood as an important risk factor for many chronic diseases, waist circumference is recommended as a measurement parameter for global obesity surveillance. This systematic review and meta-analysis focused on waist circumference as an outcome parameter for studies of school-based interventions to prevent overweight and obesity.MethodsA systematic literature search was conducted at the end of 2019 in nine data bases, including Medline and Embase, in order to identify relevant studies evaluating interventions in schools aimed at preventing obesity. Eligibility criteria admitted randomised and non-randomised controlled trials. After screening titles, abstracts and full texts, the data of the identified studies were systematically extracted. Risk of bias was assessed according to study type with the appropriate Cochrane Risk of Bias Tool. The review gives a qualitative overview over all included studies structured by extracted data. Separate meta-analyses were done for the outcome mean difference in change in waist circumference, measured in cm or reported as z-score value, using an inverse variance random-effects model due to study design.ResultsA total of 2421 publications were screened based on titles, abstracts and full texts. Complemented by results of a former systematic literature search 44 studies were identified for inclusion, comprising a total of 39.837 participants (age range: 6 to 18 years). Nearly half of the studies were conducted in Europe, two-thirds combined diet and exercise-based interventions. Likewise two thirds of the studies were conducted as cluster-randomised trials. Most of the reported effects favoured the experimental groups, indicating the basic effectiveness of school-based measures. Based on reported data, only one third of the studies could be included in the meta-analyses. For the difference in mean change of the outcome parameter waist circumference measured in cm (95% CI), we found a pooled effect estimate of -0.95 (-1.87; -0.46). For the difference in mean change of the outcome parameter waist circumference reported as z-score value (95% CI), the pooled effect estimate was -0.10 (-0.15; -0.05). Both effect estimates were in favour of the experimental group. The overall effect sizes were small with a p-value < 0.05.ConclusionsPooled effect estimates were small but in favour of the experimental groups. The same applies to the majority of the effects reported in the included studies. The included cluster of randomised controlled trials demonstrated an especially sound methodological standard. The possibility of achieving larger effects in studies of preventive interventions and health promotion is limited. Schools can only realise their full potential in preventing overweight and obesity in children and adolescents if they are accompanied by measures in other areas of the obesogenic environment.

Effectiveness of early childhood education interventions to improve complementary feeding practices in children 4 to 36 months of age: a systematic review protocol.

Healthy eating habits, which start with food introduction, can influence children's growth and development. Therefore, the educational actions carried out at school for children who are beginning to eat, involving families and school staff who attend daycare centers, can serve as strategies to improve complementary feeding practices. This review will analyze the effectiveness of early childhood education interventions to improve complementary feeding practices in children aged 4 to 36 months. The review will consider randomized clinical trials, cluster-randomized clinical trials, and controlled clinical trials that evaluate the effectiveness of early childhood education interventions involving children aged 4 to 36 months, their families, or school staff to improve complementary feeding. In their absence, observational cohort, case-control, and cross-sectional studies may be considered. This review will be conducted in line with the JBI methodology for systematic reviews of effectiveness. The search for relevant studies will be conducted in PubMed, Embase (Ovid), BIREME, Scopus, the Cochrane Library (Cochrane Central Register of Controlled Trials CENTRAL and Cochrane Database of Systematic Reviews), CINAHL (EBSCOhost), and the ProQuest Databases (ProQuest Central). No date or language limitation will be applied. Two independent reviewers will select studies by screening titles, abstracts, and keywords against the inclusion criteria. This will be followed by full-text screening. Two independent reviewers will then conduct the study method quality evaluation and data extraction. GRADEpro will be used to assess the certainty in the findings, which will be reported in a systematic review, and, if possible, grouped in a meta-analysis. PROSPERO CRD42022384704.

Economic Burden of Community-Acquired Antibiotic-Resistant Urinary Tract Infections: Systematic Review and Meta-Analysis.

Antibiotic resistance (ABR) poses a major burden to global health and economic systems. ABR in community-acquired urinary tract infections (CA-UTIs) has become increasingly prevalent. Accurate estimates of ABR's clinical and economic burden are needed to support medical resource prioritization and cost-effectiveness evaluations of urinary tract infection (UTI) interventions. This study aims to systematically synthesize the evidence on the economic costs associated with ABR in CA-UTIs, using published studies comparing the costs of antibiotic-susceptible and antibiotic-resistant cases. We searched the PubMed, Ovid MEDLINE and Embase, Cochrane Review Library, and Scopus databases. Studies published in English from January 1, 2008, to January 31, 2023, reporting the economic costs of ABR in CA-UTI of any microbe were included. Independent screening of titles/abstracts and full texts was performed based on prespecified criteria. A quality assessment was performed using the Integrated Quality Criteria for Review of Multiple Study Designs (ICROMS) tool. Data in UTI diagnosis criteria, patient characteristics, perspectives, resource costs, and patient and health economic outcomes, including mortality, hospital length of stay (LOS), and costs, were extracted and analyzed. Monetary costs were converted into 2023 US dollars. This review included 15 studies with a total of 57,251 CA-UTI cases. All studies were from high- or upper-middle-income countries. A total of 14 (93%) studies took a health system perspective, 13 (87%) focused on hospitalized patients, and 14 (93%) reported UTI pathogens. Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa are the most prevalent organisms. A total of 12 (80%) studies reported mortality, of which, 7 reported increased mortality in the ABR group. Random effects meta-analyses estimated an odds ratio of 1.50 (95% CI 1.29-1.74) in the ABR CA-UTI cases. All 13 hospital-based studies reported LOS, of which, 11 reported significantly higher LOS in the ABR group. The meta-analysis of the reported median LOS estimated a pooled excess LOS ranging from 1.50 days (95% CI 0.71-4.00) to 2.00 days (95% CI 0.85-3.15). The meta-analysis of the reported mean LOS estimated a pooled excess LOS of 2.45 days (95% CI 0.51-4.39). A total of 8 (53%) studies reported costs in monetary terms-none discounted the costs. All 8 studies reported higher medical costs spent treating patients with ABR CA-UTI in hospitals. The highest excess cost was observed in UTIs caused by carbapenem-resistant Enterobacterales. No meta-analysis was performed for monetary costs due to heterogeneity. ABR was attributed to increased mortality, hospital LOS, and economic costs among patients with CA-UTI. The findings of this review highlighted the scarcity of research in this area, particularly in patient morbidity and chronic sequelae and costs incurred in community health care. Future research calls for a cost-of-illness analysis of infections, standardizing therapy-pathogen combination comparators, medical resources, productivity loss, intangible costs to be captured, and data from community sectors and low-resource settings and countries.

The effectiveness of Balint groups at improving empathy in medical and nursing education: a systematic review and meta-analysis of randomized controlled trials

ObjectiveEmpathy is crucial for patient health. The Balint group is a commonly used method for empathy training. However, the impact of Balint groups on empathy remains unclear. This systematic review and meta-analysis of randomized controlled trials (RCTs) aims to assess the impact of Balint groups on empathy training among medical and nursing students, as well as doctors and nurses.MethodsThis review involved searching multiple databases for relevant articles. Rigorous eligibility criteria were applied during the screening of titles and abstracts, and during the selection of records. Following a full-text eligibility evaluation, two reviewers independently extracted data from the final selection of studies, and a meta-analysis was conducted. The standardized mean difference (SMD) was calculated to assess the systematic outcomes.ResultsA total of 11 studies were included in this systematic review and meta-analysis. Participants in Balint groups demonstrated a significant increase in empathy than those in the control group (SMD = 1.46, 95% confidence interval [CI] 0.86–2.06; p < 0.001). Studies conducted in China (SMD = 2.13, 95% CI 1.27–2.99; p < 0.001) revealed a greater impact of Balint groups on empathy than those conducted in France (SMD = 0.24, 95% CI 0.12–0.37; p < 0.001). The impact of Balint groups was significantly greater among physicians (SMD = 2.50, 95% CI 1.79–3.21; p < 0.001) and nurses (SMD = 2.88, 95% CI 1.34–4.43; p < 0.001) compared to medical students (SMD = 0.71, 95% CI = 0.35–1.06; p < 0.001). Participants who attended ten or more sessions (SMD = 2.37, 95% CI 1.35–3.39; p < 0.001) demonstrated better outcomes compared to those who attended fewer than ten sessions (SMD = 0.79, 95% CI 0.30–1.29; p < 0.01).ConclusionBalint groups are effective for empathy training among doctors, nurses, and medical students. Future research should incorporate patient-led measurements to evaluate empathy and ascertain the long-term impact of Balint groups on empathy training.Trial registrationPROSPERO registration number CRD42023488247.

Systematic review of clinical prediction models for psychosis in individuals meeting At Risk Mental State criteria.

This study aims to review studies developing or validating a prediction model for transition to psychosis in individuals meeting At Risk Mental State (ARMS) criteria focussing on predictors that can be obtained as part of standard clinical practice. Prediction of transition is crucial to facilitating identification of patients who would benefit from cognitive behavioural therapy and, conversely, those that would benefit from less costly and less-intensive regular mental state monitoring. The review aims to determine whether prediction models rated as low risk of bias exist and, if not, what further research is needed within the field. Bibliographic databases (PsycINFO, Medline, EMBASE, CINAHL) were searched using index terms relating to the clinical field and prognosis from 1994, the initial year of the first prospective study using ARMS criteria, to July 2024. Screening of titles, abstracts, and subsequently full texts was conducted by two reviewers independently using predefined criteria. Study quality was assessed using the Prediction model Risk Of Bias ASessment Tool (PROBAST). Studies in any setting were included. The primary outcome for the review was the identification of prediction models considering transition risk and a summary of their risk of bias. Forty-eight unique prediction models considering risk of transition to psychosis were identified. Variables found to be consistently important when predicting transition were age, gender, global functioning score, trait vulnerability, and unusual thought content. PROBAST criteria categorised four unique prediction models as having an overall low-risk bias. Other studies were insufficiently powered for the number of candidate predictors or lacking enough information to draw a conclusion regarding risk of bias. Two of the 48 identified prediction models were developed using current best practice statistical methodology, validated their model in independent data, and presented low risk of bias overall in line with the PROBAST guidelines. Any new prediction model built to evaluate the risk of transition to psychosis in people meeting ARMS criteria should be informed by the latest statistical methodology and adhere to the TRIPOD reporting guidelines to ensure that clinical practice is informed by the best possible evidence. External validation of such models should be carefully planned particularly considering generalisation across different countries. https://www.crd.york.ac.uk/PROSPEROFILES/108488_PROTOCOL_20191127.pdf, identifier CRD42018108488.

Pharmacy stakeholders' views and experiences of the credentialing of advanced or specialist pharmacist practice: A mixed methods systematic review

BackgroundCredentialing of advanced and specialist pharmacist practice (ASPP) provides essential quality assurance for ASPP, which is significantly different to entry-level practice and is developing worldwide. Several credentialing models are in place or under development internationally. Synthesis of the views and experiences of pharmacists and other relevant stakeholders on credentialing is an important research gap. Objective(s)To determine pharmacy stakeholders' views and experiences of ASPP credentialing and to explore facilitators and barriers to credentialing implementation and uptake. MethodsThe Joanna Briggs Institute convergent integrated approach for mixed methods systematic reviews was followed. The review protocol was pre-registered with PROSPERO. Five electronic databases (Medline, CINAHL, Embase, Web of Science, Google Scholar) were searched from inception to August 2022 for qualitative, quantitative, or mixed methods studies that reported the views and experiences of pharmacy stakeholders on ASPP credentialing. The Mixed Methods Appraisal Tool was used to quality appraise included studies. Thematic synthesis was undertaken to analyse and integrate data from included studies. All screening and data analysis steps were performed by two reviewers independently, with additional author input where required. ResultsSixty studies were included, after screening titles and abstracts (n = 9055) and full texts (n = 228). Studies represented the views of pharmacists, pharmacy managers/employers and professional/representative bodies in hospital, community pharmacy, general practice/primary care, and academic sectors, from 40 countries. Four analytical themes were generated describing the factors, including facilitators and barriers, to be considered when developing or optimising ASPP credentialing: I. Drivers of credentialing, II. Developing ASPP competence, III. Optimising credentialing implementation, and IV. Enhancing credentialing uptake. ConclusionsThis systematic review is the first to synthesise pharmacy stakeholders' views and experiences of ASPP credentialing. A conceptual framework highlights contextual factors, facilitators, barriers, and inter-relationships which should be considered by pharmacists, policymakers, and other key stakeholders when implementing ASPP credentialing.

Diaphragmatic Ultrasonography in Sports Performance: A Systematic Review

This paper aims to investigate and analyze the correlation between diaphragmatic parameters through ultrasonography and sports performance in various sports disciplines. This systematic review followed the PRISMA methodology. The search strategy was applied in the Medline database through Ovid, EMBASE, LILACS, the Cochrane Central Register of Controlled Trials, and Open Gray. Clinical trials, cohort, case–control, and cross-sectional studies were included, and animal experiments were excluded. A total of 388 studies were identified. After removing duplicates and screening titles and abstracts, sixteen studies were selected for full review, and six were included in the qualitative analysis. The results demonstrated a positive correlation between diaphragm excursion and thickness during inspiration with the anaerobic power, highlighting their importance in high-intensity performance. Additionally, one study reported a positive correlation between diaphragm thickness and aerobic power, suggesting the need for further research. The impact of inspiratory muscle training in Paralympic athletes was also evaluated, providing valuable insights into diaphragmatic adaptation in disabled populations. Ultrasonography is a feasible tool for evaluating the structure and function of the diaphragm, the main element of the respiratory process during sports practice. Its use could contribute to the evaluation and planning of sports training and be a possible indicator of performance improvement.

Mapping the landscape of mental health and long COVID: a protocol for scoping review

IntroductionMental health concerns are prevalent among adult patients with long COVID (LC), but the current state of knowledge regarding mental health in the context of LC is not fully understood....

Role of mothers in preventing tuberculosis in children: A scoping review

Tuberculosis (TB) remains a significant global health challenge, especially for children. The aim of this scoping review was to investigate the role of mothers in preventing childhood TB transmission and highlight effective strategies and associated barriers. A systematic literature search was conducted using PubMed, Web of Science, and Scopus, covering articles up to January 17, 2024. The search included keywords like “mother,” “parents,” “care,” “prevention,” and “tuberculosis.” Eligibility criteria included peer-reviewed articles on maternal health interventions for TB prevention in children and published in English. The study selection process involved screening titles and abstracts, followed by full-text reviews by Rayyan Artificial Intelligence (AI). Eighteen studies were analyzed, revealing the crucial roles of mothers and healthcare workers in TB prevention. The results indicated that in South Africa, only 47% of eligible pregnant women underwent Mantoux testing, with lower rates in rural areas. The isoniazid preventive therapy (IPT) uptake rate was 79%, with geographical variations. Barriers included insufficient patient information, inadequate screening facilities, and healthcare providers' knowledge gaps. Parental involvement, particularly by mothers, is vital for adherence to TB preventive measures. Challenges in integrating TB case-finding with antenatal care and prevention of mother-to-child transmission (PMTCT) services included inconsistent screening and healthcare worker shortages. Enhancing health services, reducing stigma, and integrating TB prevention into existing programs are essential. In conclusion, this review underscores that effective childhood TB prevention requires a coordinated approach that incorporates the efforts of the mother and healthcare worker. Addressing barriers such as contact tracing gaps and diagnostic delays, alongside enhancing maternal health education and support, is essential for improving TB prevention and management. Targeted interventions and collaborative efforts are needed to reduce transmission and improve health outcomes, particularly in bridging rural-urban disparities.

HEMORRAGIA PÓS-PARTO: FATORES DESENCADEANTES E IMPLICAÇÕES PARA À PRÁTICA CLÍNICA: UMA REVISÃO NARRATIVA DA LITERATURA

Postpartum hemorrhage (PPH) is a critical obstetric condition characterized by excessive blood loss after childbirth. It can occur immediately after delivery or develop within the first 24 hours, referred to as early postpartum hemorrhage, or up to 12 weeks after childbirth, known as late postpartum hemorrhage. This study is a bibliographic research, configured as a narrative review of the literature related to postpartum hemorrhage, focusing on its main triggering factors and clinical practice implications, aiming to synthesize published research on this topic. The final review sample consisted of 20 articles, after the exclusion of 133 during the full reading and application of inclusion and exclusion criteria. Initially, the screening of titles and abstracts reduced the sample from 346 to 153 articles, with 193 excluded at this stage. The original sample, obtained after applying the descriptors, included 483 articles, but was reduced to 346 after the removal of 137 duplicates. In the literature found, all studies were categorical in presenting the main triggering factors for postpartum hemorrhage. In this sense, the authors mainly discuss the "4Ts" as key risk factors associated with this obstetric emergency, a serious complication and one of the leading causes of maternal mortality worldwide. The term "4Ts" refers to four potential causes of postpartum hemorrhage: Tone, Trauma, Tissue, and Thrombin. In summary, postpartum hemorrhage is a complex and multifactorial condition that requires a multidisciplinary approach.

Mentorship in health research institutions in Africa: A systematic review of approaches, benefits, successes, gaps and challenges.

In Africa, where the burden of diseases is disproportionately high, significant challenges arise from a shortage of skilled researchers, lack of research funding, and limited mentorship opportunities. The continent faces a substantial gap in research output largely attributed to the dearth of mentorship opportunities for early career researchers. To explore existing mentorship approaches, identify challenges, gaps, successes, and benefits, and provide insights for strengthening mentorship programs in African health research institutions. We registered the review protocol on the International Prospective Register of Systematic Reviews [CRD42021285018] and searched six electronic databases-EMBASE, AJOL, Web of Science, PubMed, DOAJ, and JSTOR from inception to 10 November 2023, for studies published in English reporting on approaches of mentorship in health research in African countries. We also searched grey literature repositories, institutional websites, and reference lists of included studies for additional literature. Two independent reviewers conducted screening of titles and abstracts of identified studies, full-text screening, assessment of methodological quality, and data extraction. We assessed study quality against the Mixed Methods Appraisal Tool (MMAT). We resolved any disagreements through discussion and consensus. We employed a narrative approach to synthesize the findings. We retrieved 1799 articles and after screening, included 21 studies in the review. The reviewers identified 20 mentorship programs for health researchers (N = 1198) in 12 African countries mostly focusing on early-career researchers and junior faculty members. A few included mid-career and senior researchers. We categorized the programs under three key mentoring approaches: international collaborative programs, regional and in-country collaborations, and specialized capacity-building initiatives. Our review highlighted the following successes and benefits of health research mentorship programs: the establishment of collaborations and partnerships, development of research programs and capacities, improvement of individual skills and confidence, increased publications, and successful grant applications. The gaps identified were limited funding, lack of a mentorship culture, negative attitudes towards research careers, and lack of prioritization of research mentorship. Our review highlights a diverse landscape of health research mentorship aspects predominantly targeting early career researchers and heavily driven by the North. There is a need for locally driven mentorship initiatives in Africa to strengthen mentorship to advance health research in the region. PROSPERO registration number: CRD42021285018.

Resmetirom: A Systematic Review of the Revolutionizing Approach to Non-alcoholic Steatohepatitis Treatment Focusing on Efficacy, Safety, Cost-Effectiveness, and Impact on Quality of Life.

There has been a rise in the prevalence of non-alcoholic steatohepatitis (NASH), a subset of non-alcoholic fatty liver disease (NAFLD)with an ongoing increase in the prevalence of linked conditions such as obesity, type II diabetes mellitus, and metabolic syndrome. To date, there are no specific drugs that are approved for the treatment of NAFLD/NASH. With the recent discovery of association between subclinical hypothyroidism and NASH, various trials exploring treatment options for NASH using thyroid hormone derivatives led to the discovery of resmetirom (MGL-316) with high affinity to thyroid hormone receptors (THRs) targeting the liver. Following standardized guidelines, a systematic review was performed on the safety, efficacy, and other practical aspects of resmetirom in the treatment of NASH. Advanced search was carried out using the MeSH search strategyand appropriate keywords in major databases using various inclusion and exclusion criteria. The search was narrowed down to seven high-quality articles: four randomized control trials (RCTs), and three reviews to be included in the current study. The online database search yielded 62 articles, out of which six high-quality articles were selected to be included in the current systematic review after deleting duplicates and screening for irrelevant titles, and articles. Out of the three RCTs, two of them assessed the safetyand efficacy of resmetirom, while the remaining RCT assessed the impact on health-related quality of life with resmetirom on patients with NASH. resmetirom (MGL-316) is athyroid hormone derivative with high affinity to THRstargeting the liver and acts by improving mitochondrial oxidation, and lipophagy in the hepatic cell line. All the trials suggested in favor of resmetirom with a decrease in NASH fibrosis score by at least two points, along with reduction in hepatic fat content (minimum relative reduction of 20%), liver volume by 61%, improving secondary outcomes such as low-density lipoprotein-C, apolipoprotein-B, triglycerides, and hepatic enzymes with greater reduction in the study groups treated with higher doses of resmetirom with no significant increase in adverse events. Resmetirom was found to improve patient-reported outcomes, and thereby quality-adjusted life years (QALYs) in 12 weeks while being cost-effective compared to placebo at a willingness-to-pay threshold of US$100,000 up to a daily threshold of US$72.00, and an effective incremental cost-effectiveness ratio of US$53,925 per QALY gained. After carefully analyzing the available data by our team members, it could be concluded that resmetirom holds a strong potential to be implemented as a drug of choice in treating NAFLD/NASH in the coming years with proven efficacy, safety while being cost-effective, and also reducing secondary co-morbidities by improving cardiovascular risk factors. The results can be best achieved when combined withconventional approaches such as weight loss and dietary modifications. Long-term safety and sustainability of the achieved results are yet to be confirmed with large-scale clinical trials. However, resmetirom is still an investigational drug and could be expected to be available for clinical practice in the near future.

Inclisiran: A Systematic Review Exploring the Revolutionary Approach of Twice-Yearly Dosing Regimen in the Treatment of Hypercholesterolemia.

The global burden of hyperlipidemia is on the rise, along with an increase in associated cardiovascular complications. Since most of the patients affected by hyperlipidemia are elderly individuals with multiple comorbidities, the introduction of even a single additional drug for asymptomatic conditions such as hyperlipidemia can drastically reduce treatment compliance due to their long medication history. Hence, researchers are trying to come up with a drug with a long duration of action requiring less frequent dosing without compromising compliance and improving the outcome. This led to the discovery of inclisiran, a "wonder drug" that utilizes small interference RNA and requires only twice-yearly administration to maintain patients' lipid levels at optimal levels. We conducted a systematic review by following standardized guidelines on the long-term efficacy and safety of the new drug, inclisiran, in the treatment of hypercholesterolemia. We conducted an advanced search on PubMed using the MeSH strategy and then employed appropriate keywords to search other major databases, such as PubMed Central and Medline, using various inclusion and exclusion criteria, which yielded 94 articles from various databases.We narrowed down the search to 10 randomized controlled trials (ORION trials) after removing duplicates and screening for irrelevant titles for inclusion in the study. The ORION trials on inclisiran evaluated the drug's impact on various parameters, such as low-density lipoprotein-cholesterol (LDL-C), proprotein convertase subtilisin/kexin type 9 (PCSK9), high-density lipoprotein (non-HDL), apolipoprotein B (apoB), and so on, whileconsidering the safety aspects of the drug. All the trials indicate greater efficacy of inclisiran and long-term maintenance of the results achieved when compared to a placebo and showed a long dosing interval, thereby increasing treatment compliance. Additionally, as the drug's dose increased, we observed greater reductions in the mentioned parameters without a significant increase in the incidence of adverse events. According to the review's data analysis, inclisiran, with its greater efficacy, has the potential to replace conventional pharmacological therapy in the near future, with the best results achieved when combined with lifestyle modifications. However, a long-term assessment of the drug's efficacy and safety is required before implementing it in clinical practice to identify any potential safety concerns, particularly related to the administration of higher dosage over a longer period.

Abstract B167: Genomics and cancer clinical trials navigator training: Results from a systematic review of the literature

Abstract Introduction: Trained cancer navigators have demonstrated success in improving outcomes for cancer patients. Trainings provided by the American Cancer Society and other organizations equip navigators with the knowledge, skills and experience to support patients and address barriers to cancer-related care and survivorship. Racial/ethnic minorities continue to be underrepresented in cancer clinical trials and are less likely to receive genomic counseling and testing. There is a notable gap in the availability of cancer navigator training in genomic and clinical trials. This study used a systematic review of the literature and consultations with Genomics and Cancer Clinical Trial (CCT) experts to inform the development of cancer navigation training curriculum. Methods: Two reviewers searched the PubMed database for peer-reviewed studies published through October 2022. Key MeSH terms included cancer, genetics, and training. An ancestor search of relevant articles was also conducted. Following title screening, eleven articles were selected for abstract and full-text review. Eight articles met all the inclusion criteria from which we extracted the 1) trainee population, 2) theoretical frameworks used, 3) program design and format, 4) curricular components, and 5) outcomes. New Data: Only seven articles on the topic of navigator training in genomics within the context of CCT were identified in the search. Training participants were diverse and were located within the United States and abroad. One training program was developed for bilingual (English/Spanish) navigators, one was tailored for cancer survivors who became navigators and two programs trained navigators for specific cancer types (e.g., colorectal cancer). Social cognitive theory (SCT) was used in two of the training programs. Other adult learning theories and intervention mapping for program development were also used in training development. The process for designing navigator trainings included: conducting discussion groups; interviews and surveys; engaging advisory boards; and adapting the National Human Genomics Research Institute modules and other resources. The curricula components included in-person and web-based; single semester or year-long sessions; formal coursework; lectures; role-playing; video viewing; tours of facilities; demonstrations; short writing assignments; action plans; case studies; story- telling; discussion and networking; assessment/evaluation; and refresher sessions. Modules addressed attitudes, barrier assessment and resolution, knowledge, self-efficacy, and communication. Conclusion: The peer-reviewed literature on navigator training describes some curricular elements that measure and address knowledge about genomics and CCT as well as the skills needed to increase self-efficacy to navigate for genetic studies and cancer clinical trials. However, the field of CCT lacks a consistent and widely used program aimed at training navigators in the integral role of genetics in precision medicine. These findings informed the design of our ACS-funded curriculum. Citation Format: Desiree Rivers, Robina Josiah Willock, Victoria Churchill. Genomics and cancer clinical trials navigator training: Results from a systematic review of the literature [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B167.

Bridging Prenatal Diagnostics and AI: A Systematic Review and Meta-Analysis of the Efficacy of Advanced Algorithms in Identifying Congenital Fetal Abnormalities

Congenital fetal abnormalities have emerged as a major cause of infant mortality globally. About 3% of pregnancies are reported as fetal structural anomaly through ultrasound, ranging from minor defect to severe organ system anomalies. Our study aimed to evaluate effectiveness of Artificial intelligence (AI) algorithms in prediction of fetal heart and brain abnormalities by using meta-analysis approach. In this study, the “Reporting Items for Systematic Review and Meta-Analysis (PRISMA)" guidelines were applied for screening and selection of research articles. We searched the research articles according to research aims from Google scholar, PubMed, and Ovid MEDLINE. The data search was limited to January 2015 to May 2024. Two researchers independently screened the studies to detect research aim oriented studies. After screening of titles, those researchers assessed all abstract for eligibility. The risk bias of included studies was assessed by two researchers who used Cochrane library tool (version 5.4.0). Using the DerSimonian-Laird technique, a bivariate random effect model that generated SROC plots, we pooled test estimates. This method is particularly helpful in visualizing variability in the sensitivity and specificity across studies, accounting for the heterogeneity. This improves the reliability of the SROC plot, offering a clear summary of diagnostic performance Using the software RevMan 5.4, we carried out every statistical analysis, particularly heterogeneity through the Q test. About 243,456 screened fetus or pregnant women of 11-32 gestational weeks through 10 studies based on AI algorithms (machine learning, deep learning and AI diagnostic tool). The imaging protocols including ultrasound and MRI were used to take visuals of fetal brain and heart abnormalities in all of including studies. DL and ML algorithms provided high-performance diagnostic predictions, mostly include CNN models that assist in providing accurate diagnostic results with high sensitivity and specificity. The AI algorithm model showed a generally good accuracy scores for detection of brain and heart abnormalities and reference machine learning findings, with sensitivity ranging from 82 to 99% and specificity from 78 to 99%. Fig. 5's area under the SROC curve was 0.960. In contrast to the general detection, ML and DL seems to be more sensitive in diagnosing fetal brain and heart abnormalities. Our study provided the scientific evidence that AI models including deep learning and Machine learning are effective in generating highly reliable detection or classification results for diagnosis of fetal brain and heart anomalies. These strategies can help in reducing infant mortalities, improving treatment outcomes, and postpartum outcomes among women.