MEDLINE Search Research Articles

The Effects of Glucagon‐Like Peptide‐1 Receptor Agonists on Mitochondrial Function Within Skeletal Muscle: A Systematic Review

ABSTRACTBackgroundObesity is a chronic disease associated with increased risk of multiple metabolic and mental health–related comorbidities. Recent advances in obesity pharmacotherapy, particularly with glucagon‐like peptide‐1 (GLP‐1) receptor agonists (RAs), have the potential to transform obesity and type 2 diabetes mellitus (T2DM) care by promoting marked weight loss, improving glycaemic control and addressing multiple obesity‐related comorbidities, with added cardio‐renal benefits. Dual agonists combining GLP‐1 with other enteropancreatic hormones such as glucose‐dependent insulinotropic polypeptide (GIP) have also been developed in recent years, leading to greater weight loss than using GLP‐1 RAs alone. However, up to 40% of the weight lost with GLP‐1 RAs comes from lean body mass, raising concerns about potential adverse effects on skeletal muscle function. Mitochondrial dysfunction, characterized by reduced mitochondrial size and activity, is prevalent in individuals with obesity and T2DM and is a known contributor to muscle wasting in ageing and some chronic diseases. This systematic review investigates the impact of GLP‐1‐based therapies on skeletal muscle mitochondrial function in individuals with obesity and T2DM or in related animal and cell models.MethodsA comprehensive search of MEDLINE, Scopus, CINAHL and clinicaltrials.gov was conducted. Inclusion criteria included randomized controlled trials, randomized crossover trials, cluster randomized control trials and basic science studies involving any GLP‐1 RA or GLP‐1/GIP dual agonist. Outcomes of interest were skeletal muscle respiratory function either in the form of measurements of mass, number, content, oxidative capacity/respiratory function, mitochondrial dynamics, mitochondrial biogenesis and mitophagy.ResultsEight studies were eligible for analysis; no human studies were identified. All of the included studies used GLP‐1 RAs (single agonists) as intervention. The emerging evidence suggests that GLP‐1 RAs increase mitochondrial area, number and morphology (i.e., reduces swelling). Data are conflicting on the effect of GLP‐1 RAs upon mitochondrial mass, respiration and the expression of uncoupling proteins and PGC‐1α. Data also demonstrate muscle specific (i.e., soleus vs. extensor digitorum longus) responses to GLP‐1 RAs.ConclusionGLP‐1 RAs appear to have a positive effect upon mitochondria area, number and morphology, but effects upon other aspects of mitochondrial health remain inconclusive. Data are very limited and solely presented in animal and in vitro models. Future studies should be conducted in human populations in order to begin to understand the effect of GLP‐1 RAs and GLP‐1‐based therapies on human skeletal muscle mitochondria.

Psychological Interventions to Improve Elite Athlete Mental Wellbeing: A Systematic Review and Meta-analysis

Abstract Background Mental wellbeing, one continuum alongside mental illness in a dual-continua mental health model, has attracted less attention compared with substantial studies concerning mental illness amongst elite athletes. Notably, the promotion and protection of mental wellbeing contribute to not only a positive status of flourishing but also a reduction in the future risk of mental illness, which can potentially facilitate a status of complete mental health. Despite the critical role of wellbeing promotion and protection, there are limited evidence-based strategies to design and implement wellbeing interventions in elite athletes. Objective This review aims to identify the different types of interventions to improve mental wellbeing amongst elite athletes and meta-analyse their effects. Further, the study aims to narratively identify the factors affecting implementation success in elite athletes. Methods Peer-reviewed articles were systematically searched through five electronic databases (SPORTDiscus, PsycINFO, PSYCArticles, Academic Search Complete and MEDLINE) in July 2023 and updated in May 2024. To enrich the overall findings and reduce the risk of publication bias, grey literature was also included in this review. Dissertations and theses were the main foci and were searched in September 2023 and updated in May 2024. Standardised mean differences (SMDs) with 95% confidence intervals (CIs) were calculated to estimate the effects of the different types of interventions on mental wellbeing. Further, a narrative synthesis under the Consolidated Framework for Implementation Research was conducted to identify the potential factors that influenced the implementation success. Results A total of 27 studies were found from peer-reviewed and grey literature, of which 15 studies were subject to meta-analyses. Results indicated that psychological skills training (SMD = 0.78, 95% CI 0.24, 1.32), third-wave interventions (SMD = 0.32, 95% CI 0.01, 0.63) and positive psychology interventions (SMD = 0.58, 95% CI 0.31, 0.85) were all potentially effective in improving overall wellbeing amongst elite athletes. However, when quasi-experimental studies in the third-wave interventions were removed for the sensitivity analysis, the effect was no longer significant. Further, 11 facilitators and 3 barriers to implementation success were identified, of which adaptability, coach and teammate support, and instructor’s capacity to connect with athletes were the key facilitators, and busy schedules and complex intervention contents were the main barriers. Conclusions This review indicated that psychological skills training, third-wave interventions and positive psychology interventions could be potentially effective for elite athlete mental wellbeing, but more studies with robust experimental designs are needed in future to increase confidence in the favourable results. Moreover, future researchers and practitioners need to be aware of context-specific implementation facilitators and barriers, optimising elite athletes’ engagement and uptake of interventions. PROSPERO CRD42023437986.

Artificial Intelligence Application in Diagnosing, Classifying, Localizing, Detecting and Estimation the Severity of Skin Condition in Aesthetic Medicine: A Review

ABSTRACTBackgroundThe integration of artificial intelligence (AI) and machine learning (ML) has revolutionized aesthetic medicine, enhancing the diagnosis, classification, and treatment of skin conditions. These technologies offer high precision, personalized care, and the potential to reduce human error. This review aimed to evaluate the current applications of AI and ML in aesthetic medicine, focusing on studies graded as Level I or II evidence by the Oxford Centre for Evidence‐Based Medicine (CEBM).MethodsA comprehensive search of MEDLINE, PubMed, and Ovid databases identified studies employing AI and ML for diagnosing and managing skin conditions. Studies were included if they demonstrated high diagnostic accuracy, improved treatment personalization, or other measurable clinical outcomes.ResultsAI and ML systems showed high accuracy in detecting and diagnosing conditions such as skin cancer, acne, psoriasis, and seborrheic dermatitis. AI‐based platforms facilitated personalized treatment plans, enhancing therapeutic outcomes while minimizing errors. The integration of AI reduced diagnostic time and lowered healthcare costs, demonstrating significant potential for improving patient care. However, challenges such as algorithmic bias, data privacy concerns, and the need for high‐quality training datasets were highlighted.ConclusionAI and ML have transformative potential in aesthetic medicine, offering improved diagnostic precision, enhanced patient outcomes, and cost reductions. Addressing limitations related to algorithm bias, regulatory oversight, and data quality is essential to fully realize the benefits of AI in clinical practice. Future research should focus on developing robust, ethical, and regulatory‐compliant AI solutions.

Experiences of African women who migrate to a developed country and encounter intimate partner violence: a systematic review of qualitative evidence.

The objective of this review was to synthesize the available evidence on the experiences of African women who migrated to a developed country and encountered intimate partner violence (IPV). IPV is a significant public health issue, and migrant women living in developed countries are particularly vulnerable to IPV, experiencing disproportionately higher rates of IPV. Understanding the experiences of these women can inform health policy and decision-making in clinical practice to minimize IPV. This review considered studies that included women of African descent, aged 16years or older, who migrated from any of the 54 countries in the African continent to a developed country and who experienced IPV. Qualitative studies including, but not limited to, grounded theory, ethnography, phenomenology, case studies, and action research designs, were considered for inclusion. A comprehensive database search of CINAHL (EBSCOhost), Embase, MEDLINE (Ovid), PsycINFO (OvidSP), and Scopus was conducted in February 2022 and updated in November 2022 and February 2023. ProQuest Dissertations and Theses were searched for gray literature. Studies in the English language were considered, with no date limitation. Eligible studies were assessed by 2 independent reviewers for methodological quality. The findings were extracted and pooled, categorized by similarity of meaning, and synthesized using the JBI meta-aggregation method. The synthesized findings were graded using the ConQual approach. Eleven qualitative studies were included in the review. The narratives of 234 women generated a total of 95 findings and 10 categories based on similarity of meaning, from which 4 synthesized findings were generated: i) The influence of cultural and gender norms, religion, and women's perceptions of IPV; ii) Control and the cone of silence; iii) Psychological and emotional impact of IPV and ways of coping; and iv) Support for women who are victims of IPV. IPV is an ongoing issue for African migrant women in developed countries. The women reported that their partners continued their controlling behavior that was accepted in their country of birth, particularly regarding emotions and finances. The experience of IPV was exacerbated for women who did not have access to extended family members, and they often faced practical barriers in accessing available formal support. The synthesized findings from this review can be used to support the urgent need to address IPV in this migrant population.

Optimizing feedback reception: a scoping review of skills and strategies for medical learners

Background: Feedback remains essential to a learner’s professional development. Most feedback literature focuses on provision of feedback, and there is a lack of evidence-based data to support learners in developing skills to receive, evaluate and use feedback, independently of context. This scoping review mapped the literature regarding strategies and skills that optimize medical learners’ reception to feedback. Methods: Investigators conducted searches in MEDLINE, Embase, ERIC, APA PsycINFO and Web of Science Core collection from inception to May 2023. Study inclusion criteria were primary evidence sources, and strategies or skills for improved feedback reception for medical learners. Data were screened and extracted by pairs of independent reviewers. Investigators summarized study characteristics, outcomes, educational methods, and interventions. Results: Of 7692 total studies, six provided strategies and skills to improve feedback reception. Delivery of education was via workshops (n = 5 studies) that proposed cognitive, reflective and experiential learning activities, all reporting learners’ self-perceived improvement of feedback behaviour. Nine strategies and seven tools were identified, focusing on general approach, soliciting or evaluating feedback. Conclusion: The six included studies outline nine strategies and seven skills for improved learner feedback reception, focusing on overall approach and agentic behaviours without evaluation of the strategies or skills in practice. Key concepts and gaps in the literature were identified and may guide further investigation to optimize learner reception to feedback.

Osteopontin as a Biomarker for Coronary Artery Disease

Osteopontin (OPN) is a sialylated phosphoprotein highly expressed in atherosclerosis and upregulated in settings of both acute and chronic inflammation. It is hypothesised that plasma levels of OPN may correlate with the presence of coronary artery disease, “CAD”. This offers potential as a point-of-care testing biomarker for early diagnosis, disease monitoring, and prognosis. This review evaluates the current literature on the association between plasma OPN levels and coronary artery disease and what is currently known to support its potential as a biomarker for future practice. Electronic searches of MEDLINE and EMBASE databases were undertaken from inception until July 2024. Thirty-three studies met the inclusion criteria. All studies were observational, with gross heterogeneity in methods used to analyse the association of plasma OPN with clinical characteristics. They included case series, case–control, cross-sectional, and cohort study designs. OPN has been linked to higher cardiovascular risk and unfavourable cardiovascular outcomes. However, the evidence regarding the direct assessment of CAD severity using tools like the SYNTAX or TIMI scores, which focus on anatomical complexity and risk factors, is less definitive. This suggests that OPN may be a more precise reflection of the inflammatory processes and atherosclerotic activity contributing to unfavourable outcomes rather than a direct indicator of the anatomical severity of CAD itself. Consequently, OPN is increasingly perceived as a marker of a poor prognosis rather than a tool for assessing the severity of coronary artery lesions.

Health conditions seen frequently in hospitalized United States Veterans who served after 9/11/2001: A scoping review.

Hospitalists working outside the Veterans Affairs (VA) system frequently will serve Veterans receiving care for acute conditions and/or awaiting transfer to VA facilities. To perform a scoping review of health conditions and associated outcomes relevant to hospital medicine in US Veterans who served in active duty or reserve deployed roles after November 9, 2001. A search of MEDLINE and Embase was performed using a combination of terms related to military service period and health conditions, yielding 5634 citations published after January 1, 2013. Two reviewers performed independent screening at the title/abstract and later at the full-text levels. Conflicts at both stages were resolved through discussion. Single reviewers extracted data and synthesized results into three categories: (1) mental health and nonblast trauma, (2) neurologic outcomes, and (3) other conditions, including cardiovascular and respiratory outcomes. Of 85 included studies, 19 focused on cardiovascular, respiratory, autoimmune, and multisystem outcomes; 38 focused on mental health and nonblast trauma; and 28 focused on traumatic brain injury and neurologic outcomes. Studies showed high rates of comorbid mental health diagnoses and suicide-related behaviors relative to non-Veteran populations, as well as relatively younger incidence of cardiovascular and respiratory chronic conditions, such as atrial fibrillation. Most studied health conditions among Veterans of post-9/11 conflicts have focused on areas of particular importance to the VA. However, significant gaps remain, particularly in understanding the correlation between specific exposures and clinical outcomes currently observed and to be anticipated in the future in this population.

Systematic Analysis of the Design, Methodology and Patient Population Characteristics of the Pediatric Direct Oral Anticoagulant (DOAC) Trials of Venous Thromboembolism Treatment.

The pediatric direct oral anticoagulation (DOAC) trials provide an opportunity to evaluate and characterize challenges in their design and execution to inform future antithrombotic trials. To perform a systematic review of pediatric DOAC trials for the treatment of venous thromboembolism to critically appraise their methodology and understand the feasibility and challenges. Systematic search of MEDLINE, EMBASE, the Cochrane Library and ClinicalTrials.gov (January 2002 to December 2022). Studies reporting the results of interventional trials of a DOAC for the treatment of acute VTE in children, and their respective design papers were included. Trial registration information was reviewed in clinicaltrials.gov. Discrepancies in study design, targeted populations, sample size and analyses between planned and actual trial conduct were examined qualitatively. Five published studies, and unpublished data for two additional trials were included. All trials had modifications to their design or methodology, and discrepancies between the trial's registration and the final published study, suggesting feasibility challenges. Modifications to the eligibility criteria, changes in sample size, challenges with recruitment of younger patients, and enrolled population not matching the clinical target population were identified for all trials. Discrepancies in outcome reporting, particularly for secondary endpoints, were also common. DOAC trials experienced feasibility challenges that led to design or methodology modifications. Future pediatric antithrombotic trials will need to be adaptive in their design, prioritize enrollment of younger children and input from clinicians providing care to target populations, ensure that enrolled populations match the clinical population, and select clinically meaningful endpoints.

Academic Detailing Interventions and Evidence-Based Prescribing

Academic detailing (interactive educational outreach) is a widely used strategy to encourage evidence-based prescribing by clinicians. To evaluate academic detailing programs targeted at improving prescribing behavior and describe program aspects associated with positive outcomes. A systematic search of MEDLINE from April 1, 2007, through December 31, 2022, was performed for randomized trials and nonrandomized studies of academic detailing interventions to improve prescribing. Academic detailing was defined as evidence-based medication education outreach delivered interactively to individuals or small groups of prescribers. Only studies that measured prescribing outcomes were included. Two investigators independently assessed studies for risk of bias using validated assessment tools. Among all studies rated as having low risk of bias and randomized trials rated as having moderate risk of bias, the absolute change in the proportion of patients using the targeted medications and the proportion of studies that led to significant changes in 1 or more prescribing outcome were determined. The data analysis was performed between January 25, 2022, and November 4, 2024. The 118 studies identified varied by setting (eg, inpatient, outpatient) and academic detailing delivery (eg, individual vs groups of prescribers). The most common therapeutic targets were antibiotic overuse (32 studies [27%]), opioid prescribing (24 studies [20%]), and management of mental health conditions (16 studies [14%]) and cardiovascular disease (13 studies [11%]). Most studies (66 [56%]) combined academic detailing with other interventions (eg, audit and feedback, electronic health record reminders). Among 36 studies deemed to have the lowest risk of bias, 18 interventions (50%; 95% CI, 33%-67%) led to significant improvements in all prescribing outcomes, and 7 (19%; 95% CI, 8%-36%) led to significant improvements in 1 or more prescribing outcomes. The median absolute change in the proportion of patients using the targeted medication or medications was 4.0% (IQR, 0.3%-11.3%) in the intended direction. In this systematic review of academic detailing interventions addressing evidence-based prescribing, most interventions led to substantial changes in prescribing behavior, although the quality of evidence varied. These findings support the use of academic detailing to bring about more evidence-based prescribing in a variety of clinical settings.

Virtual reality for multiple sclerosis rehabilitation.

Multiple sclerosis (MS) is the most common neurological disease in young adults. Virtual reality (VR) offers a promising rehabilitation tool by providing controllable, personalised environments for safe, adaptable and engaging training. Virtual reality can be tailored to patients' motor and cognitive skills, enhancing motivation through exciting scenarios and feedback. Primary objective To assess the effects of virtual reality interventions compared with an alternative or no intervention on lower limb and gait function, and balance and postural control in people with MS. Secondary objective To assess the effects of virtual reality interventions compared with an alternative or no intervention on upper limb function, cognitive function, fatigue, global motor function, activity limitation, participation restriction and quality of life, and adverse events in people with MS. We identified relevant articles through electronic searches of CENTRAL, MEDLINE, Embase, PEDro, CINAHL and Scopus. We also searched trials registries (ClinicalTrials.gov and the WHO ICTRP search portal) and checked reference lists. We carried out all searches up until August 2022. We included only (quasi-)randomised controlled trials (RCTs) that assessed virtual reality interventions, defined as "an artificial, computer-generated simulation or creation of a real-life environment or situation allowing the user to navigate through and interact with", in people with MS. The primary outcomes were lower limb and gait function, and balance and postural control. Secondary outcome measures were upper limb function, cognitive function, fatigue, global motor function, activity limitation, participation and quality of life, and adverse events. Eligible participants were people with MS who were 18 years or older. Two review authors independently screened the studies based on pre-specified criteria, extracted study data and assessed the risk of bias of the included studies. We used the risk of bias 2 tool (RoB 2). A third review author was consulted to resolve conflicts. We included 33 RCTs with 1294 people with MS. The sample sizes of the included studies were relatively small and there was considerable heterogeneity between studies regarding the virtual reality devices and the outcome measures used. The control group either received no intervention, conventional therapy or an alternative intervention (an intervention that does not fit the description of conventional therapy for the rehabilitation of people with MS). We most frequently judged the risk of bias as 'some concerns' across domains, leading to an overall high risk of bias in the majority of included studies for all outcome measures. Primary outcomes When compared with no intervention, virtual reality interventions may result in no difference in lower limb and gait function (Timed Up and Go, mean difference (MD) -0.43 sec, 95% confidence interval (CI) -0.85 to 0.00; 6 studies, 264 participants; low-certainty evidence) or balance and postural control (Berg Balance Scale, MD 0.29 points, 95% CI -0.1 to 0.68; 4 studies, 137 participants; very low-certainty evidence). When virtual reality interventions are compared to conventional therapy, results for lower limb and gait function probably do not differ between interventions (Timed Up and Go, MD -0.2 sec, -1.65 to 1.25; 4 studies, 107 participants; moderate-certainty evidence). However, virtual reality interventions probably improve balance and postural control (Berg Balance Scale, MD 2.39 points, 95% CI 1.22 to 3.57; 7 studies, 201 participants; moderate-certainty evidence), almost reaching the clinically important difference (3 points). Secondary outcomes Compared to no intervention, the use of virtual reality may also improve upper limb function (9-Hole Peg Test, MD -4.19 sec, 95% CI -5.86 to -2.52; 2 studies, 84 participants; low-certainty evidence), almost reaching the clinically important difference (4.38 points) and participation and quality of life, but the evidence is very uncertain (MS International QoL, MD 9.24 points, 95% CI 5.76 to 12.73; 2 studies, 82 participants; very low-certainty evidence). Compared to conventional therapy, virtual reality interventions may improve participation and quality of life (Falls Efficacy Scale-1, MD -3.07 points, 95% CI -5.99 to -0.15; 3 studies, 101 participants; low-certainty evidence), but not upper limb function (9-Hole Peg Test, MD 0.10 sec, 95% CI -1.70 to 1.89; 3 studies, 93 participants; low-certainty evidence). For other key secondary outcome measures, i.e. global motor function and adverse events, there were no data available as these were not measured in the studies. We found evidence that the use of virtual reality may be more effective than no intervention in improving upper limb function and participation and quality of life. Training with virtual reality may be superior to conventional therapy for improving balance and postural control, and participation and quality of life. For the other outcomes, there was no clear difference between virtual reality and conventional therapy. There was insufficient evidence to reach conclusions about the effect of virtual reality on global motor function, activity limitations and adverse events. Additional high-quality, large-scale studies are needed to expand and confirm these findings.

A systematic assessment of the stability of SLA® vs. SLActive® implant surfaces over 12 weeks.

This study aims to assess the impact of two implant surfaces, SLA and SLActive, on implant stability, measured by ISQ levels over a 12-week period. A comprehensive search of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Dentistry and Oral Sciences databases for randomized controlled trials (RCTs) up to February 2023 was conducted. The inclusion criteria were studies involving adult patients treated with SLA and SLActive implants, with assessment of implant stability through ISQ levels up to 12 weeks post-placement. From the initial 180 potentially eligible publications identified, six RCTs were included in our analysis, comprising 326 implants (50.6% SLA and 49.4% SLActive). Three studies were classified as low risk, while three had an unclear risk of bias. Overall, SLActive implants demonstrated comparable stability levels, as measured by ISQ, to SLA implants within the 12-week interval for implants placed in the maxillary or mandibular region. However, findings from the RCTs suggest that the SLActive surface led to an earlier transition point, a faster return to stability levels, and higher ISQ values at the end of 12 weeks compared to the SLA surface for implants placed in the palatal region. SLActive surfaces exhibited stability levels similar to SLA surfaces for maxillary and mandibular implants. Notably, for palatal implants, SLActive resulted in a quicker transition point and higher stability levels at the 12-week mark. Due to the limited number of trials and potential study heterogeneity, further research is needed to validate these findings.

Emotional Eating Interventions for Adults Living With Overweight and Obesity: A Systematic Review and Meta-Analysis of Behaviour Change Techniques.

Emotional eating (EE) is a barrier to the long-term success of weight loss interventions. Psychological interventions targeting EE have been shown to reduce EE scores and weight (kg), though the mechanisms remain unclear. This review and meta-analysis aimed to identify the specific behaviour change techniques (BCTs) associated with improved outcomes. This is a review update and extension, with new studies extracted from searches of CINAHL, PsycINFO, MEDLINE and EMBASE 1 January 2022 to 31 April 2023. EE interventions for adults with BMI > 25 kg/m2 were considered for inclusion. Paper screening, extraction, BCT-coding and risk of bias were completed using the Template for Intervention Description and Replication (TIDieR) checklist, Behaviour Change Taxonomy v1 (BCTTv1) and Risk of Bias2 (RoB2)/Risk of Bias In Non-randomised Studies (ROBINS-I) tool. Narrative syntheses and random effects multi-level meta-analyses were conducted. In total, 6729 participants were included across 47 studies (13 identified in the update). Forty-two studies contributed to the pooled estimate for the impact of interventions on EE (SMD = -0.99 [95% CI: -0.73 to -1.25], p < 0.001). Thirty-two studies contributed to the pooled estimate for the impact of interventions on weight (-4.09 kg [95% CI: -2.76 to -5.43 kg], p < 0.001). Five BCTs related to identity, values and self-regulation were associated with notable improvements to both weight and EE ('incompatible beliefs', 'goal setting outcome'. 'review outcome goals', 'feedback on behaviour' and 'pros/cons'). Implementation and evaluation of the highlighted BCTs are required. Weight management services should consider screening patients for EE to tailor interventions to individual needs.

Systematic review of international ethics knowledge in the speech-language pathology literature (1980–2022)

Purpose A systematic review was conducted to describe various viewpoints expressed in speech-language pathology literature over four decades concerning ethics knowledge in the profession. Method The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were employed. Our sample search encompassed peer-reviewed journal articles sourced from electronic databases including MEDLINE, CINAHL, ERIC, MasterFILE Premier, E-Journals, Africa-Wide Information, and Academic Search Premier, spanning the period from 1980 to 2022. Result The initial search of articles identified 139 papers. After applying rigorous inclusion and exclusion criteria, 60 full-text papers were deemed suitable for inclusion. We conducted a qualitative, deductive analysis of the relevant data and findings. Studies primarily concentrated on the speech-language pathologist’s roles in rehabilitation/management and education, research, and administration. A predominant focus of these papers revolved around moral judgement, a fundamental component of moral behaviour. Conclusion Findings suggest an evolving landscape within the speech-language pathology discipline, with an increased focus on moral judgement, professional competency, and rehabilitation/management. The findings highlight a consistent need for further development and emphasis on ethics in education, research, administration, and advocacy/consultation roles. This underscores the necessity for ongoing ethical education and support to ensure practitioners are well-equipped to navigate the complex ethical landscape of their professional practice.

Emergency Airway Management: A Systematic Review on the Effectiveness of Cognitive Aids in Improving Outcomes and Provider Performance

Background/Objectives: Emergency airway management is a critical skill for healthcare professionals, particularly in life-threatening situations like “cannot intubate, cannot oxygenate” (CICO) scenarios. Errors and delays in airway management can lead to adverse outcomes, including hypoxia and death. Cognitive aids, such as checklists and algorithms, have been proposed as tools to improve decision-making, procedural competency, and non-technical skills in these high-stakes environments. This systematic review aims to evaluate the effectiveness of cognitive aids in enhancing emergency airway management skills among health professionals and trainees. Methods: A systematic search of MEDLINE, Embase, CINAHL, Cochrane Library, Scopus, Web of Science, and ClinicalTrials.gov was conducted from February to March 2024. Studies examining the use of cognitive aids, such as the Vortex method, the ASA difficult airway algorithm, and visual airway aids, in emergency airway scenarios were included. Outcomes assessed included decision-making speed, procedural success rates, and non-technical skills. Data were extracted using standardized protocols, and the quality of included studies was appraised. Results: Five studies met inclusion criteria, encompassing randomized controlled trials, controlled studies, and mixed-methods research. Cognitive aids improved decision-making times (reduced by 44.6 s), increased procedural success rates, and enhanced non-technical skills such as teamwork and crisis management. Participants reported reduced anxiety and improved confidence levels (self-efficacy scores increased by 1.9 points). The Vortex method and visual cognitive aids demonstrated particular effectiveness in simulated scenarios. Conclusions: Cognitive aids significantly enhance emergency airway management skills, improving performance, reducing errors, and increasing provider confidence. Integrating cognitive aids into training programs has the potential to improve patient safety and outcomes. Further research is needed to validate these findings in clinical settings and optimize cognitive aid design and implementation.

Effects of non-invasive brain stimulation over the supplementary motor area on motor function in Parkinson's disease: A systematic review and meta-analysis.

Motor dysfunction profoundly affects individuals with Parkinson's disease (PD). Non-invasive brain stimulation (NIBS) targeting the supplementary motor area (SMA), a critical region for movement-related processing, offers a promising approach to enhance motor function for PD. This systematic review and meta-analysis aims to evaluate the efficacy of NIBS over the SMA (SMA-NIBS) in alleviating motor symptoms in PD. We conducted literature searches in MEDLINE, EMBASE, Physiotherapy Evidence Database, Web of Science, the Chinese National Knowledge Infrastructure, and Scopus. The meta-analysis utilized an inverse variance method and a random-effects model. Subgroup analyses were performed based on stimulation types (e.g., TMS and tDCS), stimulation protocols (e.g., facilitatory and inhibitory stimulation), and medication status during stimulation. Twenty randomized control trials involving 442 individuals with PD were included. Compared to sham stimulation, SMA-NIBS significantly improved motor function as measured by the motor section of Unified Parkinson's Disease Rating Scale (UPDRS-III) (mean differences [MD]: -3.45, 95% confidence interval [CI]: -5.65 to -1.26). Subgroup analysis revealed that only TMS (MD: -3.62, 95%CI: -6.15 to -1.08), not tDCS (MD: -2.47, 95% CI: -5.03 to 0.08), has significant effect on motor function. Both facilitatory (MD: -2.59, 95% CI: -3.37 to -1.82) and inhibitory stimulation (MD: -4.98, 95% CI: -9.29 to -0.66) significantly improved the UPDRS-III score. Effectiveness was observed only during ON medication. Statistically significant effects of SMA-NIBS were reported on Freezing of Gait Questionnaire, not timed up and go test and walking speed. SMA-NIBS is a promising approach to enhance motor function in PD.

Early intervention in psychosis programs in Africa, Asia and Latin America; challenges and recommendations.

While early intervention in psychosis (EIP) programs have been increasingly implemented across the globe, many initiatives from Africa, Asia and Latin America are not widely known. The aims of the current review are (a) to describe population-based and small-scale, single-site EIP programs in Africa, Asia and Latin America, (b) to examine the variability between programs located in low-and-middle income (LMIC) and high-income countries in similar regions and (c) to outline some of the challenges and provide recommendations to overcome existing obstacles. EIP programs in Africa, Asia and Latin America were identified through experts from the different target regions. We performed a systematic search in Medline, Embase, APA PsycInfo, Web of Science and Scopus up to February 6, 2024. Most EIP programs in these continents are small-scale, single-site programs that serve a limited section of the population. Population-based programs with widespread coverage and programs integrated into primary health care are rare. In Africa, EIP programs are virtually absent. Mainland China is one of the only LMICs that has begun to take steps toward developing a population-based EIP program. High-income Asian countries (e.g. Hong Kong and Singapore) have well-developed, comprehensive programs for individuals with early psychosis, while others with similar economies (e.g. South Korea and Japan) do not. In Latin America, Chile is the only country in the process of providing population-based EIP care. Financial resources and integration in mental health care, as well as the availability of epidemiological data on psychosis, impact the implementation of EIP programs. Given the major treatment gap of early psychosis in Africa, Latin America and large parts of Asia, publicly funded, locally-led and accessible community-based EIP care provision is urgently needed.

Treatment for substance use disorder in mothers of young children: A systematic review of maternal substance use and child mental health outcomes.

Substance use disorders (SUD) in mothers of young children can negatively impact the family unit and promote the intergenerational cycle of mental health disorders. This systematic review aims to: 1) provide an overview of substance use treatments for mothers of young children (from birth to 5years old); 2) synthesize findings on maternal substance use and child/maternal mental health outcomes; and 3) identify key treatment components. Database searches in Medline, PsycINFO, PubMED, and PsycARTICLES were conducted on May 7th, 2024. A total of 14, 916 articles were identified following duplicate removal. Articles were screened following PRISMA guidelines. Eight articles (n=900) met inclusion criteria. Outcomes of interest included maternal substance use, child/maternal mental health, and treatment components. All studies indicated maternal substance use treatments were at least as, or more, effective in improving maternal substance use and child/maternal mental health outcomes compared to controls. Treatment components included: mother/family mental health, basic needs, parenting skills, occupation/education, operant conditioning, crisis management, and medical education. Operant conditioning was the only treatment component which appeared to positively impact maternal substance use outcomes; no other treatment components were associated with outcomes of interest. This review provides preliminary evidence highlighting the benefits of substance use treatments for mothers of young children on substance use and mental health outcomes. Future randomized controlled trials with harmonized outcome measures and qualitative data that identifies treatment needs of mothers with lived experience are crucial to evaluate maternal substance use treatments and improve treatment development.

A Systematic Review Uncovering Modifiable Influences on Statin Adherence.

Statins are effective in reducing cardiovascular disease (CVD) risk, but adherence rates remain low globally. Understanding and addressing modifiable influences on adherence is key to improving outcomes. Existing reviews have methodological limitations, often failing to integrate qualitative and quantitative data or consider specific barriers to statin adherence. This systematic review aimed to identify modifiable barriers and facilitators to statin adherence using the Theoretical Domains Framework (TDF). A comprehensive search of Embase, MEDLINE, PsycINFO, and CINAHL was conducted, covering studies from January 1998 to November 2023. Data were coded to TDF domains and synthesized to identify specific influences on adherence. The nature of the evidence (qualitative or quantitative) was recorded for each influence, and variations among patient groups were noted. Seventy studies from 20 countries were included, with only one focused on ethnic minorities. The most commonly identified domains affecting adherence were "Beliefs about Consequences", "Knowledge", 'Environmental Context and Resources', and "Social Influences". Key factors included knowledge of disease, perceived disease threat, perceived benefits of statins, and patient-provider communication and trust. While side effects had inconsistent associations with adherence, forgetfulness was mainly addressed in quantitative studies, and social influences were highlighted in qualitative research. This review identified modifiable factors that could improve statin adherence. Future research should focus on addressing barriers faced by underrepresented groups to create more inclusive and effective interventions that enhance patient support and communication for better health outcomes.

Impact of Surgeon Specialization on Outcomes in Emergency Colorectal Surgery: A Systematic Review and Meta-analysis.

Colorectal emergencies represent a large proportion of acute general surgical workload and carry significant mortality. Identify the influence of surgeon specialization on mortality and other outcomes in emergency colorectal surgery. Systematic searches of Ovid MEDLINE, Ovid Embase, and Cochrane electronic databases were performed for studies published from January 1, 1990, to August 27, 2023. Studies investigating outcomes in emergency colorectal surgery for adults, comparing colorectal against noncolorectal surgeon specialization, were included. Exclusion criteria were: 1) publications studying primarily pediatric populations; 2) studies incorporating patients who had undergone surgery before 1990; and 3) studies only published in abstract form or non-English language. Primary outcomes were 30-day mortality and in-hospital mortality. Secondary outcomes were rates of anastomotic leak, reintervention, primary anastomosis, and laparoscopic approach. Of 7676 studies identified, 155 were selected for full-text review and 21 were included for quantitative analysis. Eleven studies showed improved 30-day (OR 0.64; 95% CI, 0.60-0.68; p < 0.0001) and in-hospital mortality (OR 0.66; 95% CI, 0.49-0.89; p = 0.007) with colorectal specialization. There was a significantly higher rate of primary anastomosis (OR 2.95; 95% CI, 2.02-4.31; p < 0.0001) and use of laparoscopic surgery (OR 2.38; 95% CI, 1.42-4.00; p = 0.001) among specialized colorectal surgeons. Specialization was also associated with a significant reduction in any stoma formation (OR 0.52; 95% CI, 0.28-0.98; p = 0.04). No significant difference was observed for anastomotic leak (OR 0.70; 95% CI, 0.45-1.07; p = 0.10) or reintervention rates (OR 0.78; 95% CI, 0.55-1.10; p = 0.16). Heterogeneity exists within the included patient populations and definitions of colorectal specialization observed in different countries. Emergency colorectal surgery undertaken by specialized colorectal surgeons is associated with significantly improved postoperative mortality, lower rates of stoma formation, and increased rates of primary anastomosis and minimally invasive surgery. CRD42022300541.

Patient preferences for drug therapy in inflammatory arthritis: protocol for a living systematic review and evidence map to inform clinical practice guidelines

IntroductionThe pharmacological management of inflammatory arthritis often requires choices that involve trade-offs between benefits, risks and other attributes such as administration route, frequency and cost. This living systematic review aims...