Quality Assessment Of Studies Research Articles

Barriers and facilitators to evidence-based perioperative hypothermia management for orthopaedic patients: Asystematic review.

To assess barriers and facilitators to the implementation of guidelines for the prevention of inadvertent perioperative hypothermia in orthopaedic patients. Systematic review. Nine databases: PubMed, Embase, CINAHL, Cochrane CENTRAL, PsycINFO, ProQuest Dissertations and Theses, Scopus, Web of Science and Trip Clinical Evidence Database. Primary studies published in English between January 2008 to July 2022 were screened. Study selection, quality assessment, and data extraction were completed independently by researchers. Data were extracted using the Consolidated Framework for Implementation Research and mapped to the Expert Recommendations for Implementing Change strategies. Eighty-seven studies were included in the review. The most frequently reported barriers and facilitators related to evidence strength, relative advantage, and cost of implementing perioperative hypothermia prevention guidelines. The top four ERIC strategies were: Identify and prepare champions; Conduct educational meetings; Assess for readiness and identify barriers and facilitators; and Inform local opinion leaders. This review provides synthesized evidence regarding barriers and facilitators to perioperative hypothermia guidelines for patients undergoing orthopaedic surgery. Our work provides theory guided strategies to promote implementation of perioperative hypothermia prevention to assist nurses caring for patients undergoing orthopaedic surgery. Findings provide professionals caring for patients undergoing orthopaedic surgery with theory-informed strategies to improve perioperative hypothermia prevention. Reducing perioperative hypothermia will improve outcomes for patients undergoing orthopaedic surgery. The review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. Due to the study design, no patient or public consultation took place.

Diagnostic accuracy of deep learning using speech samples in depression: a systematic review and meta-analysis.

This study aims to conduct a systematic review and meta-analysis of the diagnostic accuracy of deep learning (DL) using speech samples in depression. This review included studies reporting diagnostic results of DL algorithms in depression using speech data, published from inception to January 31, 2024, on PubMed, Medline, Embase, PsycINFO, Scopus, IEEE, and Web of Science databases. Pooled accuracy, sensitivity, and specificity were obtained by random-effect models. The diagnostic Precision Study Quality Assessment Tool (QUADAS-2) was used to assess the risk of bias. A total of 25 studies met the inclusion criteria and 8 of them were used in the meta-analysis. The pooled estimates of accuracy, specificity, and sensitivity for depression detection models were 0.87 (95% CI, 0.81-0.93), 0.85 (95% CI, 0.78-0.91), and 0.82 (95% CI, 0.71-0.94), respectively. When stratified by model structure, the highest pooled diagnostic accuracy was 0.89 (95% CI, 0.81-0.97) in the handcrafted group. To our knowledge, our study is the first meta-analysis on the diagnostic performance of DL for depression detection from speech samples. All studies included in the meta-analysis used convolutional neural network (CNN) models, posing problems in deciphering the performance of other DL algorithms. The handcrafted model performed better than the end-to-end model in speech depression detection. The application of DL in speech provided a useful tool for depression detection. CNN models with handcrafted acoustic features could help to improve the diagnostic performance. The study protocol was registered on PROSPERO (CRD42023423603).

Outcome Reporting in Prospective Studies Evaluating Neurostimulation for Obstructive Sleep Apnea.

Due to the controversy surrounding the appropriate outcomes in neurostimulation, we sought to systematically describe ways in which polysomnography and apnea-hypopnea index are reported in prospective studies involving unilateral hypoglossal nerve stimulation. MEDLINE (Ovid), Embase (Ovid), Cochrane Library, and Scopus. Following the Preferred Reporting items of Systematic Reviews and Meta-analysis (PRISMA) Statement guidelines, a systematic two-reviewer system was used for study screening and quality assessment. Articles that met inclusion criteria were included. Quality was evaluated with either the Newcastle-Ottawa Quality Assessment Scale or the Covidence risk-of-bias tool. Fifteen studies met the inclusion criteria, which included 14 prospective cohort studies and one randomized controlled trial. Titration polysomnography was the primary sleep study used to acquire data in five of the studies compared to only three studies employing exclusively non-titration polysomnography to report outcomes. Three studies compiled data from two or more sleep studies to report a single apnea-hypopnea index. Within the 15 studies, non-titration apnea-hypopnea index was the most reported type (five studies). Titration apnea-hypopnea index was used to report outcomes in one study. Five studies did not specify what type of apnea-hypopnea index was employed to report treatment effectiveness. The reported sleep studies and corresponding apnea-hypopnea indices were highly variable across the studies. Because of the high degree of heterogeneity, future research would benefit from consistent use of a standardized apnea-hypopnea index to report outcomes related to hypoglossal nerve stimulation. NA Laryngoscope, 2024.

Multimodal prehabilitation and postoperative outcomes in upper abdominal surgery: systematic review and meta-analysis

The impact of multimodal prehabilitation on postoperative complications in upper abdominal surgeries is understudied. This review analyzes randomized trials on multimodal prehabilitation with patient and hospital outcomes. MEDLINE, Embase, CINAHL, and Cochrane CENTRAL were searched for trials on prehabilitation before elective (non-emergency) abdominal surgery. Two reviewers independently screened studies, extracted data, and assessed study quality. Primary outcomes of interest were postoperative pulmonary complications (PPCs) and all-cause complications; secondary outcomes included hospital and intensive care length of stay. A meta-analysis with random-effect models was performed, and heterogeneity was evaluated with I-square and Cochran’s Q test. Dichotomous variables were reported in log-odds ratio and continuous variables were presented as mean difference. Ten studies (total 1503 patients) were included. Odds of developing complications after prehabilitation were significantly lower compared to various control groups (− 0.38 [− 0.75– − 0.004], P = 0.048). Five studies described PPCs, and participants with prehabilitation had decreased odds of PPC (− 0.96 [− 1.38– − 0.54], P < 0.001). Prehabilitation did not significantly reduce length of stay, unless exercise was implemented; with exercise, hospital stay decreased significantly (− 0.91 [− 1.67– − 0.14], P = 0.02). Multimodal prehabilitation may decrease complications in upper abdominal surgery, but not necessarily length of stay; research should address heterogeneity in the literature.

Diagnostic accuracy of OCT angiography for macular neovascularization in central serous chorioretinopathy: A systematic review and meta-analysis.

Identifying macular neovascularization (MNV) in eyes with central serous chorioretinopathy (CSC) has important implications for its management. Optical coherence tomography angiography (OCTA) is increasingly used for this purpose. Here, we systematically reviewed the literature and conducted meta-analysis to determine the diagnostic accuracy of OCTA for detecting MNV in eyes with CSC. We systematically searched the literature in 12 databases for relevant studies from database inception until 18 November 2023. Eligible studies had eyes with CSC with MNV and CSC without MNV. Index test was OCTA. Reference test was retinal dye angiography. Study selection and data extraction were performed in duplicate, and study was evaluated using the Quality Assessment of Diagnostic Accuracy Studies 2. Our main outcome of interest was the sensitivity and specificity of OCTA for detecting MNV in CSC. Pooled diagnostic test accuracy estimates were computed using MetaDTA. Of 177 records screened, seven fulfilled the eligibility criteria for our study. These studies summarized data from a total of 1061 eyes. Summary estimate sensitivity and specificity to diagnose MNV in eyes with CSC using OCTA was 92.9% (95% CI: 81.7%-97.5%) and 99.4% (95% CI: 84.1%-100.0%), respectively. The main source of bias across studies was the reference standard, as four studies used multimodal imaging including OCTA for the reference standard. OCTA alone is excellent for detecting MNV in CSC compared to retinal dye angiography or multimodal imaging. Using OCTA first before considering retinal dye angiography could potentially save an important number of retinal dye angiographies.

Leadership development programmes in healthcare research: a systematic review, meta-analysis and meta-aggregation

BackgroundAcademic institutions benefit from researchers adopting leadership positions and, subsequently, leadership development programmes are of increasing importance. Despite this, no evaluation of the evidence basis for leadership development programmes for...

Deep learning in pulmonary nodule detection and segmentation: a systematic review.

The accurate detection and precise segmentation of lung nodules on computed tomography are key prerequisites for early diagnosis and appropriate treatment of lung cancer. This study was designed to compare detection and segmentation methods for pulmonary nodules using deep-learning techniques to fill methodological gaps and biases in the existing literature. This study utilized a systematic review with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searching PubMed, Embase, Web of Science Core Collection, and the Cochrane Library databases up to May 10, 2023. The Quality Assessment of Diagnostic Accuracy Studies 2 criteria was used to assess the risk of bias and was adjusted with the Checklist for Artificial Intelligence in Medical Imaging. The study analyzed and extracted model performance, data sources, and task-focus information. After screening, we included nine studies meeting our inclusion criteria. These studies were published between 2019 and 2023 and predominantly used public datasets, with the Lung Image Database Consortium Image Collection and Image Database Resource Initiative and Lung Nodule Analysis 2016 being the most common. The studies focused on detection, segmentation, and other tasks, primarily utilizing Convolutional Neural Networks for model development. Performance evaluation covered multiple metrics, including sensitivity and the Dice coefficient. This study highlights the potential power of deep learning in lung nodule detection and segmentation. It underscores the importance of standardized data processing, code and data sharing, the value of external test datasets, and the need to balance model complexity and efficiency in future research. Deep learning demonstrates significant promise in autonomously detecting and segmenting pulmonary nodules. Future research should address methodological shortcomings and variability to enhance its clinical utility. Deep learning shows potential in the detection and segmentation of pulmonary nodules. There are methodological gaps and biases present in the existing literature. Factors such as external validation and transparency affect the clinical application.

Deep learning in pulmonary nodule detection and segmentation: a systematic review.

The accurate detection and precise segmentation of lung nodules on computed tomography are key prerequisites for early diagnosis and appropriate treatment of lung cancer. This study was designed to compare detection and segmentation methods for pulmonary nodules using deep-learning techniques to fill methodological gaps and biases in the existing literature. This study utilized a systematic review with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searching PubMed, Embase, Web of Science Core Collection, and the Cochrane Library databases up to May 10, 2023. The Quality Assessment of Diagnostic Accuracy Studies 2 criteria was used to assess the risk of bias and was adjusted with the Checklist for Artificial Intelligence in Medical Imaging. The study analyzed and extracted model performance, data sources, and task-focus information. After screening, we included nine studies meeting our inclusion criteria. These studies were published between 2019 and 2023 and predominantly used public datasets, with the Lung Image Database Consortium Image Collection and Image Database Resource Initiative and Lung Nodule Analysis 2016 being the most common. The studies focused on detection, segmentation, and other tasks, primarily utilizing Convolutional Neural Networks for model development. Performance evaluation covered multiple metrics, including sensitivity and the Dice coefficient. This study highlights the potential power of deep learning in lung nodule detection and segmentation. It underscores the importance of standardized data processing, code and data sharing, the value of external test datasets, and the need to balance model complexity and efficiency in future research. Deep learning demonstrates significant promise in autonomously detecting and segmenting pulmonary nodules. Future research should address methodological shortcomings and variability to enhance its clinical utility. Deep learning shows potential in the detection and segmentation of pulmonary nodules. There are methodological gaps and biases present in the existing literature. Factors such as external validation and transparency affect the clinical application.

Barriers and facilitators for physical activity in people living with chronic pain: a systematic review and combined analysis.

Chronic pain is a prevalent and complex health issue associated with physical, emotional, and social consequences. Management of pain is multifactorial and challenging; however, physical activity (PA) has consistently been shown to be beneficial. Despite this, PA levels among people with chronic pain are low. This study aimed to identify facilitators and barriers to PA among adults with chronic pain and analyse these using the structure of a validated behaviour change model: the capability, opportunity, and motivation behaviour change model (COM-B). We performed a systematic review of 6 databases and subsequent combined analysis including peer-reviewed primary research published in English up to November 15, 2023. Search terms consisted of 3 components: pain, PA, and facilitators/barriers. Quality appraisal of studies was conducted using appropriate tools. The systematic search yielded 40 eligible studies with a total of 2164 participants. The studies represented various chronic pain conditions, locations, and study designs. The key barriers to engagement in PA were the impact of pain severity, comorbidities, lack of knowledge about PA benefits, and time constraints. Key facilitators were a personalised approach, social support, and awareness of the benefits. The findings were categorised according to the COM-B model, allowing for the identification of modifiable factors. Person-centred approaches, education, and accessible environments were identified as important aspects to consider for successful PA promotion among people with chronic pain. Utilising the factors identified in the COM-B model is crucial for successful future interventions to increasing PA uptake and adherence in this population.

Barriers and facilitators for physical activity in people living with chronic pain: a systematic review and combined analysis.

Chronic pain is a prevalent and complex health issue associated with physical, emotional, and social consequences. Management of pain is multifactorial and challenging; however, physical activity (PA) has consistently been shown to be beneficial. Despite this, PA levels among people with chronic pain are low. This study aimed to identify facilitators and barriers to PA among adults with chronic pain and analyse these using the structure of a validated behaviour change model: the capability, opportunity, and motivation behaviour change model (COM-B). We performed a systematic review of 6 databases and subsequent combined analysis including peer-reviewed primary research published in English up to November 15, 2023. Search terms consisted of 3 components: pain, PA, and facilitators/barriers. Quality appraisal of studies was conducted using appropriate tools. The systematic search yielded 40 eligible studies with a total of 2164 participants. The studies represented various chronic pain conditions, locations, and study designs. The key barriers to engagement in PA were the impact of pain severity, comorbidities, lack of knowledge about PA benefits, and time constraints. Key facilitators were a personalised approach, social support, and awareness of the benefits. The findings were categorised according to the COM-B model, allowing for the identification of modifiable factors. Person-centred approaches, education, and accessible environments were identified as important aspects to consider for successful PA promotion among people with chronic pain. Utilising the factors identified in the COM-B model is crucial for successful future interventions to increasing PA uptake and adherence in this population.

Effects of different parameters of Tai Chi on the intervention of chronic low back pain: A meta-analysis.

To evaluate the effects of Tai Chi in the treatment of patients with chronic low back pain by Meta-analysis and to investigate its influencing factors. The study searched eight databases (PubMed, Embase, The Cochrane Library, Web of Science, China Knowledge Network, Wanfang, VIP, and CBM) from inception to October 2023. Two investigators independently selected 10 eligible randomized controlled trials (RCT) against inclusion and exclusion criteria, followed by data extraction and study quality assessment by ROB 2. The outcomes of interest were pain intensity and disability. The studies were combined using meta-analysis when statistical pooling of data was possible. The quality of the evidence was assessed using the GRADE approach. 10 randomized controlled studies with a total sample of 886 cases were included, of which 4 (40%) were assessed as low risk of bias. The effect size of Tai Chi for chronic low back pain was [Weighted Mean Difference (WMD) with 95% Confidence Interval (CI) = -1.09 (-1.26, -0.92), p < 0.01], all achieving large effect sizes and statistically significant; the effect size for disability was [Standard Mean Difference (SMD) with 95% CI = -1.75 (-2.02, -1.48), p < 0.01], and the combined effect sizes of physical health and mental health for quality of life were [WMD (95% CI) = 4.18 (3.41, 4.95), p < 0.01; WMD (95% CI) = 3.23 (2.42, 4.04), p < 0.01] respectively. The incidence of adverse reactions was low. Meta regression and subgroup analysis showed that there was no significant effect on intervention measures (Tai Chi alone, Tai Chi as additional therapy, water Tai Chi), Tai Chi school (Chen and Yang) and the number of total intervention sessions (> 30 and ≤ 30). The evidence quality evaluation showed that the evidence of pain, physical health of quality of life and mental health score was medium quality, while the evidence of disability and adverse reactions was low quality. Tai Chi has an obvious effect of in relieving chronic low back pain. Tai Chi alone and Tai Chi as supplementary therapy have good effects. Tai Chi in water have not been verified. Chen style Tai Chi and Yang's Tai Chi, intervention more than 30 times or less than 30 times had no significant difference in the effect of intervention on CLBP.

Liquid Biopsies Based on Cell-Free DNA Integrity as a Biomarker for Cancer Diagnosis: A Meta-Analysis

Liquid biopsies have been identified as a viable source of cancer biomarkers. We aim to evaluate the diagnostic accuracy of cell-free DNA integrity (cfDI) in liquid biopsies for cancer. A comprehensive literature search was conducted through PubMed, Embase, Web of Science, and Cochrane Library up to June 2024. Seventy-two study units from forty-six studies, comprising 4286 cancer patients, were identified and evaluated. The Quality Assessment for Studies of Diagnostic Accuracy-2 (QUADAS-2) was used to assess study quality. Meta-regression analysis was employed to investigate the underlying factors contributing to heterogeneity, alongside an evaluation of publication bias. The bivariate random-effect model was utilized to compute the primary diagnostic outcomes and their corresponding 95% confidence intervals (CIs). The pooled sensitivity, specificity, and positive and negative likelihood ratios of cfDI in cancer diagnosis were 0.70 and 0.77, 3.26 and 0.34, respectively. The overall area under the curve was 0.84, with a diagnostic odds ratio of 10.63. This meta-analysis suggested that the cfDI index has a promising potential as a non-invasive and accurate diagnostic tool for cancer. Study registration: The study was registered at PROSPERO (reference No. CRD42021276290).

Liquid Biopsies Based on Cell-Free DNA Integrity as a Biomarker for Cancer Diagnosis: A Meta-Analysis

Liquid biopsies have been identified as a viable source of cancer biomarkers. We aim to evaluate the diagnostic accuracy of cell-free DNA integrity (cfDI) in liquid biopsies for cancer. A comprehensive literature search was conducted through PubMed, Embase, Web of Science, and Cochrane Library up to June 2024. Seventy-two study units from forty-six studies, comprising 4286 cancer patients, were identified and evaluated. The Quality Assessment for Studies of Diagnostic Accuracy-2 (QUADAS-2) was used to assess study quality. Meta-regression analysis was employed to investigate the underlying factors contributing to heterogeneity, alongside an evaluation of publication bias. The bivariate random-effect model was utilized to compute the primary diagnostic outcomes and their corresponding 95% confidence intervals (CIs). The pooled sensitivity, specificity, and positive and negative likelihood ratios of cfDI in cancer diagnosis were 0.70 and 0.77, 3.26 and 0.34, respectively. The overall area under the curve was 0.84, with a diagnostic odds ratio of 10.63. This meta-analysis suggested that the cfDI index has a promising potential as a non-invasive and accurate diagnostic tool for cancer. Study registration: The study was registered at PROSPERO (reference No. CRD42021276290).

Echocardiographic assessment of left ventricular mechanics in individuals with mitral valve prolapse: a systematic review and meta-analysis.

During the last decade, a number of echocardiographic studies have employed speckle tracking echocardiography (STE) for assessing myocardial deformation properties in individuals with mitral valve prolapse (MVP), reporting not univocal results. Accordingly, we performed a systematic review and meta-analysis to summarize the main findings of these studies and to examine the overall influence of MVP on left ventricular (LV) global longitudinal strain (GLS). All echocardiographic studies assessing conventional echoDoppler parameters and myocardial strain indices in MVP individuals vs. controls without MVP, selected from PubMed and EMBASE databases, were included. The risk of bias was assessed by using the National Institutes of Health (NIH) Quality Assessment of Case-Control Studies. Continuous data (LV-GLS) were pooled as a standardized mean difference (SMD) comparing MVP group with healthy controls. The overall SMD of LV-GLS was calculated using the random-effect model. The full-texts of 15 studies with 1088 individuals with MVP and 591 healthy controls were analyzed. Average LV-GLS magnitude was significantly, even though modestly, reduced in MVP individuals in comparison to controls (19.4 ± 3.4% vs. 21.1 ± 2.8%, P < 0.001). The overall effect of MVP on LV-GLS was small-to-medium (SMD - 0.54, 95%CI -0.76,-0.32, P < 0.001). Substantial heterogeneity was detected for the included studies, with an overall I2 statistic value of 75.9% (P < 0.001). Egger's test for a regression intercept gave a P-value of 0.58, indicating no publication bias. On meta-regression analysis, none of the moderators (the age, the percentage of females among MVP individuals, body mass index, heart rate and systolic blood pressure of MVP individuals, the degree of mitral regurgitation, the type of ultrasound machine employed for strain echocardiographic imaging and finally the beta blocker treatment) was significantly associated with effect modification (all P < 0.05). Regional strain analysis, performed by two-third of the studies, highlighted a more enhanced reduction in myocardial strain parameters at level of the LV basal infero-lateral segments in all directions (longitudinal, circumferential and radial), with apical sparing. The longitudinal strain impairment detected in MVP individuals is more regional than global, with peculiar involvement of the LV basal infero-lateral segments and relative apical sparing pattern.

A standard to report biological variation data studies- based on an expert opinion.

There is a need for standards for generation and reporting of Biological Variation (BV) reference data. The absence of standards affects the quality and transportability of BV data, compromising important clinical applications. To address this issue, international expert groups under the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) have developed an online resource (https://tinyurl.com/bvmindmap) in the form of an interactive mind map that serves as a guideline for researchers planning, performing and reporting BV studies. The mind map addresses study design, data analysis, and reporting criteria, providing embedded links to relevant references and resources. It also incorporates a checklist approach, identifying a Minimum Data Set (MDS) to enable the transportability of BV data and incorporates the Biological Variation Data Critical Appraisal Checklist (BIVAC) to assess study quality. The mind map is open to access and is disseminated through the EFLM BV Database website, promoting accessibility and compliance to areporting standard, thereby providing a tool to be used toensure data quality, consistency, and comparability of BV data. Thus, comparable to the STARD initiative for diagnostic accuracy studies, the mind map introduces a Standard for Reporting Biological Variation Data Studies (STARBIV), which can enhance the reporting quality of BV studies, foster user confidence, provide better decision support, and be used as a tool for critical appraisal. Ongoing refinement is expected toadapt to emerging methodologies, ensuring a positive trajectory toward improving the validity and applicability of BV data in clinical practice.

Association of preserved ratio impaired spirometry with mortality and cardiovascular diseases: a systematic review and meta-analysis

BackgroundPreserved ratio impaired spirometry (PRISm) is a type of abnormal lung function. PRISm and mortality have been explored in several studies, but a comprehensive evaluation of the associations is limited. The current study aims to conduct a systematic review and meta-analysis in order to investigate the mortality and cardiovascular diseases in patients with PRISm.MethodsPubMed, Embase, and Web of Science databases, as well as gray literature sources, were searched for relevant studies published up to 7 September 2023 without language restrictions. This review included all published observational cohort studies that investigated the association of PRISm with mortality in the general population, as well as subgroup analyses in smokers and pre-bronchodilation spirometry studies. The outcomes of interest were all-cause mortality, cardiovascular mortality, and respiratory-related mortality. The Newcastle–Ottawa scale assessed study quality. Sensitivity and subgroup analyses explored heterogeneity and robustness. Publication bias was assessed with Egger’s and Begg’s tests.ResultsOverall, eight studies were included in this meta-analysis. The pooled HR was 1.60 (95% CI, 1.48–1.74) for all-cause mortality, 1.68 (95% CI, 1.46–1.94) for CVD mortality, and 3.09 (95% CI, 1.42–6.71) for respiratory-related mortality in PRISm group compared to normal group. In the subgroup analysis, participants with PRISm had a higher effect (HR, 2.11; 95% CI, 1.74–2.54) on all-cause mortality among smokers relative to participants with normal spirometry. Furthermore, the association between PRISm and mortality risk was consistent across several sensitivity analyses.ConclusionsPeople with PRISm were associated with an increased risk of all-cause mortality, CVD mortality, and respiratory-related mortality as compared to those with normal lung function in the general population.Systematic review registrationPROSPERO CRD42023426872.

Groundwater quality assessment using machine learning models: a comprehensive study on the industrial corridor of a semi-arid region.

Water plays a significant role in sustaining the lives of humans and other living organisms. Groundwater quality analysis has become inevitable, because of increased contamination of water resources and global warming. This study used machine learning (ML) models to predict the water quality index (WQI) and water quality classification (WQC). Forty groundwater samples were collected near the Ranipet industrial corridor, and the hydrogeochemistry and heavy metal contamination were analyzed. WQC prediction employed random forest (RF), gradient boosting (GB), decision tree (DT), and K-nearest neighbor (KNN) models, and WQI prediction used extreme gradient boosting (XGBoost), support vector regressor (SVR), RF, and multi-layer perceptron (MLP) models. The grid search method is used to evaluate the ML model by F1 score, accuracy, recall, precision, and Matthews correlation coefficient (MCC) for WQC and the coefficient of determination (R2), mean absolute error (MAE), mean square error (MSE), and median absolute percentage error (MAPE) for WQI. The WQI results indicate that the groundwater quality of the study area is very poor and unsuitable for drinking or irrigation purposes. The performance metrics of the RF model excelled in predicting both WQC (accuracy = 97%) and WQI (R2 = 91.0%), outperforming other models and emphasizing ML's superiority in groundwater quality assessment. The findings suggest that ML models perform well and yield better accuracy than conventional techniques used in groundwater quality assessment studies.

P-716 What do Africans know about their fertility? A systematic literature review exploring fertility knowledge, attitudes, and behaviour among African population groups

Abstract Study question What is the knowledge, attitude, and behaviour regarding fertility, among African population groups? Summary answer Fertility knowledge and uptake of treatment options for infertility were found to be sub-optimal while the attitude towards fertility were mixed. What is known already Infertility affects 1 in 6 couples worldwide according to the WHO, with some evidence of higher incidence among the African population. Health policies have highlighted the importance of optimising fertility through better knowledge and, recently, there has been a concerted effort from several stakeholders to improve fertility-education. An important component of doing this effectively is to understand the current status and identify gaps. Most studies on this topic, however, have focused on high-income countries. This study aimed to assess current patterns of fertility knowledge, attitudes, and behaviour; and identify improvement opportunities but with a focus on the African population group. Study design, size, duration Global Health, MEDLINE, Web of Science PubMed, Scopus, and Google scholar databases were systematically searched for articles published between 2000 and 2023. Articles covering fertility knowledge, attitude and practices were included if they had been conducted in Africa and were published in an English language peer-reviewed journal. Participants/materials, setting, methods Articles were extracted and reviewed independently by two researchers. Content was analysed and categorised thematically. Quality assessment of studies were conducted. Main results and the role of chance The systematic search yielded 1939 articles and 25 articles were included, studies were from Nigeria, South Africa, Gambia, Egypt, Kenya. Overall, the reviewed studies showed that Africans place a high value on their fertility and have high aspirations towards parenthood, with childbearing being perceived as fulfilment or destiny. Knowledge and understanding of ART and treatment options was found to be low in studies assessed. There was also low knowledge of age-related fertility decline and low understanding of the menstrual cycle and ovulation. Although the attitude towards infertility and assisted reproductive technology was mixed, there is more openness within the higher-socioeconomic demographics, although generally sub-optimal. Overall studies also highlighted several myths and misinformation about ART. There were important factors influencing behaviour: such as the importance of being married, having a steady income, and safe-housing. Some studies also highlighted that cultural beliefs and religion also play an important role. Research findings showed that there is stigma associated with childlessness in many African communities. Although some studies reported attributing infertility to fate or destiny, most remain open to treatment through various methods, ranging from ART to herbalist and spiritual intervention, with some considering prayer a method of treatment. Limitations, reasons for caution This study focused on fertility knowledge, attitude and practices of Africans which has implications for generalisability among wider population groups. From our quality assessment, some of the studies in the systematic review had methodological limitations. Wider implications of the findings While strategies and policies to improve fertility awareness are being deployed, it is important to consider the needs of lower- and middle-income countries. Findings can inform government policies aiming to improve education, minimise ART costs, improve health-equity and access; ultimately allowing people to achieve their desired family-building intentions. Trial registration number not applicable

P-433 Endometrial cavity fluid and clinical pregnancy outcomes in assisted reproduction cycles. A systematic review and meta-analysis

Abstract Study question Does Endometrial cavity fluid (ECF) presence affect clinical pregnancy rates in assisted reproduction (ART) cycles? Does ECF aspiration improve clinical pregnancy outcomes? Summary answer ECF aspiration appears to improve clinical pregnancy outcomes by 56%. What is known already Accumulation of ECF has been a notable finding in ART cycles. The origin of ECF is up to debate; nonetheless, it is frequently associated with a concurrent diagnosis of hydrosalpinx, gonadotropin therapy, subclinical uterine infections, polycystic ovary syndrome amongst other causes. A recent meta-analysis of nine studies highlighted that the presence of ECF substantially diminishes the rates of implantation and clinical pregnancy following embryo transfer, particularly when exceeding 3.5 mm. However, the benefit of ECF aspiration upon clinical pregnancy remains obscure. Study design, size, duration The present meta-analysis aimed to compare clinical pregnancy rates between patients with ECF on the day of embryo transfer undergoing ECF aspiration vs. those who did not. The study was conducted according to the PRISMA guidelines. Six databases (Embase, MEDLINE®, APA PsycInfo, Global Health, HMIC Health Management Information Consortium and Google Scholar) and two additional sources were searched from inception to 23rd November 2023. Participants/materials, setting, methods Observational and Randomized Control Trials meeting inclusion criteria underwent analysis. Quality assessment for observational studies utilised the ROBINS-I Risk of Bias (RoB) tool, and Cochrane RoB V2 tool was used to assess RCTs. Certainty of evidence was evaluated through the GRADE framework. The Meta-analysis was conducted by computing Odds Ratio (OR), Random Effects (RE) using the Haensel-Mantel method. Summative and subgroup data were analysed via the web-based Cochrane RevMan platform. Main results and the role of chance A total of 3 studies were deemed eligible for inclusion, of which 2 were observational (Hou et al., 2022; Hussaini et al., 2018) and a single RCT (Saad et al., 2019). Observational studies were deemed of moderate RoB while the RCT of low RoB. Certainty in overall evidence (GRADE) was deemed moderate. A total of 379 patients were included in the meta-analysis, of a median age 29 [IQR 24.45, 34]. Previous diagnoses of endometriosis, adenomyosis or uterine surgery were not reported in any of the included studies, while only two studies reported the percentage of tubal factor infertile patients in their respective included sample (73% and 25%, Ntotal=125). When aggregately analysed, ECF aspiration resulted in a significant increase in clinical pregnancy rates, OR 1.56 [95% CI 1.04, 2.33], I2= 1%, P = 0.03. Additionally, subgroup analysis of low RoB studies, OR 1.61 [95% CI 1.08, 2.40], I2= 0%, P = 0.02, successfully controlled for heterogeneity whilst also yielding statistically significant results. Limitations, reasons for caution Inherent to the nature of observational studies, our meta-analysis suffers from the scarcity of robust randomized control studies and adequately powered observational evidence. Wider implications of the findings Our study suggests that ECF aspiration at embryo transfer may improve clinical pregnancy outcomes. However, robust RCTs are required to assess the degree of clinical impact as well as the patient subgroups and their clinical characteristics that may benefit more from such an intervention. Trial registration number not applicable

A Systematic Review of Methods of Fixation of Greater Trochanter Fracture during Hip Arthroplasty

Abstract Background The rigid fixation of greater trochanter has been supported by more and more surgeons, but the choice of fixation is still controversial. Traditional steel wires and titanium is widely used because of its relatively simple procedure and low cost. But the high failure rate of internal fixation also led orthopedists to seek for other more effective fixation methods. Objective To compare between methods of fixation of greater trochanter during hip arthroplasty according to type and postoperative outcome. Patients and Methods Studies that meet the inclusion criteria were reviewed and data were analysed. We assessed the participants, methods, and intervention effects of included studies for heterogeneity. This enabled us to determine whether results can be pooled across studies. Results This review was on Non randomized and randomized controlled trials, prospective and retrospective studies which compare different methods of fixation of trochanter during hip arthroplasty. The search strategy identified 780 unique citations. Screening of titles and Abstracts identified 93 potentially relevant articles. Full text review of these articles identified 10 studies meeting the inclusion criteria. 10 studies were included 8 were retrospective and 2 prospective studies. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2021. Data Extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures. Conclusion The different fixation methods were successful in achieving proper reduction and fixation of greater trochanteric fractures during hip arthroplasty. We preferred the cable plates, which not only provides strongest fixation but also results in lower rate of postoperative complications. But further prospective randomized and cohort studies are needed to validate their safety and efficacy.