Quality Of Studies Research Articles

The 6 Minute Walk Test as a predictor of mortality in idiopathic pulmonary fibrosis: A systematic review.

The 6 Minute Walk Test as a predictor of mortality in idiopathic pulmonary fibrosis: A systematic review.

Effect of Home-based Virtual Reality Training on Upper Extremity Recovery in Patients with Stroke: Systematic Review.

Stroke is a leading cause of long-term disability, often resulting in upper extremity dysfunction. Traditional rehabilitation methods often face challenges such as limited patient access to resources and lack of sustained motivation. Home-based virtual reality (VR) training is gaining traction as an innovative, sustainable and interactive alternative. However, the effect of home-based VR, specifically for upper extremity recovery in patients with stroke, remains insufficiently explored. This systematic review aims to synthesize existing evidence to evaluate the impact of home-based VR interventions on upper extremity function recovery in patients with stroke. This systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive literature search was conducted across PubMed, Web of Science, Scopus, and CINAHL Ultimate databases, targeting English-language randomized controlled trials (RCTs) published up to June 30, 2024. Eligible studies involved stroke patients with upper extremity dysfunction who received home-based VR interventions. Data extraction was performed by two independent reviewers, and study quality was assessed using the PEDro scale. Due to heterogeneity in study designs and outcome measures, a narrative synthesis was performed instead of a meta-analysis. Eight RCTs with 392 participants were included. This review shows that home-based VR training positively affects upper extremity function recovery in patients with stroke, especially in motor control improvement. Customized VR systems were more effective than commercial VR systems in patients with moderate to severe disorders. Although studies generally showed positive results, differences in intervention protocols and small sample sizes limited the validity of results. The effect of VR therapy also varied based on the VR system type, intervention intensity, and the functional level of patients. This systematic review shows that home-based VR training has a positive impact on upper extremity rehabilitation for stroke patients, particularly in those with varying degrees of dysfunction. However, heterogeneity in study design and differences in outcome measures affect the reliability of the current conclusions. Future studies should include larger, standardized RCTs with long-term follow-up to assess their continued effects. Future research should explore how VR technology can be integrated into comprehensive rehabilitation programs, focusing on patient-centered approaches that incorporate sustainable, personalized technology and support services to optimize recovery outcomes. PROSPERO CRD42024526650; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024526650.

Penile prosthesis for erectile dysfunction: recommendations from the 5th International Consultation on Sexual Medicine.

Penile prosthesis (PP) is one of the main approved therapies for erectile dysfunction (ED). Greater than 50years of clinical use has led to considerable innovation in PP surgery and patient care. To summarize the current literature and provide updated clinical evidence to inform healthcare providers on best practices with PP. A consensus panel was held with leading sexual medicine experts during the 5th International Consultation on Sexual Medicine (ICSM). Relevant peer-reviewed literature was reviewed with focus on research from but not limited to the last 10years. The quality of each individual study was judged with Oxford levels of evidence (LOE) criteria, but overall LOE were not used as systematic review was not performed. The expert panel generated consensus statements based on the quality of evidence and criteria of GRADE (Grading of Recommendations Assessment, Development and Evaluation). PP provides excellent outcomes for the treatment of ED. The panel developed 35 recommendations building upon previous recommendations. Nine recommendations (4, 5, 11,13,17, 25, 26, 31, and 32) are retained without change from 2015. Twelve recommendations (1, 2, 3, 7, 9,14,16,19,21, 28, 33, and 34) change syntax to make statements more active or change details. Fourteen recommendations (6, 8, 10, 12, 15, 18, 20, 22, 23, 24, 27, 29, 30, and 35) are novel in this update. Since the 4th ICSM, new evidence has emerged to guide PP use in modern sexual medicine. While multi-institutional studies are needed to improve outcomes, key challenges remain: reducing infections, enhancing devices, and improving awareness and accessibility. We recommend following 5th ICSM guidelines while emphasizing the importance of clinical judgment and shared decision-making for optimal PP outcomes.

The Role of Immersive Virtual Reality in Upper Limb Rehabilitation for Subacute Stroke: A Review

Background: Patients with stroke sequelae experience motor impairments that make it difficult to perform many activities of daily living, resulting in reduced social participation. Immersive virtual reality (VR) provides the necessary conditions for motor learning, such as repetitiveness, intensity, and task meaningfulness, and it could be a promising rehabilitation tool for upper limb recovery in individuals with stroke sequelae. Objective: The objectives of this study are to summarize the current scientific evidence on the use of immersive VR for upper limb rehabilitation in patients with subacute stroke and to identify clinical and instrumental criteria that may inform the development of a standardized VR treatment protocol. Materials and Methods: Bibliographic research on primary and secondary studies was conducted using the keywords “subacute stroke”, “immersive virtual reality/head-mounted display (HMD)”, and “upper extremity/arm/hand” in the following electronic databases: CINAHL, PubMed (MEDLINE), Embase, Web of Science, Cochrane Library, PEDro, and Google Scholar. Then, we performed the selection of studies and the assessment of the methodological quality of such studies using the PEDro scale. Finally, the qualitative synthesis of the data extracted from the selected studies was carried out. This systematic review was conducted according to the PRISMA 2020 guidelines. Results: After the selection process, five studies were included in this systematic review (two RCTs, two controlled clinical studies, one study protocol). Four studies reported significant improvements in some main outcomes after the VR intervention, including a significant increase in the Fugl-Meyer Upper Extremity total score, in favor of the virtual rehabilitation group. Conclusions: VR appears to be a promising rehabilitation tool for upper limb motor recovery. However, further research is needed to determine the intervention methods and long-term effects of VR on the stroke population.

Breast cancer characteristics in low- and middle-income countries: An umbrella review.

Breast cancer characteristics in low- and middle-income countries: An umbrella review.

Foot and Ankle Ability Measure (FAAM) Questionnaire: A Systematic Review.

The Foot and Ankle Ability Measure is frequently used by clinicians and researchers to assess the effectiveness of therapeutic interventions for patients with foot and ankle pathologies. To review different versions of the FAAM and to evaluate the methodological quality of studies published in this respect. Systematic review. A search was conducted in the PubMed, SCOPUS, PEDro, PROSPERO and SPORTDiscus databases, applying the following inclusion criteria: validation studies of the Foot and Ankle Ability Measure, in different languages, with no time limit, in a population aged ≥18 years. Two of the present authors independently assessed the quality of the studies located and extracted the relevant data. The COSMIN checklist was employed to assess methodological quality. Thirteen instruments met the inclusion criteria for this review. In many cases, significant methodological flaws were detected, mostly regarding criterion validity and measurement error. Only the Spanish-language cultural adaptation of the FAAM presents adequate methodological quality. Further studies, with greater methodological rigour, are required of the cultural adaptations of this measurement instrument.

Sex differences in electrical activity of the brain during sleep: a systematic review of electroencephalographic findings across the human lifespan

BackgroundWith the explosion of techniques for recording electrical brain activity, our recognition of neurodiversity has expanded significantly. Yet, uncertainty exists regarding sex differences in electrical activity during sleep and whether these differences, if any, are associated with social parameters. We synthesised existing evidence applying the PROGRESS-Plus framework, which captures social parameters that may influence brain activity and function.MethodsWe searched five databases from inception to December 2024, and included English language peer-reviewed research examining sex differences in electrical activity during sleep in healthy participants. We performed risk of bias assessment following recommended criteria for observational studies. We reported results on sex differences by wave frequency (delta, theta, alpha, sigma, beta, and gamma) and waveforms (spindle and sawtooth), positioning results across age-related developmental stages. We created visualizations of results linking study quality and consideration of PROGRESS-Plus parameters, which facilitated certainty assessment.ResultsOf the 2,783 unique citations identified, 28 studies with a total of 3,374 participants (47% male, age range 4–5 months to 101 years) were included in data synthesis. Evidence of high certainty reported no sex differences in alpha and delta relative power among participants in middle-to-late adulthood. Findings of moderate certainty suggest no sex differences in alpha power; and theta, sigma and beta relative power; and delta density. There is evidence of moderate certainty suggesting that female participants had a steeper delta wave slope and male participants had greater normalized delta power. Evidence that female participants have higher spindle power density is of low certainty. All other findings were regarded as very low in certainty. The PROGRESS-Plus parameters were rarely integrated into the methodology of studies included in this review.ConclusionEvidence on the topic of sex differences in sleep wave parameters is variable. It is possible that the reported results reflect unmeasured social parameters, instead of biological sex. Future research on sex differences in sleep should be discussed in relevance to functional or clinical outcomes. Development of uniform testing procedures across research settings is timely. PROSPERO: CRD42022327644. Funding: Canada Research Chairs (Neurological Disorders and Brain Health, CRC-2021-00074); UK Pilot Award for Global Brain Health Leaders (GBHI ALZ UK-23-971123).

Mentorship in surgical training; a systematic scoping review to inform a mentorship framework for ophthalmology trainees

BackgroundMentorship plays a vital role in surgical training. In the field of ophthalmology, effective mentorship is particularly critical due to the specialised nature of surgeries and the need for comprehensive skill development. However, the landscape of mentorship remains underexplored. Understanding key characteristics and components of effective mentorship is essential for optimising training and ensuring the success of future generations of surgeons. This scoping review aims to analyse existing literature on mentorship in surgical training and to employ Levac et al.‘s enhanced methodological framework to construct a conceptual framework for a bespoke mentorship programme tailored to the needs of ophthalmology trainees.MethodsThe search strategy adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included relevant databases such as MEDLINE, Scopus, CINAHL Complete, ERIC, EMBASE, and the Cochrane Library. Selection criteria encompassed studies exploring mentorship experiences, perceptions, and outcomes across all surgical training domains. A two-step screening process was employed, followed by thematic analysis using Braun and Clarke’s approach. The Medical Education Research Study Quality Instrument (MERSQI) assessed study quality.ResultsOf the 81 identified articles, 24 were included in the review, with an average MERSQI score of 11.65. Studies comprised randomised controlled trials, systematic reviews, cohort, cross-sectional studies, and reviews. The thematic analysis identified five domains: (1) mentorship and burnout; (2) surgical skill and performance; (3) career paths and professional development; (4) diversity promotion; and (5) work-life balance.ConclusionsThis review underscores the significance of mentorship in surgical training and proposes a conceptual framework tailored to ophthalmology trainees. By synthesising existing literature and through author engagement with relevant training bodies, the study contributes to the development of an imminent mentoring programme, aiming to enhance surgical training outcomes and foster trainee well-being and professional growth.

Efficacy of nutrient supplements in managing malnutrition and sarcopenia in Chronic Obstructive Pulmonary Disease (COPD) patients: a protocol for systematic review and meta-analysis

BackgroundCOPD patients suffering from malnutrition or sarcopenia often incur higher healthcare costs and experience adverse clinical outcomes. Despite this, the effectiveness of nutrient supplements in this population remains uncertain.Methods and analysisTwo reviewers will independently search seven databases—PubMed, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, Chinese Biomedical Literature Database, and the Cochrane Library—for randomized controlled trials (RCTs) published before August 31, 2024. These RCTs should compare the effects of nutrient supplements against either a standard diet or placebo supplements in patients with COPD. The risk of bias in the included studies will be evaluated using the modified Jadad scale and the Cochrane Collaboration's risk of bias tool. Data synthesis will be conducted using RevMan software. Trial sequential analysis (TSA) will be applied to the primary outcomes. Additionally, subgroup and sensitivity analyses will be performed to assess the robustness of the findings.Ethics and disseminationEthical approval is not required because this study is a secondary analysis of existing data. We will disseminate the findings through peer- reviewed publications.Systematic review registrationCRD42024585694.Strengths and limitations of this studyThis systematic review and meta-analysis provides a thorough assessment of the efficacy of nutrient supplements in COPD patients, covering a wide range of studies.·The use of the modified Jadad scale and the Cochrane Collaboration's risk of bias tool ensures a robust evaluation of study quality. Additionally, trial sequential analysis and subgroup analyses are employed to enhance the robustness of the findings.·The credibility of the evidence may be compromised due to the potential for uncertain study quality and limited sample sizes in some included trials.

A systematic review and meta-analysis of the comparison of laparoscopic radiofrequency ablation to percutaneous radiofrequency ablation for hepatocellular carcinoma

BackgroundThe comparative evaluation of laparoscopic and percutaneous techniques for liver radiofrequency ablation remains unexplored. This study aims to determine the most effective ablation technique and patient selection for hepatocellular carcinoma (HCC) by analyzing the efficacy and safety of laparoscopic radiofrequency ablation (LRFA) versus percutaneous radiofrequency ablation (PRFA).MethodsTwo investigators (Y-QW and PZ) independently performed a literature search in the Cochrane Library, PubMed, Web of Science and Embase databases. Study quality was assessed using the Newcastle–Ottawa Scale or Cochrane risk-of-bias tool. Meta-analysis was conducted with Review Manager 5.4, applying either fixed- or random-effects models depending on study heterogeneity. The chi-square test (χ²) and I² statistics were employed for heterogeneity analysis.ResultsEight publications involving 1059 patients were included. Among them, 456 underwent LRFA and 603 underwent PRFA. LRFA showed a significantly better 3-year RFS than PRFA (OR: 1.89, 95% CI: 1.27-2.83, p = 0.002), the incidence rate of local recurrence was significantly fewer in the LRFA group (OR: 0.40, 95% CI: 0.23-0.69, p = 0.0010), but the postoperative hospital stay time was slightly shorter in the PFRA group (MD = 1.30; 95% CI 0.26 to 2.35; p=0. 01). Patients in the LRFA group had no significant difference in total postoperative complications, ablation success rates, overall survival (OS) and 1,5-year disease-free survival (DFS).ConclusionBoth LRFA and PRFA are effective treatments for HCC. LRFA shows better oncologic outcomes, including lower local recurrence and improved mid-term DFS. PRFA is simpler, less invasive and shorter hospital stays. The choice should be tailored to individual patient needs, considering tumor characteristics, comorbidities, and available expertise. Future research should focus on large-scale, prospective trials to validate these findings.Systematic review and registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024601797.

Assessing the efficacy of nonsurgical periodontal treatment on rheumatoid arthritis: an umbrella review.

The relationship between periodontitis and rheumatoid arthritis (RA) has attracted considerable interest. However, the effect of non-surgical periodontal treatment (NSPT) on RA remains uncertain. This umbrella review aims to consolidate current research to establish a stronger evidence base. Medline, Embase, and the Cochrane library were searched from inception to August 2024. Two independent reviewers handled study selection, data extraction, and quality assessment (AMSTAR-2). The qualitative analysis covered clinical activity, joint symptoms, inflammatory markers, cytokines, and autoantibodies. Quantitative results for disease activity score 28 (DAS28), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were reported as mean differences (MD)with 95% confidence intervals (CI). A total of 2,982 records were screened, with 41 full-text articles assessed for eligibility, and9 selected for evidence synthesis. Qualitative analysis suggests that NSPT may reduce clinical activityin patients with periodontitis and RA. Quantitative analysis provided suggestive evidence on theeffects of NSPT on DAS28, with the MD ranging from -0.38 (95% CI: -0.46 to -0.31) to -1.18 (95%CI: -1.43 to -0.93). One-third of the included studies were rated as "high" quality, while another one-third were "critically low". The present evidence suggests that NSPT may provide benefits in managing RAsymptoms in patients with periodontitis; however, the potential bias of current evidence calls forfurther rigorous studies. Clinicians should account for the complex interplay between periodontitis andRA when devising treatment strategies.

Effectiveness of School Interventions in Reducing Bullying Behavior: Systematic Literature Review

Bullying among adolescents remains a critical issue that affects students' psychological and social well-being. This study analyzes the effectiveness of various school-based interventions in reducing bullying behavior and identifies key factors influencing their success. Utilizing a systematic literature review approach, this study examines research published between 2019 and 2024 from databases such as ScienceDirect, Garuda, and SpringerLink. The Joanna Briggs Institute (JBI) Critical Appraisal checklist and the Mixed Methods Appraisal Tool (MMAT), version 2018, were employed to assess study quality. The findings indicate that school-based interventions are effective when they emphasize relationship-building, empathy, and holistic involvement of all school stakeholders. Consistent program implementation, teacher training, and parental engagement play a crucial role in intervention success. However, challenges such as limited resources, inadequate teacher training, and cultural resistance hinder program effectiveness. Additionally, the study highlights that while interventions improve students' affective empathy, cognitive empathy remains underdeveloped, suggesting the need for more targeted approaches. Practical recommendations include the integration of social-emotional learning in school curricula, teacher professional development programs, and culturally adapted interventions. Policymakers should establish sustainable anti-bullying policies with clear guidelines for intervention and support mechanisms. Future research should explore long-term intervention impacts, digital-based anti-bullying strategies, and the role of genetic and cultural factors in bullying behavior. This study enriches the existing literature by emphasizing the importance of localized, evidence-based intervention strategies tailored to different educational and cultural contexts.

Enfortumab Vedotin With or Without Pembrolizumab in Metastatic Urothelial Carcinoma

Metastatic urothelial carcinoma (mUC) presents a therapeutic challenge with poor outcome. Enfortumab vedotin has emerged as a promising treatment, necessitating a comprehensive evaluation of its effectiveness and safety. To synthesize the available evidence on enfortumab vedotin, both as monotherapy and in combination with pembrolizumab, as an mUC treatment for the purpose of guiding clinical decision-making and future research. Cochrane Library, MEDLINE (via PubMed), Google Scholar, and Web of Science were searched from database inception to August 31, 2024. Major conference abstracts from 2019 to 2024 were also included. Search strategy used a combination of Medical Subject Heading terms and free-text keywords related to mUC and enfortumab vedotin. Randomized clinical trials and prospective studies investigating enfortumab vedotin in adult patients with mUC were included. Eleven studies met the inclusion criteria. Two independent reviewers extracted data and assessed study quality using the Cochrane Risk of Bias tool 2 and Risk of Bias in Non-Randomized Studies of Interventions tool. The meta-analysis used a random effects model, while a network meta-analysis was performed using a frequentist approach. Primary outcomes were disease control rate (DCR), objective response rate (ORR), and 1-year survival rate. The 11 included studies (3 randomized clinical trials [27.3%] and 8 nonrandomized prospective studies [72.7%]) involved 2128 patients. Of these patients, 563 (26.5%) received enfortumab vedotin plus pembrolizumab, 814 (38.3%) received enfortumab vedotin without pembrolizumab, and 751 (35.3%) received chemotherapy. Enfortumab vedotin plus pembrolizumab was associated with a pooled DCR of 86% (95% CI, 83%-89%), ORR of 68% (95% CI, 64%-71%), and a 1-year survival rate of 79% (95% CI, 75%-82%). Enfortumab vedotin monotherapy had a pooled DCR of 73% (95% CI, 70%-76%), ORR of 43% (95% CI, 40%-47%), and a 1-year survival rate of 52% (95% CI, 48%-56%). Network meta-analysis revealed that enfortumab vedotin plus pembrolizumab significantly outperformed chemotherapy in ORR (odds ratio [OR], 3.47; 95% CI, 1.49-8.09; P = .004) and 1-year survival (OR, 2.32; 95% CI, 1.75-3.06; P < .001). In this systematic review and meta-analysis, enfortumab vedotin plus pembrolizumab showed high response rates in first-line settings, while enfortumab vedotin monotherapy was associated with clinical benefit in later lines of therapy. These findings underscore the importance of personalized treatment approaches, and future research is warranted to refine enfortumab vedotin-based therapies for mUC management.

Frailty and the Survival of Patients With Endometrial Cancer: A Meta‐Analysis

ABSTRACTThe aim of this study is to investigate the association between frailty and overall survival (OS) and progression‐free survival (PFS) in women with endometrial cancer (EC). Frailty is increasingly recognized as a significant predictor of outcomes in cancer patients, yet its impact on survival among EC patients remains unclear. This study is a systematic review and meta‐analysis. PubMed, Embase, and Web of Science from database inception to September 28, 2024 were searched for cohort studies evaluating frailty in relation to survival in EC patients. Inclusion criteria focused on studies reporting hazard ratios (HRs) for OS or PFS, comparing frail versus nonfrail patients. A random‐effects model was applied. Eight cohort studies involving 486,138 women reported the outcome of OS, and 4 of them involving 378 women also reported the outcome of PFS. Frailty was associated with poor OS (HR: 1.78, 95% confidence interval [CI]: 1.56–2.03, p &lt; 0.001) without significant heterogeneity (I2 = 0%). Sensitivity analyses confirmed the stability of this association. Subgroup analyses according to the mean age of the patients, tools for evaluating frailty, follow‐up duration, and study quality score showed consistent results (p for subgroup difference: 0.35–0.98). Four studies indicated a significant association between frailty and worse PFS (HR: 1.91, 95% CI: 1.24–2.95, p = 0.003), also with no heterogeneity (I2 = 0%). The results of the study conclude that frailty is associated with poor survival in EC. Although these findings should be validated in large prospective cohort studies, this meta‐analysis highlights the possible role of frailty assessment in risk stratification and prognostic prediction of patients with EC. No patient or public contribution.

Training and assessment of skills in flexible optical intubation - Protocol of a scoping review.

Flexible optical intubation (FOI) is the preferred technique for managing anticipated difficult airways, particularly in awake patients when anatomical factors complicate conventional laryngoscopy. Mastering the procedure requires skills, but a comprehensive overview of the evidence on training and assessment of FOI skills is lacking. There is no evidence-based consensus on educational strategies and recommendations for skill acquisition and retention, thus highlighting a significant gap in airway management training. Accordingly, we aim to assess the current evidence on training and assessment in FOI for future educational recommendations. This scoping review adheres to the Preferred Reporting Items for Systematic and Meta-Analysis (PRISMA) statement and the PRISMA Extension for Scoping Reviews guideline. Eligible studies include qualitative and quantitative research focusing on education, technical training, and assessment of FOI skills in clinical personnel with no obligate comparator. Outcomes should be assessable using Kirkpatrick's four levels of training evaluation. A systematic literature search will be conducted across multiple databases, including Cochrane Library, EMBASE, Cinahl, Scopus, and PubMed. Two independent authors will screen the studies, with discrepancies resolved by a third reviewer. Extracted data will be analyzed descriptively, with a discussion on potential biases in the included literature. The quality of the studies will be assessed using the Medical Education Research Study Quality Instrument (MERSQI). The results of this scoping review may serve as a foundation for educational recommendations. By synthesizing available evidence, this review aims to guide future research and policy recommendations for FOI skill acquisition and maintenance.

Effective probiotic regimens for bacterial vaginosis treatment and recurrence prevention: A systematic review

Probiotics represent a promising alternative therapy for bacterial vaginosis; however, consensus on the most effective species, strains, and doses remains lacking, and long-term safety data are limited. The aim of this study was to evaluate the effectiveness of probiotics in managing bacterial vaginosis, considering species, strain, clinical outcomes, optimal dosage, duration, and side effects. This study included randomized-controlled trials (RCTs) published in English (2014–2024) on probiotic treatment for bacterial vaginosis, assessing species, strain, dose, duration, and efficacy. A systematic search was conducted on December 20, 2024, in Scopus, Web of Science, and PubMed using the keywords "vaginosis," "bacterial vaginosis," and "probiotic." Data were extracted and synthesized, and study quality was assessed using the Risk of Bias 2 tool, while NVivo 14 software facilitated thematic analysis. The systematic search yielded 1,560 initial records, of which 16 RCTs were included. The findings revealed that Lactobacillus rhamnosus TOM 22.8 (10×10⁹ CFU/day for 10 days) was the most effective strain and dose, significantly improving Nugent scores, vaginal pH, and microbiota composition and reducing bacterial vaginosis recurrence rate. Alternative strains, including L. crispatus, L. plantarum, and L. acidophilus, showed therapeutic potential at doses of 1×10⁸ to 5.4×10⁹ CFU/day for treatment durations ranging from 6 days to 4 months. The reported side effects were mild and self-limiting. This study supports the use of probiotics as an adjunctive or alternative bacterial vaginosis treatment, emphasizing the need for a personalized approach based on patient characteristics. However, limitations such as small sample sizes and heterogeneous outcome measures necessitate further research. Larger, well-designed trials with standardized methodologies are required to refine probiotic recommendations.

FGF-23 as a Biomarker for Carotid Plaque Vulnerability: A Systematic Review

Background/Objectives: Carotid artery disease is a condition affecting 3% of the general population which significantly contributes to the development of cerebrovascular events. Fibroblast Growth Factor-23 (FGF-23) is a hormone that has been linked to atherosclerosis and increased cardiovascular risk, including stroke and myocardial infarction. This review explores the association of FGF-23 with carotid artery disease progression in an endarterectomy clinical context. Methods: Based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a search was performed relying on MEDLINE, Scopus and Web of Science, identifying publications focused on the correlation between serum FGF-23 and carotid artery disease. Assessment of study quality was made using National Heart, Lung and Blood Institute Study Quality Assessment Tool (NHLBI). Results: Three observational studies, comprising 1039 participants, were included. There was considerable heterogeneity among the populations from the different studies. Elevated FGF-23 levels were consistently associated with unstable plaque features, including intraplaque neovascularization, as identified through Superb Microvascular Imaging (SMI). Plasma levels of inflammatory mediators, such as Interleukin-6 (Il-6), Monocyte Chemoattractant Protein-1 (MCP-1), and Osteoprotegerin (OPG), positively correlated with carotid artery disease, but their link to unstable plaques is conflicting. None of the studies investigated clinical complications following carotid endarterectomy. Conclusions: FGF-23 is a potential biomarker for plaque vulnerability in carotid disease. Despite promising findings, limitations such as small sample sizes and lack of longitudinal data suggest the need for larger and more diverse studies to improve risk stratification and inform personalized treatment strategies for carotid atherosclerosis.

Association of clonal haematopoiesis with heart failure incidence and outcomes: A systematic review and meta‐analysis

AbstractAimsClonal haematopoiesis (CH) is recognized as a significant risk factor for various non‐haematologic conditions, including cardiovascular diseases. However, recent studies examining its relationship with heart failure (HF) have reported conflicting findings. To address these inconsistencies, the present meta‐analysis aimed to evaluate the association of CH with the incidence and clinical outcomes of HF.Methods and resultsMEDLINE, Cochrane Library and Scopus were searched until 12 December 2024. Triple‐independent study selection, data extraction and quality assessment were performed. Evidence was pooled using three‐level mixed‐effects meta‐analyses. Participants (n = 57 755) with CH had significantly greater risk of new‐onset HF compared to the non‐CH group (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.12–1.35, p &lt; 0.0001; I2 = 0%), irrespective of a prior history of coronary artery disease. CH was also correlated with a higher risk of the composite outcome of all‐cause mortality and hospitalization for HF (HHF) compared to the non‐CH group in patients with established HF (HR 1.84, 95% CI 1.25–2.70, p = 0.002; I2 = 0%). Specifically, CH was associated with a 95% higher risk of all‐cause mortality (HR 1.95, 95% CI 1.54–2.47, p &lt; 0.0001; I2 = 0%), with a 3% increase in risk for every 1% increase in variant allele fraction. Participants with concomitant HF and CH had a 56% higher risk of HHF compared to non‐CH HF patients (HR 1.56, 95% CI 1.05–2.33, p = 0.029; I2 = 19%).ConclusionClonal haematopoiesis is associated with an increased risk of incident HF and worse prognosis in individuals affected by HF. These findings highlight the potential of CH to contribute to a deeper understanding of HF, improve risk stratification, and support more personalized approaches to its management.

Global approaches to older abuse research in institutional care settings: A systematic review.

Over the last two decades, abuse of older adults in institutional settings has been underestimated due to challenges in defining and responding to the issue. This systematic review aims to analyze empirical studies on measuring abuse of older people residing in a long-term care facility, specifically staff-to-resident abuse. Following PRISMA guidelines, we searched 10 databases from January 2005 till June 2024. Inclusion criteria encompassed World Health Organization-defined abuse types (physical, psychological, financial, sexual and neglect, intentional or unintentional), reported by staff, residents, family, or public registries, with methodological critical assessment. In the last 18 years, 22 studies from eight counties examined of staff-to-resident abuse, with significant heterogeneity in definitions, reporting sources, and measurement tools. Quality of studies varied, lacking consistency. Relatives and staff typically report highest abuse rates, while residents report fewer incidents, even with fewer incidents of observed abuse. Registries tend to capture extreme cases, resulting in lower reported prevalence rates, particularly of physical or sexual abuse and neglect. Physical abuse was the most reported, with 81 different descriptors identified and varying recall periods. Staff witnessing abuse ranged from 44% over four weeks to as low as 1.4% over 12 months, posing challenges for data interpretation. These variations in study methodologies impacted the ability to synthesise the findings making it difficult to estimate a global prevalence rate of aged care abuse. From the analysis, we develop an Aged Care Abuse Research Checklist (ACARC) as a first step towards achieving a global standardized, evidence-based methodology for this field. Doing so will normalize processes within organizations and the community, allowing early interventions to change practices, reduce the risk of recurrence and improve resident quality of care and workplace cultures. PROSPERO CRD42018055484.

Translating Evidence into Practice: The Importance of Systematic Reviews in Homeopathic Research

In recent years, the integration of evidence-based practice within the field of homeopathy has become increasingly crucial. Despite the ongoing debate surrounding the efficacy of homeopathic treatments, there remains a significant body of literature that merits systematic review to inform clinical practice. This letter aims to underscore the importance of systematic reviews in homeopathic research and their role in translating evidence into practical application for practitioners and patients alike. Systematic reviews are pivotal in summarizing and critically evaluating existing research, providing a robust foundation for clinical decision-making. They employ rigorous methodologies to assess the quality and outcomes of numerous studies, enabling practitioners to identify effective interventions and understand the scope of available evidence. In homeopathy, where anecdotal evidence often prevails, systematic reviews can serve as a counterbalance, shedding light on the therapeutic potential of homeopathic treatments while maintaining scientific integrity.