Summary Of Meta-analyses Research Articles

Physical Activity in Pregnancy: The Role of Exercise in Promoting Maternal and Fetal Health

Introduction and Objective: There is no doubt that engaging in regular physical activity is beneficial for individuals of all ages. Pregnancy is a special time of life for most women. This period presents a unique opportunity for them to improve their lifestyle choices and adopt healthier habits such as exercise. The aim of this article is to find out if regular physical activity during pregnancy has a positive impact for both the mother and the baby.Review and Methods: Review and summary of available studies and meta-analyses found in open-access formats on Google Scholar and PubMed.State of Knowledge: The WHO defines physical activity as any bodily movement requiring energy expenditure, including during leisure, transport, work, and domestic activities. Regular exercise reduces the risk of noncommunicable diseases (NCDs) and poor health outcomes, while sedentary behavior contributes to this and burdens healthcare systems. For pregnant and postpartum women, physical movement decreases the risk of various complications, with no negative effects on birthweight or stillbirth risk. Conclusions: Studies show that physical activity decreased risk of pre-eclampsia, gestational hypertension, gestational diabetes, excessive gestational weight gain, delivery complications, postpartum depression and newborn complications.

Stress, anxiety, depression and sleep disturbance among healthcare professional during the COVID-19 pandemic: An umbrella review of 72 meta-analyses.

The outbreak of SARS-CoV-2, which causes COVID-19, has significantly impacted the psychological and physical health of a wide range of individuals, including healthcare professionals (HCPs). This umbrella review aims provide a quantitative summary of meta-analyses that have investigated the prevalence of stress, anxiety, depression, and sleep disturbance among HCPs during the COVID-19 pandemic. An umbrella review of systematic reviews and meta-analyses reviews was conducted. The search was performed using the EMBASE, PubMed, CINAHL, MEDLINE, PsycINFO, and Google Scholar databases from 01st January 2020 to 15th January 2024. A random-effects model was then used to estimate prevalence with a 95% confidence interval. Subgroup analysis and sensitivity analyses were then conducted to explore the heterogeneity of the sample. Seventy-two meta-analyses involved 2,308 primary studies were included after a full-text review. The umbrella review revealed that the pooled prevalence of stress, anxiety, depression, and sleep disturbance among HCPs during the COVID-19 pandemic was 37% (95% CI 32.87-41.22), 31.8% (95% CI 29.2-34.61) 29.4% (95% CI 27.13-31.84) 36.9% (95% CI 33.78-40.05) respectively. In subgroup analyses the prevalence of anxiety and depression was higher among nurses than among physicians. Evidence from this umbrella review suggested that a significant proportion of HCPs experienced stress, anxiety, depression, and sleep disturbance during the COVID-19 pandemic. This information will support authorities when implementing specific interventions that address mental health problems among HCPs during future pandemics or any other health crises. Such interventions may include the provision of mental health support services, such as counseling and peer support programs, as well as the implementation of organizational strategies to reduce workplace stressors.

Sleep and memory consolidation in healthy, neurotypical children, and adults: a summary of systematic reviews and meta-analyses.

This review systematically assesses the impact of sleep on memory and cognition in healthy individuals across different life stages. It specifically examines how sleep affects memory processes in children, adults, and older adults. The methodology involved a comprehensive literature search, starting with 46 known papers. Keywords and Mesh terms related to sleep and memory consolidation were derived using the Word Frequency Analysis tool in SR Accelerator and Mesh on Demand. A detailed search on PubMed yielded a large set of records. Classifier training on 4854 decisions, these were narrowed down to 1437 papers for full-text screening, culminating in 19 systematic reviews and meta-analyses. Sleep enhances memory consolidation, especially for complex declarative information. While the role of sleep in procedural memory consolidation in children remains less robust compared to declarative memory, findings suggest potential but inconsistent benefits. Sleep improves prospective memory consolidation and aids in complex associative memory tasks. Memory reactivation during sleep, specifically slow-wave sleep, and spindles are implicated in memory consolidation. Meta-analytic evidence suggests that while sleep benefits both emotional and neutral memory consolidation, there is no strong preferential effect of sleep on emotional memory in comparison to neutral memory. In older adults, there is a noticeable reduction in sleep-dependent memory consolidation, particularly for declarative memory, likely linked to a decline in slow-wave sleep. This suggests a decrease in the benefits of sleep for memory consolidation with aging. Overall, the review underscores the importance of sleep in memory processes across all ages, highlighting variations in its impact on different types of memory and across age groups. It points to future research directions for enhancing understanding and practical applications in clinical and educational settings.

Insomnia symptoms as risk factor for somatic disorders: An umbrella review of systematic reviews and meta-analyses.

The objective of this umbrella review is to present a comprehensive summary of systematic reviews and meta-analyses on the longitudinal association between insomnia and the risk of developing somatic disorders. Pubmed, Medline, CINAHL, PsycInfo and PsycArticles were searched until 16 December 2022. Fourteen systematic reviews and meta-analyses met the inclusion criteria. Results suggest that insomnia symptoms (i.e. aspects of disturbed sleep continuity as a single symptom) convey a risk factor for cardiovascular diseases, hypertension and thyroid cancer. The presence of insomnia symptoms may also enhance the risk for obesity, cognitive decline and dementia-however, results are contradictory and not conclusive here. Results do not suggest an association between insomnia symptoms and mortality. No conclusions can be drawn regarding insomnia disorder because the reviews did not ensure a valid diagnosis. It remains unclear what proportion of participants with insomnia symptoms fulfil diagnostic criteria for insomnia disorder and/or suffer from an organic sleep disorder such as sleep-related breathing disorder. Moreover, most of the included reviews were assessed to have critically low confidence according to the AMSTAR-2 tool. Inconsistent definitions of insomnia and methodological unclarities further underline that results should be interpreted with caution. There is a need for future longitudinal studies that focus on a careful definition and differential diagnosis of both insomnia and the outcome.

Effect of COVID-19 on Pregnancy and Neonate's Vital Parameters: A Systematic Review.

COVID-19 is a new pandemic, which was declared by the World Health Organization in 2019 as a threat to public health. According to numerous reports, it can have negative consequences for pregnant women, labour, and neonates born to infected mothers. The aim of this paper was to gather the evidence and to present a summary of the results of studies concerning COVID-19 in pregnant women and their neonates. Articles from prestigious journals covering the period from 2020 to February 2023, relevant review papers, and original research articles from PubMed were analysed. In order to analyse the available research literature, the Web of Science, Scopus, and PubMed databases were used, in which the search for articles was conducted using terms ("pregnancy," "coronavirus," "SARS-CoV-2," and "newborn") and using PRISMA (Preferred Reporting Items for Systemic Reviews and Meta-Analysis) guidelines for clinical trials. Meta-analyses and systematic reviews (2022-2023) on symptoms, neonatal course, and risk of COVID-19 infection have been summarized. Summary of meta-analyses and systematic reviews (2022-2023) on the effect and adverse reaction of the COVID-19 vaccination is presented. As a result of the research conducted, it was confirmed that in most pregnant women, no serious signs of the infection were observed, although isolated cases of death related to COVID-19 in pregnant women were reported. Several authors called attention to the more severe course of the infection in pregnant women with obesity. It seemed that no vertical transmission from mother to child was occurring. Nevertheless, the information was not clinching. The condition of the neonates born to mothers with COVID-19 was in most cases described as normal; however, some papers reported deaths of infected neonates. Due to insufficient data, further research is necessary. Further studies and follow-up are recommended, which would make possible an assessment of remote effects of COVID-19 on pregnancy and vital parameters of the newborn.

Psychosis as a potential mental health consequence of racism

Introduction Evidence shows that racism can have a negative effect on mental health in the lived experiences of Black people and People of Colour. In critical theory discourse including postcolonial and decolonial approaches, racism is suggested to be an everyday phenomenon. Additionally, racism specifically targets the perceived cultural and phenotypic foreignness of Black migrants and migrants Of Colour, as well as the ascribed migrant status attributed to the perceived foreignness of racialized persons who do not actually have any direct migration experiences. Objectives The stigma associated with severe mental disorders such as psychosis has historically been applied to Black people and People of Colour who have been engaged in anti-racist activism as a form of punishment and social control. Higher incidence rates of psychosis in racialized communities have frequently been conceptualized as cultural differences in family composition and levels of expressed emotion in families. The objective of this study is to sensitively investigate psychosis as a potential mental health consequence of racism. Methods The incidence rates of psychosis - positive symptoms, negative symptoms, non-affective psychosis disorders and first episode psychosis - among migrants by country of migration were compiled in an umbrella review, which offers a summary of meta-analyses. Quantitative research has the limitation of enabling the observation of patterns but not allowing an understanding of the reasons behind them to be theorized through the data. Therefore, qualitative methods complement the quantitative data. Twenty people of diverse genders who self-identified as Black people or People of Colour in Berlin were interviewed about their experiences of racism and sexism and about how those experiences affected their mental health. Results The umbrella review found an association between migration and psychosis, with migration from the Caribbean and African countries showing the strongest correlation. A constant comparative analysis of the qualitative data suggests that racism contributes to the emergence of a subclinical psychosis symptomatology profile that consists of a sense of differentness, negative self-awareness, paranoid ideation regarding general persecution, and self-questioning with self-esteem instability. Conclusions The findings are interpreted as a situational diagnosis, as coined by the psychiatrist and political philosopher Frantz Fanon in the seminal book ‘Black Skin, White Masks’ (1975). The findings are also contextualized within a critique of institutional racism, both historically and currently, and within an intersectional discussion of the need for structural competency and the provision of safety for racialized groups in clinical settings. Disclosure of Interest None Declared

Association of Patients' Epidemiological Characteristics and Comorbidities with Severity and Related Mortality Risk of SARS-CoV-2 Infection: Results of an Umbrella Systematic Review and Meta-Analysis.

The objective of this study was to assess the association between patients’ epidemiological characteristics and comorbidities with SARS-CoV-2 infection severity and related mortality risk. An umbrella systematic review, including a meta-analysis examining the association between patients’ underlying conditions and severity (defined as need for hospitalization) and mortality of COVID-19, was performed. Studies were included if they reported pooled risk estimates of at least three underlying determinants for hospitalization, critical disease (ICU admission, mechanical ventilation), and hospital mortality in patients diagnosed with SARS-CoV-2 infection. Evidence was summarized as pooled odds ratios (pOR) for disease outcomes with 95% confidence intervals (95% CI). Sixteen systematic reviews investigating the possible associations of comorbidities with severity or death from COVID-19 disease were included. Hospitalization was associated with age > 60 years (pOR 3.50; 95% CI 2.97–4.36), smoking habit (pOR 3.50; 95% CI 2.97–4.36), and chronic pulmonary disease (pOR 2.94; 95% CI 2.14–4.04). Chronic pulmonary disease (pOR 2.82; 95% CI 1.92–4.14), cerebrovascular disease (pOR 2.74; 95% CI 1.59–4.74), and cardiovascular disease (pOR 2.44; 95% CI 1.97–3.01) were likely to be associated with increased risk of critical COVID-19. The highest risk of mortality was associated with cardiovascular disease (pOR 3.59; 95% CI 2.83–4.56), cerebrovascular disease (pOR 3.11; 95% CI 2.35–4.11), and chronic renal disease (pOR 3.02; 95% CI 2.61–3.49). In conclusion, this umbrella systematic review provides a comprehensive summary of meta-analyses examining the impact of patients’ characteristics on COVID-19 outcomes. Elderly patients and those cardiovascular, cerebrovascular, and chronic renal disease should be prioritized for pre-exposure and post-exposure prophylaxis and early treatment.

Scoping review of recent evidence on the management of pediatric urolithiasis: summary of meta-analyses, systematic reviews and relevant randomized controlled trials.

This scoping review aimed to evaluate and summarize the recent 10year pediatric urolithiasis literature with a particular focus on systematic reviews, randomized-controlled trials (RCT) and meta-analysis. The systematic literature search performed on September 1, 2021, restricted to the recent 10years, focused on pediatric urolithiasis that are RCTs, meta-analysis and systematic reviews. The summarized literature included etiology, diagnostics, medical and surgical management. GRADE criteria are used to evaluate and standardize the reporting of evidence quality. A total of 33 relevant articles were included. The recent high-level studies included topics of genetic and diet association with pediatric stone formation, diagnostic assessment, medical management intervention including medical dissolution and expulsion therapy. The study extended to include the efficacy and safety of extracorporeal lithotripsy, percutaneous nephrolithotomy and retrograde intrarenal surgery. However, evidence quality was ranked "very-low" or "low". Based on the GRADE criteria downgrading of the quality level was due to heterogeneity and low precision. A majority of the RCTs were categorized as having a "high" to "uncertain" risk of bias. The relevant RCTs, meta-analyses and systematic reviews within the past decade are of low quality. Consequently, the research provided no clear evidence-based recommendations for managing pediatric urolithiasis. More rigorous research and high-quality studies are needed to determine the best practices.

Adverse childhood experiences and physical diseases in adulthood: A summary of meta-analyses.

Adverse childhood experiences and physical diseases in adulthood: A summary of meta-analyses.

Summary of Meta-analyses of Studies Considering Lesion Size Cut-off Thresholds for The Assessment of Eligibility for FNAB and Sonoelastography and Inter- and Intra-observer Agreement in Estimating the Malignant Potential of Focal Lesions of The Thyroid Gland.

Thyroid cancer is a tumour with a steadily increasing incidence. It accounts for 7% to 15% of focal lesions detected by ultrasound, depending on age, gender and other factors affecting its occurrence. Fine-needle aspiration biopsy is an essential method to establish the diagnosis but, in view of its limitations, sonoelastography is seen as a non-invasive technique useful in differentiating the nature of lesions and monitoring them after fine-needle aspiration biopsy. This paper presents a literature review on the role of both sonoelastographic techniques (relative strain sonoelastography, shear wave sonoelastography) to assess the deformability of focal thyroid lesions. Ultrasound examination is a relatively subjective method of thyroid imaging, depending on the skills of the examiner, the experience of the centre, and the quality of equipment used. As a consequence, there are inconsistencies between the results obtained by different examiners (inter-observer variability) and by the same examiner (intra-observer variability). In this paper, the authors present a review of the literature on inter-observer and intra-observer variability in the assessment of individual features of ultrasound imaging of focal lesions in the thyroid. In addition, the authors report on an analysis of cut-off thresholds for the size of lesions constituting the basis for fine-needle aspiration biopsy eligibility assessment. The need to diagnose carcinomas up to 10 mm in diameter is highlighted, however a more liberal approach is recommended in terms of indications for biopsy in lesions associated with a low risk of malignancy, where, based on consultations with patients, active ultrasound surveillance might even be considered.

Summary of Meta-analyses of Studies Involving TIRADS Classifications (EU-TIRADS, ACR-TIRADS, and K-TIRADS) in Evaluating the Malignant Potential of Focal Lesions of The Thyroid Gland.

Numerous scientific societies around the world have published their TIRADS (Thyroid Imaging Reporting and Data System) classifications that evaluate the risk of malignancy of focal thyroid lesions, presenting different ultrasound features for each category and lesion size thresholds to determine eligibility for biopsy. The use of such risk estimation systems in focal thyroid lesions facilitates the reporting of thyroid ultrasound findings and improves the qualification of focal lesions for fine-needle aspiration biopsy (FNAB). In this publication, the three most popular TIRADS classifications, European – EU-TIRADS, Korean – K-TIRADS, and developed by the American Society of Radiology – ACR-TIRADS, are presented and discussed based on a literature review. The results of available head-to-head statistical analyses comparing the classifications are also presented. The advantage of the EU-TIRADS and K-TIRADS systems is that they include only the most important ultrasound features, so their application is not time-consuming, and the scores are easy to incorporate into clinical practice. ACR-TIRADS, unlike other scales, is based on a unique classification system and represents the most comprehensive classification. Each of the five categories of ultrasound features – morphology, echogenicity, shape, margins, microcalcifications – are evaluated and assigned a score from 0 to 3, with a higher score being associated with a higher risk of cancer. Based on the available data, the greatest benefit has been demonstrated for the ACR-TIRADS classification, which also has implications for minimising the number of unnecessary FNABs. However, limitations related to the heterogeneity of the groups analysed in the study, including differences in the populations studied, inclusion criteria, proportions of patients of either sexes, and the number of malignant lesions analysed, should also be taken into account.

Extrapulmonary clinical manifestations of COVID-19: an umbrella review of meta-analysis

Since its emergence, the coronavirus disease 2019 (COVID-19), compared to other coronavirus diseases throughout history, has generated large waves of infection with symptoms such as fever, chills, cough, fatigue, headache, and sore throat appeared. Despite many efforts and gains through meta-analyses of the symptoms of COVID-19 thus far, there has been a need of summarized concise information for clinicians. This review presents a summary of recent meta-analyses by categorizing the various extra-pulmonary clinical symptoms of COVID-19 according to organ systems. The article focuses on six groups: generalized symptoms such as fever (prevalence rate, 71% to 91%), fatigue (prevalence rate, 32% to 58%), and myalgia (20% to 33%), neurologic symptoms (headache [8% to 44%], dizziness [7% to 10%], confusion [5% to 11%], and impaired consciousness [2% to 7%]), psychiatric symptoms (anxiety or agitation [15% to 45%], post-traumatic stress disorder [20% to 41%], sleep disorder [35% to 82%], and depression [21% to 42%]), cardiovascular symptoms (chest pain [8% to 13%], palpitation [9.3%], arrhythmia [1.9%], arrhythmias [18.4%], angina [10.2%], myocardial injury [10.3%], myocardial infarction [3.5%], and acute heart failure [2.0%]), gastrointestinal symptoms (anorexia [20.0% to 27%], nausea or vomiting [5% to 10%], diarrhea [7% to 17%], and abdominal pain [4% to 9%]), and olfactory, gustatory/oral, and ocular symptoms (ocular symptoms [11.2%], olfactory dysfunction [38% to 53%], and gustatory dysfunction [7% to 37%]). The aim of this study is to provide clinicians concise information of the various extra-pulmonary clinical symptoms of COVID-19 and promote the understanding of administrators who set appropriate quarantine policies.

A Systematic Review of Systematic Reviews on the Epidemiology, Evaluation, and Treatment of Plantar Fasciitis.

The number of systematic review and meta-analyses on plantar fasciitis is expanding. The purpose of this review was to provide a comprehensive summary of reviews on the topic pertaining to plantar fasciitis, identify any conflicting and inconsistent results, and propose future research direction. A qualitative review of all systematic reviews and meta-analyses related to plantar fasciitis up to February 2021 was performed using PubMed, Embase, Web of Science, and the Cochrane Database. A total of 1052 articles were initially identified and 96 met the inclusion criteria. Included articles were summarized and divided into the following topics: epidemiology, diagnosis, and treatment. While the majority of reviews had high level of heterogeneity and included a small number of studies, there was general consensus on certain topics, such as BMI as a risk factor for plantar fasciitis and extracorporeal shockwave therapy as an effective mode of therapy. A qualitative summary of systematic reviews and meta-analyses published on plantar fasciitis provides a single source of updated information for clinicians. Evidence on topics such as the epidemiology, exercise therapy, or cost-effectiveness of treatment options for plantar fasciitis are lacking and warrant future research.

Giorgio Treglia, Luca Giovanella (Eds): Evidence-Based Positron Emission Tomography: Summary of Recent Meta-Analyses on PET

Interuniversity Research Center for Sustainability (CIRPS), Naples, Italy Luigi Mansi You can also search for this author in PubMed Google Scholar Correspondence to Luigi Mansi. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Reprints and Permissions Mansi, L. Giorgio Treglia, Luca Giovanella (Eds): Evidence-Based Positron Emission Tomography: Summary of Recent Meta-Analyses on PET. Eur J Nucl Med Mol Imaging (2020). https://doi.org/10.1007/s00259-020-05032-1 Download citation Published: 11 September 2020 DOI: https://doi.org/10.1007/s00259-020-05032-1

An Up-to-Date Review of the Meniscus Literature: A Systematic Summary of Systematic Reviews and Meta-analyses.

Background:A large number of systematic reviews and meta-analyses regarding the meniscus have been published.Purpose:To provide a qualitative summary of the published systematic reviews and meta-analyses regarding the meniscus.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic search of all meta-analyses and systematic reviews regarding the meniscus and published between July 2009 and July 2019 was performed with PubMed, CINAHL, EMBASE, and the Cochrane database. Published abstracts, narrative reviews, articles not written in English, commentaries, study protocols, and topics that were not focused on the meniscus were excluded. The most pertinent results were extracted and summarized from each study.Results:A total of 332 articles were found, of which 142 were included. Included articles were summarized and divided into 16 topics: epidemiology, diagnosis, histology, biomechanics, comorbid pathology, animal models, arthroscopic partial meniscectomy (APM), meniscal repair, meniscal root repairs, meniscal allograft transplantation (MAT), meniscal implants and scaffolds, mesenchymal stem cells and growth factors, postoperative rehabilitation, postoperative imaging assessment, patient-reported outcome measures, and cost-effectiveness. The majority of articles focused on APM (20%), MAT (18%), and meniscal repair (17%).Conclusion:This summary of systematic reviews and meta-analyses delivers surgeons a single source of the current evidence regarding the meniscus.

Meta-analysis of authentic assessment instrument development to measure learning outcomes of learners SMA/MA

This Meta-analysis aims to summarize the research results related to the development of authentic assessment instruments in measuring the learning outcomes that have been done before. Based on the analysis from the background of several journals that have been selected, the biggest problem lies in the less active learning process from the communication to the assumption of the learners on the learning of physics that only study Count with definite results without knowing the usefulness of science in technology development. In addition, the teacher’s difficulties in creating, executing, and analyzing authentic assessments led to the teacher being more likely to assess cognitive aspect assessment and override other aspects of judgment. Based on the problem, one of them is to develop an authentic assessment instrument that able to measure learning outcomes according to the needs of learners. Summary of meta-analyses using a descriptive survey method. Based on the analysis done, the assessment aspect of attitudes and skills is more dominant than the cognitive assessment aspect. In addition, analysis results show that not all researchers have tested the level of reliability, effectiveness, practicality, assessment implementation, and student response. It depends on the development method used. Based on all the final results of the journal, the instrument is developed in criteria worthy of use in the school in measuring the outcome of SMA/MA physics.

Intra-articular platelet-rich plasma injection for knee osteoarthritis: a summary of meta-analyses

ObjectiveThe purpose of this study was (1) to perform a summary of meta-analyses comparing platelet-rich plasma (PRP) injection with hyaluronic acid (HA) and placebo injection for KOA patients, (2) to determine which meta-analysis provides the best available evidence to making proposals for the use of PRP in the treatment of KOA patients, and (3) to highlight gaps in the literature that require future investigation.Material and methodsPubMed, EMBASE, and Cochrane databases search were performed for meta-analyses which compared PRP injection with HA or placebo. Clinical outcomes and adverse events were extracted from these meta-analyses. Meta-analysis quality was assessed using the Quality of Reporting of Meta-analyses (QUOROM) systems and the Oxman-Guyatt quality appraisal tool. The Jadad decision algorithm was also used to determine which meta-analysis provided the best available evidence.ResultsFour meta-analyses were included in our study, and all of these articles were Level I evidence. The QUOROM score of each included meta-analysis range from 14 to 17 points (mean score 15, maximum score 18), and the Oxman-Guyatt score range from 4 to 6 points (mean score 5, maximum score 7). Three meta-analyses indicated PRP showed more benefit in pain relief and functional improvement than the control group, and the other one suggested no difference between these groups. All included meta-analyses found no statistical difference in adverse events between these groups. In addition, a meta-analysis conducted by Shen et al. got the highest methodological quality score and suggested that PRP provided better pain relief and function improvement in the treatment of KOA.ConclusionsFor short-term follow-up (≤1 year), intra-articular PRP injection is more effective in terms of pain relief and function improvement in the treatment of KOA patients than HA and placebo, and there is no difference in the risk of an adverse event between PRP and HA or placebo.Level of evidenceLevel I evidence, a summary of meta-analysesTrial registrationPROSPERO ID CRD42018116168

Dietary Patterns and Cardiometabolic Outcomes in Diabetes: A Summary of Systematic Reviews and Meta-Analyses.

The Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD) conducted a review of existing systematic reviews and meta-analyses to explain the relationship between different dietary patterns and patient-important cardiometabolic outcomes. To update the clinical practice guidelines for nutrition therapy in the prevention and management of diabetes, we summarize the evidence from these evidence syntheses for the Mediterranean, Dietary Approaches to Stop Hypertension (DASH), Portfolio, Nordic, liquid meal replacement, and vegetarian dietary patterns. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence. We summarized the evidence for disease incidence outcomes and risk factor outcomes using risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs), respectively. The Mediterranean diet showed a cardiovascular disease (CVD) incidence (RR: 0.62; 95%CI, 0.50, 0.78), and non-significant CVD mortality (RR: 0.67; 95%CI, 0.45, 1.00) benefit. The DASH dietary pattern improved cardiometabolic risk factors (P < 0.05) and was associated with the decreased incidence of CVD (RR, 0.80; 95%CI, 0.76, 0.85). Vegetarian dietary patterns were associated with improved cardiometabolic risk factors (P < 0.05) and the reduced incidence (0.72; 95%CI: 0.61, 0.85) and mortality (RR, 0.78; 95%CI, 0.69, 0.88) of coronary heart disease. The Portfolio dietary pattern improved cardiometabolic risk factors and reduced estimated 10-year coronary heart disease (CHD) risk by 13% (−1.34% (95%CI, −2.19 to −0.49)). The Nordic dietary pattern was correlated with decreased CVD (0.93 (95%CI, 0.88, 0.99)) and stroke incidence (0.87 (95%CI, 0.77, 0.97)) and, along with liquid meal replacements, improved cardiometabolic risk factors (P < 0.05). The evidence was assessed as low to moderate certainty for most dietary patterns and outcome pairs. Current evidence suggests that the Mediterranean, DASH, Portfolio, Nordic, liquid meal replacement and vegetarian dietary patterns have cardiometabolic advantages in populations inclusive of diabetes.

The Effect of Electrolytes on Blood Pressure: A Brief Summary of Meta-Analyses.

Nutrition is known to exert an undeniable impact on blood pressure with especially salt (sodium chloride), but also potassium, playing a prominent role. The aim of this review was to summarize meta-analyses studying the effect of different electrolytes on blood pressure or risk for hypertension, respectively. Overall, 32 meta-analyses evaluating the effect of sodium, potassium, calcium and magnesium on human blood pressure or hypertension risk were included after literature search. Most of the meta-analyses showed beneficial blood pressure lowering effects with the extent of systolic blood pressure reduction ranging between −0.7 (95% confidence interval: −2.6 to 1.2) to −8.9 (−14.1 to −3.7) mmHg for sodium/salt reduction, −3.5 (−5.2 to −1.8) to −9.5 (−10.8 to −8.1) mmHg for potassium, and −0.2 (−0.4 to −0.03) to −18.7 (−22.5 to −15.0) mmHg for magnesium. The range for diastolic blood pressure reduction was 0.03 (−0.4 to 0.4) to −5.9 (−9.7 to −2.1) mmHg for sodium/salt reduction, −2 (−3.1 to −0.9) to −6.4 (−7.3 to −5.6) mmHg for potassium, and −0.3 (−0.5 to −0.03) to −10.9 (−13.1 to −8.7) mmHg for magnesium. Moreover, sufficient calcium intake was found to reduce the risk of gestational hypertension.

Probiotic Guidelines and Physician Practice: A Cross-Sectional Survey

Introduction: Probiotic use has dramatically increased over the last decade, though formal guidelines and robust clinical trials are lacking. Our study examined probiotic prescribing practices among providers at a tertiary medical center. Methods: An electronic survey was sent to 2331 health care providers (HCP) at a tertiary medical center with questions regarding probiotic prescribing practices. A review of the literature was performed.Table 2: Summary of guidelines, Cochrane reviews, and large meta-analyses (n>500) investigating probiotic use for specific indicationsResults: A total of 632 HCP (27%) completed the survey, of whom 582 routinely prescribed medications of any kind (Table 1). Most (61%) had recommended probiotics to their patients, including both foods and supplements. After adjustment for covariates, female HCP were more likely to prescribe probiotics than male (OR 1.5 [95% CI 1.0-2.1]). Gastroenterologists were also more likely to prescribe probiotics than other HCP (OR 3.9 [95% CI 1.5-10.1]) and more likely to give a specific strain recommendation (OR 4.2 [95% CI 1.4-12.5]). Among probiotic prescribers, 49% said they prescribed them inconsistently or only upon patient request, and 40% left probiotic choice to the patient. The most common indications for probiotics were prevention and treatment of antibiotic-associated diarrhea (AAD)(79% and 66% of prescribers, respectively), with Lactobacillus GG (LGG) being most commonly used. Probiotics, especially Lactobacillus spp., were often prescribed for “general bowel health” and at patient request (by 16% and 23% of responders, respectively). For preventing AAD, 64% left probiotic choice to the patient and 11% prescribed L. acidophilus, despite strong evidence for LGG and S. boulardii.Table 1: Characteristics of survey respondents.Among gastroenterologists (n=33), leading indications were IBS (70%, primarily probiotic mixtures and Bifidobacteria), patient request (48%), IBD (45%), and reduction of infant colic (27%, mostly L. reuteri). Among all HCP, perceived barriers to probiotic use included safety and monitoring concerns, lack of clear guidelines and evidence in certain patient populations, non-acceptance by colleagues, and unfamiliarity with current evidence. Fifty-six percent of respondents thought an EMR pop-up would change their probiotic prescribing pattern. Conclusion: Probiotic prescribing is common, particularly among gastroenterologists and female HCP, but is inconsistent, with the choice of probiotic frequently being left to the patient. For evidence-based indications, implementation of EMR pop-ups or pocket guides may be helpful to increase consistency in probiotic-prescribing.