Systematic Meta-Analyses Research Articles

Leveraging the Synergy of Digital Twins and Artificial Intelligence for Sustainable Power Grids: A Scoping Review

As outlined by the International Energy Agency, 44% of carbon emissions in 2021 were attributed to electricity and heat generation. Under this critical scenario, the power industry has adopted technologies promoting sustainability in the form of smart grids, microgrids, and renewable energy. To overcome the technical challenges associated with these emerging approaches and to preserve the stability and reliability of the power system, integrating advanced digital technologies such as Digital Twins (DTs) and Artificial Intelligence (AI) is crucial. While existing research has explored DTs and AI in power systems separately, an overarching review of their combined, synergetic application in sustainable power systems is lacking. Hence, in this work, a comprehensive scoping review is conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The main results of this review analysed the breadth and relationships among power systems, DTs, and AI dynamics and presented an evolutionary timeline with three distinct periods of maturity. The prominent utilisation of deep learning, supervised learning, reinforcement learning, and swarm intelligence techniques was identified as mainly constrained to power system operations and maintenance functions, along with the potential for more sophisticated AI techniques in computer vision, natural language processing, and smart robotics. This review also discovered sustainability-related objectives addressed by AI-powered DTs in power systems, encompassing renewable energy integration and energy efficiency, while encouraging the investigation of more direct efforts on sustainable power systems.

Social Media in Oral Health Education: A Scoping Review.

The literature on the use of social media in oral health education has grown in recent years; however, the research activity on this topic has not been comprehensibly summarised. This scoping review aimed to map the available literature on students' and faculty's use of social media in oral health education across the platforms. This review was guided by Arksey and O'Malley's scoping review framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extensions for scoping reviews (PRISMA-ScR). Seven databases were searched to include literature until October 2023. Studies were included if they were published in English and focused on using social media in oral health education. Two independent reviewers screened for article eligibility and extracted the relevant data. The review included 40 articles published between January 2008 and October 2023. Most studies used quantitative approaches, did not specify the study design, were noninterventional and reported on undergraduate dental students' use of social media. Included studies centred on patterns of use, views and actual effectiveness of social media. YouTube emerged as the most frequently used platform, followed by Podcast, Facebook and WhatsApp. The use of social media in oral health education was found to be useful based on direct and indirect outcome measures. However, robust research designs are required to further evaluate the impact of social media on oral health education.

Sparse and inconsistent reporting of pre- and post-operative radiographic angles of total knee arthroplasty using true unrestricted kinematic alignment: An umbrella review and secondary meta-analysis.

To identify, synthesise and critically appraise findings of systematic reviews and meta-analyses on pre- and post-operative radiographic angles (lateral distal femoral angle [LDFA], medial proximal tibial angle [MPTA] and hip-knee-ankle [HKA] angle) of unrestricted kinematic alignment versus mechanical alignment in total knee arthroplasty (TKA). Two authors searched MEDLINE, EMBASE and Epistemonikos for systematic reviews, with or without meta-analyses, that reported on TKA outcomes using unrestricted kinematic alignment. The methodological quality of the included systematic reviews and meta-analyses was independently assessed using A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2). The effect size with its 95% confidence interval (CI) for radiographic angles was extracted from the systematic reviews and meta-analyses. The characteristics of clinical studies included in systematic reviews were listed and tabulated. Pre- and post-operative MPTA, LDFA and HKA angles were summarised using meta-analytic random-effects models. Nineteen records were eligible for data extraction. Systematic reviews and meta-analyses included 44 clinical studies, of which 31 were on unrestricted kinematic alignment and 13 were on restricted versions of kinematic alignment. None of the included systematic reviews or meta-analyses fulfiled all seven critical AMSTAR-2 domains. Few comparative studies reported both pre- and post-operative angles (LDFA, n = 3; MPTA, n = 4; and HKA angle, n = 10). Mean pre- and post-operative LDFAs were 88.0° (range, 83-94°) and 88.0° (range, 80-96°) for the kinematic alignment group, and 88.2° (range, 83-95°) and 90.2° (range, 84-97°) for the mechanical alignment group. Mean pre- and post-operative MPTAs were 86.0° (range, 78-93°) and 87.1° (range, 78-94°) for the kinematic alignment group and 86.4° (range, 77-94°) and 89.6° (range, 84-95°) for the mechanical alignment group. Mean pre- and post-operative HKA angles were -3.3° (range, -24° to 24°) and -0.3° (range, -10° to 8°) for the kinematic alignment group and -6.9° (range, -25° to 7°) and -0.9° (range, -8° to 7°) for the mechanical alignment group. Most systematic reviews and meta-analyses that report outcomes of TKA using kinematic alignment do not distinguish between the different versions of kinematic alignment. The clinical studies included in systematic reviews are limited and inconsistent in their reporting of radiographic angles. Different alignment strategies are often grouped under the umbrella term of kinematic alignment, which contributes to conflicting reports, confusion and unresolved questions regarding the efficacy of true unrestricted kinematic alignment. Level IV.

Tranexamic acid for postpartum bleeding: a systematic review and individual patient data meta-analysis of randomised controlled trials

Tranexamic acid is a recommended treatment for women with a clinical diagnosis of postpartum haemorrhage, but whether it can prevent bleeding is unclear. We conducted a systematic review and individual patient data (IPD) meta-analysis of randomised controlled trials to assess the effects of tranexamic acid in women giving birth. In this systematic review and IPD meta-analysis, we searched the WHO International Clinical Trials Registry Platform from database inception to Aug 4, 2024 for randomised trials that assessed the effects of tranexamic acid in women giving birth. Trials were eligible if they were prospectively registered, placebo-controlled, included more than 500 women, and had a low risk of bias for random sequence generation and allocation concealment. IPD were requested from the trial investigators. The primary outcomes were the numbers of women with life-threatening bleeding and thromboembolic events. We used a one-stage model to analyse the data and explored whether the effect of tranexamic acid varied by the underlying risk of life-threatening bleeding, type of birth, presence of moderate or severe anaemia, or timing of administration (before or after a diagnosis of postpartum haemorrhage). This study is registered with PROSPERO, CRD42022345775. We analysed data on 54 404 women from five trials. We obtained IPD for 43 409 women from four trials and aggregate data on 10 995 women from one trial. All trials had a low risk of bias. Life-threatening bleeding occurred in 178 (0·65%) of 27 300 women in the tranexamic acid group versus 230 (0·85%) of 27 093 women in the placebo group (pooled odds ratio [OR] 0·77 [95% CI 0·63-0·93]; p=0·008). There was no evidence that the effect of tranexamic acid varied by the underlying risk of life-threatening bleeding, type of birth, presence of moderate or severe anaemia or timing of administration. No significant difference was identified between tranexamic acid and placebo groups with regard to thromboembolic events: 50 (0·2%) of 26 571 women in the tranexamic acid group had fatal or non-fatal thromboembolic events versus 52 (0·2%) of 26 373 women in the placebo group (pooled OR 0·96 [0·65-1·41]; p=0·82) with no significant heterogeneity identified in the subgroup analyses. Tranexamic acid reduces the risk of life-threatening postpartum bleeding. We found no evidence that tranexamic acid increases the risk of thrombosis. Although we do not recommend the use of tranexamic acid in all women giving birth, consideration should be given to its use before a diagnosis of postpartum haemorrhage in women at high risk of death. The Bill & Melinda Gates Foundation.

Comparative efficacy of non-pharmacological interventions on xerostomia and salivary flow rate among hemodialysis patients: a systematic review and network meta-analysis

Abstract Background Xerostomia is a distressing symptom experienced by patients undergoing dialysis. We sought to compare and rank the efficacy of different non-pharmacological interventions on xerostomia and salivary flow rate among dialysis patients. Methods A systematic search was conducted in six English databases: Pubmed, CINAHL, Scopus, Web of Science, Embase, and Cochrane trials, in April 2023. Screening, quality appraisal, and data extraction were undertaken by two independent reviewers. A network meta-analysis was performed to assess the relative efficacy of different non-pharmacological interventions. Results The analysis included 11 randomized controlled trials involving 739 patients and eight non-pharmacological interventions. The pairwise analysis indicated that in comparison with the control group, sugarless candy, chewing sugarless gum, acupressure auricular, and licorice mouthwash had a significant positive effect on reducing the severity of xerostomia, also transcutaneous electrical nerve stimulation (TENS), licorice mouthwash, sugarless chewing gum, photobiomodulation, and pure water mouthwash, significantly improved saliva flow rate. The network analysis indicated that sugarless chewing gum significantly reduced the symptoms of xerostomia, while TENS and sugarless chewing gum were effective in improving UWS. Chewing sugarless gum and using TENS were the top-ranked interventions for relieving xerostomia and enhancing saliva flow rate among dialysis patients, respectively. Conclusions Several non-pharmacological interventions have demonstrated effectiveness in relieving xerostomia and enhancing saliva flow rates. While further research may be needed to confirm and refine these findings the interventions used in this review offer promising results and should be incorporated into the standard care of dialysis patients experiencing these symptoms to enhance their quality of life and oral health.

"I didn't really fit into any boxes": understanding the experiences of women affected by cancer in pregnancy and up to one-year postpartum-a mixed-method systematic review.

Little is known about women's experiences of cancer during pregnancy and up to one-year postpartum. As the incidence of gestational cancer rises parallel to increasing rates of early onset cancers there is an imperative need to understand their experiences. The aim of this research is to understand women's experiences of gestational cancer during pregnancy and up to one-year postpartum. This systematic integrative review followed the JBI methodology for mixed method systematic reviews (MMSR) which integrates empirical data from qualitative and quantitative primary studies. The search strategy included electronic databases, APA PsycINFO, CINHAL, Medline, Scopus, and the Web of Science Core Collection. The review has been reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive methodological quality assessment was undertaken using the Mixed Methods Appraisal Tool (MMAT). Thirteen studies were included, reporting on the experiences of 266 women. The findings represented the women's insight on the psychological impact of their gestational cancer, the impact on women's identity as a mother and a patient, and women's experiences of complex care. Gestational cancer reflects an emerging focus of clinical practice and an opportunity for much needed new research to explore woman-centered care exploring supportive care needs and models of maternity care. Women's experiences indicate that services are under-resourced to address the holistic and integrated supportive care needs of women affected by cancer across both maternity and cancer care teams.

Technology for preventing work-related musculoskeletal injuries in healthcare professionals: A scoping review

Background & Aim: This scoping review aims to identify and summarize how technology can help prevent work-related musculoskeletal injuries in healthcare professionals. Methods & Materials: We conducted a scoping review following the steps provided by the Joanna Briggs Institute. The PRISMA® - Preferred Reporting Items for Systematic Reviews and Meta-Analyses model was used to organize the information, following the recommendations described in PRISMA-ScR (PRISMA Extension for Scoping Reviews) for the article presentation. A search of PubMed, Scopus, and CINAHL databases was conducted for all articles in December 2023. Results: Of the 964 initial articles identified, 7 met the inclusion criteria. The reviewed studies highlight the effectiveness of various technological interventions in reducing musculoskeletal injuries among healthcare professionals. Wearable technologies, such as inertial measurement units, have been effective in promoting correct posture and reducing the risk of musculoskeletal disorders. However, the studies also identified significant challenges, including the generalizability of findings, the need for more robust empirical evidence, and issues related to the long-term sustainability and cost-effectiveness of these technologies. Conclusion: The conclusion of this analysis highlights the need for scalable, effective, and customized therapies and calls for more study and development in gamification, wearable technologies, and tailored mobile applications.

Lumpy Skin Disease: A review of epidemiological study and preventive measures

Background: Lumpy skin disease (LSD) is a highly infectious and economically important transboundary disease that is rapidly spreading to the globe. The disease causes high morbidity and a low mortality rate of infection. The animals show acute or chronic illnesses depending on the immune responses of the hosts. The economic burden of LSD manifested the poor-quality hides, a drop in milk and meat production, abortion, and death. Methods: This systematic literature review was accomplished according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature on lumpy skin disease has been explored over the last two decades and searched keywords on online databases such as Google Scholar, PubMed, and Scopus. Both automated and manual searching tools were used to screen the articles. The literature published other than English was rejected during the screening process. Conference papers were excluded during the screening. Results: LSD is transmitted by blood-sucking arthropods and is most prevalent in summer and rainy seasons. Exotic-bred cattle and calves are highly susceptible. Although the disease has low mortality, the high mortality of the disease prevails in endemic regions in complicated cases. Calves from unvaccinated cows should be vaccinated at any age, on the other hand, the calves from vaccinated cows should be immunized at 3 months of age. Animals should be vaccinated before the risk period. Strict biosecurity, quarantine, and immunoprophylaxis can reduce the prevalence of the disease. Conclusions: Lumpy skin disease (LSD) is an acute infectious and contagious disease affecting cattle and water buffaloes. The disease causes serious economic loss due to decreased production, skin problems, and mortality in complicated cases. Further details on genetic characterization, transmission dynamics, and host-pathogen interaction should be performed to prevent the prevalence of the disease in emerging or re-emerging countries.

The construct of attitude in mathematics education research: current trends and new research challenges from a systematic literature review

AbstractThe crucial role of attitude towards mathematics in the processes of teaching and learning mathematics is now recognized by both school practitioners and researchers in the field. However, “attitude” is a construct borrowed by disciplines other than mathematics education, and it is still conceptualized in various ways within the broad body of research about the role of affect in the teaching and learning of mathematics. In this context, developing a systematic literature review is particularly significant to characterise the recent trends—through the critical description of studies, foci, and approaches—and to guide future research by highlighting new possible research challenges in light of the current state of the art. Adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, this paper describes the systematic literature analysis of 180 papers published between the beginning of 2016 and the end of 2023, sourced from the Web of Science and Elsevier’s Scopus databases. The review confirms the worldwide interest and production about attitude towards mathematics, highlighting new remarkable findings and interests, such as the critical discussion about the translation of validated scales, as well as the persistence of some typical critical issues related to the “quantitative domain” in methodologies and to the widespread absence of precise definitions for attitude or of appropriate theoretical frameworks.

Effectiveness of combined physical exercise and cognitive training in older adults with cognitive impairment: A systematic review and meta-analysis

Falls among cognitively impaired older adults are a global concern. The aim of this study was to assess the efficacy of combining physical exercise and cognitive training to improve balance among older adults. A systematic search of databases, including Embase, Medline-OVID, CINAHL-EBSCOhost, and Central-Cochrane Library, was conducted from March 9 to April 6, 2023. The search used keywords based on the PICO question, where the population was older adults with cognitive impairment. Compared to a single therapy, the intervention involved a combination of muscle strengthening and cognitive therapy, with the outcome of falls or balance. Inclusion criteria were randomized controlled trials (RCTs) in any setting. Studies with participants under 60 years old and lacking baseline clinical assessments were excluded. EndNote 20 was used as a reference manager tool, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 flow diagram was used to map out the number of identified records. Two investigators worked independently, and the Jadad scale was used for critical appraisal. The PROSPERO registration number is CRD42023454876. A fixed-effects meta-analysis was performed using an inverse-variance method. Four articles met the inclusion criteria, three of which were included in the meta-analysis. Studies were from Europe, New Zealand, and the Philippines, with a total sample of 255 participants and mean ages of 65.9–87.5 years. The studies used combined physical and cognitive training in one group. Results showed a significant moderate effect size (effect size (ES): 2.29; standardized mean difference (SMD): 0.41; p<0.05; heterogeneity (I2): 0%) indicating no heterogeneity. In conclusion, the combined intervention displayed the potential to improve balance for cognitively impaired older adults.

Systematic Literature Review on Knowledge-Driven Approaches for Construction Safety Analysis and Accident Prevention

Due to its inherent complexities in the process and the dynamic interactions with external environmental factors, the construction industry is widely considered one of the most hazardous industries worldwide. With advancements in artificial intelligence (AI), construction safety management practices have increasingly used knowledge-driven approaches. Such incorporation of knowledge-based methods has led to significant improvements in various elements of construction safety management systems, including hazard identification and risk assessment, selection of risk mitigation strategies, analysis of accident information, sharing of health and safety knowledge, access to regulations, and identification of applicable safety requirements. Against this background, this paper presents a systematic literature review to provide an overview of the current state of the art in the use of knowledge-driven approaches in construction safety management. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) procedure, this study reviews how the knowledge-driven approach is utilized in the construction safety management field to automate different activities that come under it. Journal papers published from 2000 were considered for this review, and the analysis focused on the contributions of research, the evolution of knowledge-driven approaches, sources of incorporated knowledge, methods of system development, yearly publications, and publication by journals. The results provide a comparison of related studies over two decades and offer insights into trends and gaps in this research field. Notably, the trend analysis shows a dramatic increase in the number, as well as the depth, of research efforts utilizing AI techniques for analyzing unstructured data, such as construction images and texts from construction documents, and drawing data-based decisions for accident prevention.

Post-Traumatic Growth Promoting and Inhibiting Factors Among Intimate Partner Violence Survivors: A Systematic Review.

Intimate partner violence (IPV) is a traumatic experience that is universally present across the globe. Undeniably, there are expected adverse outcomes. However, it is also conceivable that IPV survivors might see, feel, and experience a hopeful, positive future after their IPV experience. Notably experienced by IPV survivors is post-traumatic growth (PTG). PTG is a type of positive psychological change that occurs following the struggle with a traumatic experience. The changes are then reflected across five domains. As more studies on PTG among IPV survivors continue to rise, there must be a better understanding of the process. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol, this systematic review consolidated findings from existing literature guided by the research questions: (a) What areas of PTG do IPV survivors most experience positive psychological growth? (b) What factors are associated with PTG among IPV survivors? A total of 22 studies met the criteria and were included. Spiritual growth and new possibilities domains were experienced the most by adult IPV survivors. Contributing and inhibiting factors toward PTG were identified and categorized as interpersonal, contextual, or intrapersonal. Targeted interventions aiding the process toward PTG for IPV survivors were also identified, including commonly maladaptive coping strategies. This systematic review contributes to the literature by increasing knowledge that can be used for more effective support, interventions, and policies that promote PTG for adult IPV survivors.

Prevalence of spin reporting bias in hip labrum reconstruction: a qualitative assessment of systematic reviews and meta-analyses

Hip labral reconstruction is an evolving technique to treat labral pathology. Spin is a recent concept that is defined as a reporting bias that misrepresents research. The purpose of this study is to identify the prevalence of spin in meta-analysis and systematic review abstracts regarding acetabular labral reconstruction. Electronic libraries were queried for meta-analyses and systematic reviews regarding hip labrum reconstruction. The nine most severe types of spin found in abstracts were used as an evaluation tool. Two reviewers each performed a blinded assessment of each article for spin. A third reviewer was used to address any discrepancies between the original reviewers. Other variables evaluated include number of citations, journal impact factor, reported conflicts of interest (COI), adherence to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, and methodologic quality according to a measurement tool to assess systematic reviews (AMSTAR-2). The electronic database search resulted in 1,148 articles, of which 10 met inclusion criteria. Of these 10 articles, 70% (7/10) were found to have at least one form of spin present, 20% (2/10) contained 3 different types of spin, 30% (3/10) contained 2 different types of spin, and 20% (2/10) contained 1 type of spin. The most common type of spin found was type 5, “conclusion claims the beneficial effect of the experimental treatment despite high risk of bias in the primary studies,” which was found in 60% (6/10) of the articles. When assessing AMSTAR-2 score, 90% (9/10) of the articles were found to be ‘low quality’ or ‘critically low quality.’ Spin was present in 70% of the abstracts of meta-analyses and systematic reviews pertaining to hip labrum reconstruction. Recognition of spin is crucial for orthopaedic surgeons. Improved guidelines should be considered to reduce the prevalence of spin in orthopaedic literature.

The efficacy of cryotherapy compared to the other modalities for the management of palmoplantar warts: a systematic review and network meta-analysis

There are several treatment modalities for Palmoplantar Warts (PPW) introduced, but none have been proven to be significantly effective in all patients. The study aims to assess the efficacy and safety of cryotherapy compared to other modalities for PPW. Searches were conducted in Medline, Embase, Scopus, and CENTRAL databases, along with additional reference and citation tracking from included studies. Randomized Controlled Trials (RCTs) comparing various treatments for PPW were included. Two independent pairs extracted the data from the included studies. Outcomes assessed included cure rates, pain scores, recurrence rates, and adverse events. Network meta-analysis using Netmeta in R software was utilized, with treatments ranked by p-scores. A total of 27 RCTs that enrolled 2,539 participants were deemed eligible. As per p-scores, needling yielded the highest odd for the cure rate (p=1.00), followed by intralesional injection of the Measles, Mumps, and Rubella (MMR) vaccine (p=0.90). For the pain score, 76% topical monochloroacetic acid (p=0.13) showed the lowest mean pain score, while cryotherapy yielded the highest score (p=0.90). Furthermore, cryotherapy showed the highest odds for recurrence rate (p=0.75), followed by intralesional injection of Candida antigen (p=0.61). 0.05% intralesional bleomycin (p=0.93) was the highest agent for adverse events rate, followed by cryotherapy (p=0.61). Needling was the most effective in achieving a cure rate. Cryotherapy has the highest odds for pain score and recurrence rate, while 0.05% intralesional bleomycin has the highest adverse events profile.

Effect of the glucagon-like peptide-1 receptor agonists on diabetic peripheral neuropathy: A meta-analysis.

Previous researches found that glucagon-like peptide 1 receptor agonists (GLP-1RA) offer benefits beyond their anti-diabetic properties, including weight loss and cardiovascular disease prevention. However, the effects of GLP-1RA on diabetic peripheral neuropathy (DPN) remain unclear. This meta-analysis aims to assess the potential benefits of GLP-1RA treatment in DPN patients by evaluating peripheral neural function. Following the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a meta-analysis of the clinical trials investigating the impact of GLP-1RA treatment on peripheral neural function in patients with DPN. Outcomes were measured using electrophysiological tests, including nerve conduction velocity (NCV) and action potential amplitude. Our meta-analysis included six studies with 271 participants. Following GLP-1RA treatment, NCV significantly improved compared to the control group (MD 1.74; 95% CI 1.16 to 2.33; p < 0.001) and before treatment (MD 2.16; 95% CI 1.04 to 3.27; p < 0.001). Despite the improvement in NCV, blood glucose levels did not change significantly (MD -0.20 95% CI -0.87 to 0.46, p = 0.55) indicating that GLP-1RA enhances NCV through mechanisms other than glucose lowering. Nonetheless, as a result of the limited population studied, further research is needed to strengthen the reliability of these findings.

Uncovering the Evidence for Sustainability in Urology: A Scoping Review.

This article focuses on the environmental impact of urology devices and procedures in hospitals and identifies practices that can reduce greenhouse gas emissions associated with urology services. A scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted using MEDLINE, EMBASE, and Google Scholar to find studies on the carbon footprint of urologic procedures and sustainable practices. We identified 14 studies, 6 of which used life cycle assessments to compare the environmental impact of single-use and reusable urology devices. Three studies favored single-use devices, 2 favored reusable ones, and 1 found no significant difference, with the sterilization of reusable devices being a major carbon contributor. To enhance sustainability in urology, 8 articles suggested measures including day-case procedures, minimizing low-value care, drapeless cystoscopy, fluid management systems, using quick response (QR) codes in documentation, telehealth initiatives, and low-emission anesthetics. Promoting sustainability in healthcare requires more than just using reusable equipment; it necessitates a comprehensive approach from manufacturing to disposal, including the carbon footprint of sterilization. Encouraging low-emission anesthetics, QR codes, and telemedicine can significantly reduce emissions in urology.

Mechanical Thrombectomy Access Score: A Systematic Review and Modified Delphi of Global Barriers to Endovascular Therapy.

The availability of mechanical thrombectomy (MT) for acute ischemic stroke is limited, and vast disparities exist between countries. We aim to create a MT access score to measure the drivers of access to help quantify and accelerate treatment worldwide. We used a systematic review complemented by a modified Delphi method. In the first of 3 rounds, 4 independent investigators performed a systematic literature review using key search terms that drive MT access, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In the second round, a panel of 6 anonymous international experts selected key attributes needed for scoring. In the final round, a total of 12 attributes were selected on consensus, each given a score on a 0 to 3 scale. An ultimate MT access score (range, 0-36) was proposed as a new tool to use in identifying barriers to MT access and assist in providing an initial framework for public health interventions. Of 2864 abstracts screened, 121 studies were included in the final systematic review. A total of 34 attributes that potentially drive MT access were initially identified. In the final round, 12 attributes were selected by the expert panel: public awareness, emergency medical services transportation, prehospital large vessel occlusion screening, interhospital transfer policy, emergency department protocols, stroke imaging protocols, emergency department stroke expertise or telestroke availability, interventionalists, MT-capable centers, device availability, and insurance coverage. These attributes were weighted as part of the final score of 0 to 36. The MT access score represents the first tool to quantify barriers to global MT access. Its implementation stands not just as an academic achievement but as a beacon of hope for improving stroke care and outcomes worldwide, bringing us a step closer to bridging the gap in stroke treatment disparities.

Music Therapy for Pain and Anxiety Reduction in Pediatric Patients Undergoing Procedures: A Systematic Review and Meta-Analysis Protocol

Introduction: Many children undergo invasive and noninvasive procedures in the pediatric medical setting, which can be associated with pain and anxiety. Both pharmacological and nonpharmacological interventions are currently being used to minimize pain and anxiety in pediatric patients in the medical setting. Music therapy is an evidence-based, cost-effective, and nonpharmacological service administered by a board-certified music therapist which may reduce pediatric pain and anxiety during procedures. We will undertake a systematic review and meta-analysis that will comprehensively analyze the quantitative publications that detail the effects of music therapy on pediatric pain and anxiety for patients undergoing invasive or noninvasive medical procedures. Method: This protocol is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement and is registered in the International Prospective Register of Systematic Reviews (Prospero; CRD42023474635 ). A three-step, iterative search strategy will include (1) an initial scoping search, (2) development and execution of a comprehensive search strategy, and (3) a search for additional publications. Procedures for disagreements among reviewers and the article screening process are outlined. Statistical analyses including analysis of outcomes and sensitivity analysis has been determined. A plan for critical appraisal of sources using the Grading Recommendations Assessment, Development, and Evaluation (GRADE) and quality of evidence using the Outcome Reporting Bias in Trials (ORBIT) of evidence is also present in this protocol. Conclusion: This protocol is presented with the intention to execute and publish results of this systematic review and meta-analysis to help inform clinical practice and future research.

Organ Donation Process for Transplantation: A Scoping Review

Objectives: To identify studies in the literature that address the strategies used in the organ donation process. Method: Scoping review based on the Joanna Briggs Institute ( JBI) methodology, in the databases Medical Literature and Retrieval System Online (MEDLINE), Scopus, Web of Science, Latin American and Caribbean Literature in Health Sciences (LILACS), and Embase via the Virtual Health Library (VHL), following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist, carried out from August to December 2023. Results:"irty-three studies were eligible, which showed that the donation process must happen systematically, following the steps: 1) identi#cation of patients suspected of having brain death (BD); 2) opening the protocol and notifying organizations; 3) con#rmation of the diagnosis of BD; 4) communicating the death to the family; 5) conducting the interview; 6) consent to donation; 7) donor maintenance; 8) procurement and allocation of organs; 9) transplant; and 10) follow-up. Conclusion: Donation requires a multifaceted approach, including awareness, investment, evaluation and research.

Impacts of completely endophytic renal masses on perioperative, oncologic, and functional outcomes in robot-assisted partial nephrectomy: a systematic review and meta-analysis

BackgroundThe objective of this study was to perform a comprehensive pooled analysis aimed at comparing the efficacy and safety of robot-assisted partial nephrectomy (RAPN) between completely endophytic tumors (CERT) and non-completely endophytic tumors (non-CERT).MethodsThis study adhered rigorously to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to conduct a systematic review and meta-analysis. We performed a systematic search in the PubMed, Embase, Web of Science, and Cochrane Library databases, focusing on studies published in English up to May 2024. Our analysis primarily evaluated key outcomes, specifically perioperative, functional, and oncological outcomes.ResultsA total of 2126 patients across six studies were included in the analysis. Compared to non-CERT, CERT was associated with significantly higher rates of major complications (Odds Ratio [OR]: 2.47; 95% CI: 1.14 to 5.34; p = 0.02), longer warm ischemia times (Weighted Mean Difference [WMD]: 3.27 min; 95% CI: 0.61 to 5.39; p = 0.02), a greater decline in estimated glomerular filtration rate (eGFR) (WMD: 2.93 ml/min/1.73 m2; 95% CI: 0.75 to 5.11; p = 0.008), and relatively lower trifecta achievement rates (OR: 0.63; 95% CI: 0.41 to 0.96; p = 0.03). However, no statistically significant differences were observed between the two groups in terms of operative time, length of stay, blood loss, transfusion rates, intraoperative complications, overall complications, positive surgical margins, and local recurrence.ConclusionsAlthough CERT was associated with greater declines in eGFR and lower rates of trifecta achievement, it yielded perioperative, functional, and oncologic outcomes comparable to those of non-CERT in RAPN. Our findings suggest that RAPN for completely endophytic renal masses can achieve acceptable outcomes when performed in centers with substantial expertise in robotic surgery.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=555067, identifier CRD42024555067.