Systematic Review Method Research Articles

Learning analytics in distance education: A systematic review study

AbstractThis study aims to reveal the main trends and findings of the studies examining the use of learning analytics in distance education. For this purpose, journal articles indexed in the SSCI index in the Web of Science database were reviewed, and a total of 400 journal articles were analysed within the scope of this study. The systematic review method was used as the research methodology. The first study on the subject was published in 2011, and the publications continued to increase over the years. It was found that the publications on the subject were primarily found in “Computers and Education” and “Education and Information Technologies” journals. It was observed that China, USA, and Spain were the leading countries where the related studies were conducted. The studies primarily used the quantitative method, and university students were included as the sample. In addition, within the scope of learning analytics, it was observed that the data were mainly analysed with “regression analysis”, “correlation analysis”, “special algorithms-models”, “ANOVA”, and “cluster analysis” methods. It was determined that the most preferred platforms in the studies were learning management systems and MOOCs, learning behaviours were mostly examined, and log data were mainly used in this process. It was observed that the variables tested in the studies mainly consisted of students’ behaviours on the platform, learning performances, communication processes, dropout behaviours and course designs. Furthermore, in the studies examined, the advantages of learning analytics in the context of distance education are mostly related to the possibilities of improving the teaching process, and as disadvantages, it is stated that learning analytics is not suitable for use in some situations, negatively affect students’ performances, have limited interaction with students and are an expensive investment.

Effects of elastic band resistance training on the physical and mental health of elderly individuals: A mixed methods systematic review.

Elastic band resistance training in elderly individuals can improve physical fitness and promote mental health in addition to other benefits. This systematic review aimed to review, summarize, and evaluate quantitative, qualitative, and mixed methodological studies on the use of elastic band resistance training in elderly individuals, and to investigate the influence of elastic band resistance training on the physical and mental health of elderly individuals, as well as their preferences and obstacles in training. A convergent separation approach was used to synthesize and integrate the results, specifically the mixed systematic review approach recommended by the Joanna Briggs Institute. The extensive search strategy included electronic database searches in the Cochrane Library, PubMed, Embase, Web of Science, Google Scholar, MEDLINE, and CINAHL. The researchers rigorously screened the literature, extracted and analyzed the data, and evaluated the quality of the included studies using the Mixed Methods Appraisal Tool (MMAT). Twenty-eight studies were included, of which 25 were quantitative studies, 2 were qualitative studies, and 1 was a mixed-methods study. A total of 1,697 subjects were investigated across all studies. Quantitative evidence supports the notion that elastic band resistance training can improve upper and lower limb flexibility, endurance, upper strength, physical balance, and cardiopulmonary function and enhance the mental health of elderly individuals. Participants in the qualitative study reported some preferences and obstacles with band resistance training, but most participants reported physical benefits. Despite the heterogeneity between studies, this review is the first systematic review to comprehensively evaluate the effectiveness of elastic band resistance training in older adults. It not only shows the influence of elastic band resistance training on the physical and mental health of the elderly, but also emphasizes the preference and obstacles of elderly individuals face.

Autistic Women’s Experiences of the Perinatal Period: A Systematic Mixed Methods Review

AbstractThe perinatal period has challenges for autistic women. This review synthesises evidence on the experiences of autistic women during the perinatal period. This mixed methods evidence synthesis followed JBI guidance for mixed methods systematic reviews. The Mixed Methods Appraisal Tool assessed study quality. Thematic analysis was used to synthesise findings. Thirteen studies were included. Themes identified included sensory demands of the perinatal period are frequently overwhelming; experiencing healthcare as an autistic person is challenging; parenting as an autistic mother has difficulties but also rewards; predictability and control are important in labour and birth. Individualised care with reasonable adjustments can make a difference to the perinatal experiences of autistic women. Despite challenges, autistic women also have many strengths as mothers.

Bridging Geo-Data and Natural Gas Pipeline Design Standards: A Systematic Review of BIM-GIS Integration for Natural Gas Pipeline Asset Management

In today’s world, effective management and the use of spatial data are of great importance in many sectors. Industries such as land management, asset management, and infrastructure management are areas where spatial data are heavily utilized. Advanced technologies such as Geographic Information Systems (GISs) and Building Information Modeling (BIM) are used in the processes of collecting, analyzing, and managing geographically enabled data (geo-data). These technologies enable the effective processing of large datasets, improve decision-making processes based on geographic information, and facilitate more efficient collaboration across sectors. This study conducts an in-depth examination of the existing literature on asset management, infrastructure management, and BIM-GIS integration using bibliometric analysis and systematic literature review methods. Bibliometric analysis is employed to determine statistical values such as current research trends, frequently cited authors, most used keywords, and country performances in the relevant field. This study’s results highlight future research trends and significant gaps in the areas of asset management, infrastructure management, natural gas pipelines, and BIM-GIS integration. In particular, this study demonstrates the critical importance of asset management and BIM-GIS integration for sustainable infrastructure design, construction, and management. In this context, attention is drawn to the importance of data standardization, digitization, systematic integration, and contemporary land management requirements.

Optimization methods in powder metallurgy for enhancing the mechanical properties: A systematic literature review

Abstract Powder metallurgy offers several advantages over traditional manufacturing methods, such as improved material utilization and waste reduction. The powder metallurgy process involves four primary steps, metal powder preparation, mixing, compaction, and sintering, followed by secondary operations such as forging, rolling, and extrusion. However, existing studies have predominantly focused on refining the primary processes, neglecting secondary processes that could further enhance mechanical properties. A systematic literature review following the Preferred Reporting Items for Systematic Review and Meta-Analysis method identified twenty-three relevant articles over a ten-year period, highlighting three main optimization methods, that are, the Taguchi method, Taguchi-based Grey Relational Analysis, and Response Surface Methodology. These methods effectively reduce experimental trials and optimize key parameters like compaction pressure and weight percentage, which significantly influence mechanical properties. The review emphasizes the key powder metallurgy process parameters that have a significant impact on mechanical properties, becoming the primary targets for optimization. It offers a focused examination of which process parameters require thorough investigation for optimization and the suitable optimization method to achieve optimal outcomes, whether for single or multiple responses, thereby enhancing the manufacturing process. However, inconsistencies in parameter significance across studies indicate the material-dependent nature of powder metallurgy materials. The review also identifies a gap in the literature regarding secondary process optimization and comparative analyses of optimization methods. Future research should explore optimizing secondary processes in powder metallurgy, conduct comparative studies of different optimization methods, and develop novel approaches for optimization to further enhance mechanical properties and process efficiency.

Barriers and Facilitators to Health Professionals' Engagement in Quality Improvement Initiatives: A Mixed-Methods Systematic Review.

Background Quality improvement (QI) initiatives in healthcare are crucial for enhancing service quality and healthcare outcomes. The success of these initiatives depends on the active engagement of healthcare professionals, which can be influenced by several factors within the healthcare system. This systematic review synthesised the factors influencing healthcare professionals' engagement in QI projects, focusing on identifying both barriers and facilitators. Methods A mixed methods systematic review (MMSR) was conducted using the JBI methodology for MMSR. Databases such as MEDLINE, CINAHL, Scopus, and Embase were searched for studies that explored barriers and facilitators to QI engagement of health professionals in the clinical setting. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT). The extracted data were synthesised using the JBI convergent integrated approach to MMSR. Results Eighteen studies (seven qualitative, nine quantitative, and two mixed-methods) published between 2007 and 2023 were included in the review. The analysis revealed barriers and facilitators to engagement in QI initiatives at different levels of the health system. At the QI program level, the engagement of health professionals to QI was influenced by the approach to QI, evidence underpinning the QI initiative, QI knowledge and training and access to QI specialists. At the health professional level, barriers and facilitators were related to their organisational role, motivation, perceptions about QI, and collaborations with individuals and groups. At the organisational level, factors related to culture and climate, leadership, available resources (including human resource and workload, infrastructure, and incentives) and institutional priorities influenced health professionals' participation in QI. Conclusion This review highlights the complex interplay of organisational, individual and QI program level factors that influence the engagement of healthcare professionals in QI. Overcoming these complex barriers and leveraging facilitators is crucial for enhancing participation in QI efforts. The findings underscore the need for a multi-level strategy that focuses on creating a conducive organisational culture, providing robust leadership, and ensuring adequate resources and training for healthcare professionals. Such strategies hold the potential to enhance the effectiveness and sustainability of QI initiatives in healthcare settings.

Assessing the Healthfulness of University Food Environments: A Systematic Review of Methods and Tools

The availability, promotion, and price of healthy foods within the university food environment may impact students’ dietary choices. This systematic review summarizes the tools and methods used to assess the healthfulness of university food environments where many students spend a significant portion of their emerging adulthood. Thirty-six global studies published between 2012 and 2022 were sourced from PubMed (NNLM), Cochrane Library (Wiley), Web of Science (Clarivate), APA PsycInfo (EBSCO), CINHAL Complete (EBSCO), ProQuest Nursing, and Allied Health, following PRISMA 2020 guidelines. Of the included studies, 58% were institutional-level audits, 17% examined individual-level perceptions, and 25% combined both. Most institutional-level audits focused on one aspect of the food environment (e.g., eateries, vending machines). For studies examining multiple spaces within the campus environment (38%), comprehensive assessments were limited, and most studies had to employ a combination of assessment tools. Surveys were most often used to gather individual perceptions about the food environment. The Nutrition Environment Measures Survey (NEMS) was the most commonly used tool across all studies. This review highlights the need for a standardized tool, method, or a “healthy” benchmark for specific use at universities to improve methodological rigor and comparability of findings across institutions.

Child life specialist services, practice, and utilization across health care: a scoping review.

The objective of this review was to map the available evidence regarding the scope of child life specialist services, practice, and utilization. Child life specialists are members of multidisciplinary health care system teams who prioritize the developmental needs of pediatric patients to support and improve patient and family health care experiences. Evidence of the effectiveness of child life specialist services and the utilization of those services is often incorporated in multidisciplinary research reports and thus overlooked. All quantitative, qualitative, and mixed methods research study reports and systematic reviews investigating child life specialist services, practice, and utilization in health care systems were included. This review was guided by the JBI methodology for scoping reviews and a published a priori protocol. CINAHL (EBSCOhost), MEDLINE (PubMed), Scopus, and PsycINFO (APA) were searched for evidence published from January 1980 to August 2022. Research publications about child life specialist services, practice, and utilization have increased dramatically over the past decade with more than 50% of studies published in the last 5 years. Although the first authors of the majority of the research publications were physicians, these multidisciplinary author teams depicted child life specialist services in a variety of roles, including co-investigators, interventionists, and research subjects. The 105 full-text publications reviewed were from 10 countries and occurred across a wide scope of health care settings and medical subspecialties, but primarily in hospitals and health centers, and to a lesser extent, in ambulatory clinics and communities. A wide variety of child life specialist services were described across these settings. The concept of child life services began in 1922 and emerged as the child life specialist services specialty in the United States in the 1970s and 1980s. Mapping the research can help delineate the barriers and facilitators to these services in health care systems. This scoping review provides evidence of the global diffusion of child life specialist services across health care system settings with recent increases in research publications involving child life specialist services.

Enhancing surgical planning for abdominal tumors in children through advanced 3D visualization techniques: a systematic review of future prospects

IntroductionPreoperative three-dimensional (3D) reconstruction using sectional imaging is increasingly used in challenging pediatric cases to aid in surgical planning. Many case series have described various teams' experiences, discussing feasibility and realism, while emphasizing the technological potential for children. Nonetheless, general knowledge on this topic remains limited compared to the broader research landscape. The aim of this review was to explore the current devices and new opportunities provided by preoperative Computed Tomography (CT) scans or Magnetic Resonance Imaging (MRI).MethodsA systematic review was conducted to screen pediatric cases of abdominal and pelvic tumors with preoperative 3D reconstruction published between 2000 and 2023.DiscussionSurgical planning was facilitated through virtual reconstruction or 3D printing. Virtual reconstruction of complex tumors enables precise delineation of solid masses, formulation of dissection plans, and suggests dedicated vessel ligation, optimizing tissue preservation. Vascular mapping is particularly relevant for liver surgery, large neuroblastoma with imaging-defined risk factors (IDRFs), and tumors encasing major vessels, such as complex median retroperitoneal malignant masses. 3D printing can facilitate specific tissue preservation, now accessible with minimally invasive procedures like partial nephrectomy. The latest advancements enable neural plexus reconstruction to guide surgical nerve sparing, for example, hypogastric nerve modelling, typically adjacent to large pelvic tumors. New insights will soon incorporate nerve plexus images into anatomical segmentation reconstructions, facilitated by non-irradiating imaging modalities like MRI.ConclusionAlthough not yet published in pediatric surgical procedures, the next anticipated advancement is augmented reality, enhancing real-time intraoperative guidance: the surgeon will use a robotic console overlaying functional and anatomical data onto a magnified surgical field, enhancing robotic precision in confined spaces.

The effects of Teaching Practices Based on Biomimicry Approach on Learning-Teaching Processes

The aim of this research is to evaluate the effect of biomimicry approach on the learning-teaching process, based on the results of the studies on teaching practices on the biomimicry approach. The research was carried out by systematic review method. Depending on this method, the review protocol of scientific studies, which consists of four stages: planning, research, selection and synthesis, was employed. Within the scope of the research, the studies indexed in the Web of Science (WOS) database were searched with the keywords "biomimicry", "biomimicry in education", and then the relevant studies were selected by scanning TRDizin, Wiley, Scopus databases. Additionally, the relevant postgraduate studies were scanned through the National Dissertation Center and ProQuest databases and were included in the review. Within the scope of research themes, all the related studies in the fields of Educational Sciences, Social Sciences, Education, Psychology and Sociology were included in the review. During the selection phase, the contents were evaluated and the studies suitable for the research purpose were determined in line with the elimination criteria. In the synthesis phase, the selected studies were evaluated in terms of their theoretical basis, aims, methods, findings, and limitations. The total number of studies included in the systematic review was determined as 16. The results of the study provide a perspective on the current status of the biomimicry approach in the field of social sciences, how it is conceptually defined, and the effects of this approach on responding to needs in the field of education and learning characteristics.

A Systematic Review of the Impact of ChatGPT on Higher Education

ChatGPT is shaking up the higher education world by generating informative content that mimics human writing. However, its integration into university settings raises concerns about academic integrity and potential information security risks. The aim of this study is to systematically review the impact of using ChatGPT in university settings and its implications for higher education. This study employed a systematic review method to assess the evidence in the literature. Thirty-nine articles were analyzed according to PRISMA principles. The findings suggest that ChatGPT has the potential to personalize learning and improve writing performance. However, there are still potential issues, such as undermining academic integrity and breaching personal information. Therefore, urgent action is needed to address these issues and optimize the use of ChatGPT in higher education. Future research could further discuss how to fully utilize ChatGPT in academia while carefully considering ethical issues.

The learning curve in endoscopic transsphenoidal skull-base surgery: a systematic review

BackgroundThe endoscopic endonasal transsphenoidal approach (EETA) has revolutionized skull-base surgery; however, it is associated with a steep learning curve (LC), necessitating additional attention from surgeons to ensure patient safety and surgical efficacy. The current literature is constrained by the small sample sizes of studies and their observational nature. This systematic review aims to evaluate the literature and identify strengths and weaknesses related to the assessment of EETA-LC.MethodsA systematic review was conducted following the PRISMA guidelines. PubMed and Google Scholar were searched for clinical studies on EETA-LC using detailed search strategies, including pertinent keywords and Medical Subject Headings. The selection criteria included studies comparing the outcomes of skull-base surgeries involving pure EETA in the early and late stages of surgeons’ experience, studies that assessed the learning curve of at least one surgical parameter, and articles published in English.ResultsThe systematic review identified 34 studies encompassing 5,648 patients published between 2002 and 2022, focusing on the EETA learning curve. Most studies were retrospective cohort designs (88%). Various patient assortment methods were noted, including group-based and case-based analyses. Statistical analyses included descriptive and comparative methods, along with regression analyses and curve modeling techniques. Pituitary adenoma (PA) being the most studied pathology (82%). Among the evaluated variables, improvements in outcomes across variables like EC, OT, postoperative CSF leak, and GTR. Overcoming the initial EETA learning curve was associated with sustained outcome improvements, with a median estimated case requirement of 32, ranging from 9 to 120 cases. These findings underscore the complexity of EETA-LC assessment and the importance of sustained outcome improvement as a marker of proficiency.ConclusionsThe review highlights the complexity of assessing the learning curve in EETA and underscores the need for standardized reporting and prospective studies to enhance the reliability of findings and guide clinical practice effectively.

Factors That Encourage Investors to Decide to Invest in Shares in the Capital Market for the 2020-2023 Period (Covid-19 Pandemic): Systematic Literature Review

Investment is a very important element for a country because it has two roles, namely as a supporter of income and a driver of economic growth. In this research, the author analyzes what factors encourage investors to decide to invest in shares in the capital market. This research uses the Systematic Literature Review (SLR) method. This research comes from articles published in 2020-2023 found in Publish or Perish and Google Scholar. Data is collected, identified and assessed before being systematically reviewed with the aim of supporting further research. The results of this review show that during the Covid-19 pandemic, many investors made stock investment decisions in the capital market due to psychological factors. As a result of the economic problems that have arisen as a result of the Covid-19 pandemic, many people's perspectives have changed from previously preferring traditional investments such as deposits to looking for investment options that provide high returns such as mutual funds and shares with different investment objectives. This is also supported by the rapid development of digital and information technology during the Covid-19 pandemic, which has caused public participation in the capital market to increase. Many fintech companies that adopt automatic investment technology are able to remove obstacles for potential investors who lack investment literacy and limited capital without having to study and understand the entire investment scheme in the capital market. Apart from that, financial literacy is also mentioned as a factor that can determine stock investment decisions because the knowledge that comes from literacy will strengthen stock investment decisions.

Evaluating Graph Layout Algorithms: A Systematic Review of Methods and Best Practices

AbstractEvaluations—encompassing computational evaluations, benchmarks and user studies—are essential tools for validating the performance and applicability of graph and network layout algorithms (also known as graph drawing). These evaluations not only offer significant insights into an algorithm's performance and capabilities, but also assist the reader in determining if the algorithm is suitable for a specific purpose, such as handling graphs with a high volume of nodes or dense graphs. Unfortunately, there is no standard approach for evaluating layout algorithms. Prior work holds a ‘Wild West’ of diverse benchmark datasets and data characteristics, as well as varied evaluation metrics and ways to report results. It is often difficult to compare layout algorithms without first implementing them and then running your own evaluation. In this systematic review, we delve into the myriad of methodologies employed to conduct evaluations—the utilized techniques, reported outcomes and the pros and cons of choosing one approach over another. Our examination extends beyond computational evaluations, encompassing user‐centric evaluations, thus presenting a comprehensive understanding of algorithm validation. This systematic review—and its accompanying website—guides readers through evaluation types, the types of results reported, and the available benchmark datasets and their data characteristics. Our objective is to provide a valuable resource for readers to understand and effectively apply various evaluation methods for graph layout algorithms. A free copy of this paper and all supplemental material is available at osf.io, and the categorized papers are accessible on our website at https://visdunneright.github.io/gd‐comp‐eval/.

Identifying and prioritizing the barriers to green innovation in SMEs and the strategies to counteract the barriers: An interval-valued intuitionistic fuzzy approach

Increasing environmental burdens and the importance of innovation in the presently competitive environment have encouraged small- and mid-size enterprises (SMEs) to adopt and implement green innovation practices. This process, however, is faced with many limitations and obstacles. The purpose of this study is to propose a framework to identify barriers to green innovation in SMEs and to provide solutions/strategies to overcome such barriers. Using the systematic literature review (SLR) method and the opinions of 20 experts, the study primarily identified 29 sub-categories of barriers falling under seven main categories including “management”, “organization”, “human resources”, “financial resources”, “external cooperation”, “customers, markets or competitors”, and “the external environment.” Similarly, 22 strategies were discovered that could help to counteract the barriers identified. To determine the weights of the barriers, the Intuitionistic Fuzzy Multiplicative Best-Worst Method (IFMBWM) was used. The strategies, too, were ranked through the Interval-Valued Intuitionistic Fuzzy MULTIMOORA (IVIF-MULTIMOORA) method. Then, a sensitivity analysis and a comparative analysis were applied to confirm the robustness of the proposed method and ensure the consistency of the obtained ranking of alternatives. As the results revealed, the optimal and effective solutions that could be used by policy-makers/managers to overcome the barriers to green innovation were “simplifying authorization and licensing procedures”, “effective environmental laws and regulations”, “shared responsibility throughout the supply chain”, “a supportive organizational culture”, and “merit-based selection of managers.”

Literature review of potential materials for the construction of an alternative flat-plate solar collector

Through systematic review method the article presents the potential of existing solar energy in Mozambique for use in water heating with the integration of thermal energy storage systems that are currently being investigated. It emphasizes the need for affordable materials in building solar collectors for Mozambique’s homes, leveraging the country’s solar potential to reduce electricity consumption and environmental impact for sustainable development. It explores current research on thermal energy storage systems for solar water heating and reviews alternative materials for solar collectors based on their properties, cost, and availability. The importance of thermal energy storage in solar collectors for efficiency and load balancing is highlighted., it discusses and list the potential alternative materials for the construction of flat plate solar thermal collectors from roofing material, frame, absorber, pipes, and heat storage material according to their thermophysical properties, costs, and availability in the Mozambican market in the context of industrialization.

TEMPORARY REMOVAL: Estimated doses to the heart, lungs and oesophagus and risks from typical UK radiotherapy for early breast cancer during 2015-2023

PurposeBreast cancer radiotherapy can increase the risks of heart disease, lung cancer and oesophageal cancer. At present, the best dosimetric predictors of these risks are mean doses to the whole heart, lungs and oesophagus, respectively. We aimed to estimate typical doses to these organs and resulting risks from UK breast cancer radiotherapy. MethodsA systematic review and meta-analysis was conducted of planned or delivered mean doses to the whole heart, lungs or oesophagus from UK breast cancer radiotherapy in studies published during 2015-2023. Average mean doses were summarised for combinations of laterality and clinical targets. Heart disease and lung cancer mortality risks were then estimated using established models. ResultsFor whole heart, thirteen studies reported 2893 doses. Average mean doses were higher in left than in right-sided radiotherapy and increased with extent of clinical targets. For left-sided radiotherapy, average mean heart doses were: 2.0 Gy (range 1.2-8.0 Gy) breast/chest wall, 2.7 Gy (range 0.6-5.6 Gy) breast/chest wall with either axilla or supraclavicular nodes and 2.9 Gy (range 1.3-4.7 Gy) breast/chest wall with nodes including internal mammary. For right-sided radiotherapy, average mean heart doses were: 1.0 Gy (range 0.3-1.0 Gy) breast/chest wall and 1.2 Gy (range 1.0-1.4 Gy) breast/chest wall with either axilla or supraclavicular nodes. There were no whole heart dose estimates from right internal mammary radiotherapy.For whole lung, six studies reported 2230 doses. Average mean lung doses increased with extent of targets irradiated: 2.6 Gy (range 1.4-3.0 Gy) breast/chest wall, 3.0 Gy (range 0.9-5.1 Gy) breast/chest wall with either axilla or supraclavicular nodes and 7.1 Gy (range 6.7-10.0 Gy) breast/chest wall with nodes including internal mammary.For whole oesophagus, two studies reported 76 doses. Average mean oesophagus doses increased with extent of targets irradiated: 1.4 Gy (range 1.0-2.0 Gy) breast/chest wall with either axilla or supraclavicular nodes and 5.8 Gy (range 1.9-10.0 Gy) breast/chest wall with nodes including internal mammary. ConclusionThe typical doses to these organs may be combined with dose-response relationships to estimate radiation risks. Estimated 30-year absolute lung cancer mortality risks from modern UK breast cancer radiotherapy for patients irradiated when aged 50 years were 2 to 6% for long-term continuing smokers, and <1% for non-smokers. Estimated 30-year mortality risks for heart disease were <1%.

Are Tourniquets Indicated in Total Knee Arthroplasty in the Era of Tranexamic Acid: A Meta-analysis and Systematic Review

IntroductionThere is conflicting evidence in the literature regarding the clinical utility of tourniquets in total knee arthroplasty (TKA), specifically in regards to perioperative blood loss. In this meta-analysis and systematic review, we aim to evaluate the clinical advantages and disadvantages associated with tourniquet use in the setting of TKA. MethodsA systematic review was conducted through April 2017using keywords: “tourniquet” and “total knee arthroplasty” or “total knee replacement”. Perioperative variables including TXA use, blood loss, incidence of venous thromboembolism (VTE), and wound complications were either extracted from the studies or corresponding authors were contacted. A sub-analysis was conducted to evaluate the effects of TXA on intraoperative and total blood loss (TBL), and VTE incidence. ResultsAfter review of 558 articles, 19 studies reporting outcomes in 1094 patients were analyzed. Intraoperative blood loss was significantly lower in the tourniquet cohorts compared to non-tourniquet (p<0.01). TBL was reduced in tourniquet groups but not significantly (p=0.08). In contrast, calculated blood loss was greater in tourniquet groups, but this difference was not significant (p=0.43). There was a greater likelihood for wound complications and VTE among tourniquet assisted TKA, albeit only significant for the former (p=0.01). TXA sub-analysis demonstrated intraoperative blood loss was significantly reduced with tourniquet use regardless of TXA implementation (p<0.01). In studies without TXA, tourniquet patients were at greater risk of developing VTE (p=0.08). These risks decreased with TXA administration. ConclusionThis meta-analysis demonstrates that tourniquets prevent intraoperative blood loss, yet within the postoperative period, there is no significant difference in TBL between tourniquet and non-tourniquet assisted TKA. Level of EvidenceLevel II; Systematic Review and Meta-Analysis

The concomitant use of Beta Blockers with vasopressors/inotropes in critically ill patients with septic shock: A systematic review and meta-analysis

BackgroundSeptic shock is associated with systemic inflammatory response, hemodynamic instability, impaired sympathetic control, and the development of multiorgan dysfunction that requires vasopressor/inotropic support. The regulation of immune function in sepsis is complex and varies over time. However, activating Beta-2 receptors and blocking Beta-1 receptors reduces the proinflammatory response by influencing cytokine production. Evidence that supports the concomitant use of ultra short beta-blockers with inotropes and vasopressors in septic shock patients is still limited. This study aimed to evaluate this practice on the ICU related outcomes such as mortality, length of stay, heart rate control, shock resolution, and vasopressors/inotropes requirements. MethodsA systematic review and meta-analysis of studies including critically ill patients with septic shock who received inotropes and vasopressors. Patients who received vasopressor/inotropes without beta-blockers “control group” were compared to patients who used ultra short beta-blockers concomitantly with either epinephrine or norepinephrine “Intervention group”. MEDLINE and Embase databases were utilized to systematically search for studies investigating the use of ultra beta-blockers in critically ill patients on inotropes from inception to October 10, 2023. The primary outcome was the 28-day mortality. Length of stay, heart rate control, and inotropes/ vasopressors requirement were considered secondary outcomes. ResultsAmong 47 potentially relevant studies, nine were included in the analysis. The 28-day mortality risk was lower in patients with septic shock who used beta-blockers concomitantly with vasopressors/inotropes compared with the control group (RR (95%CI): 0.69 (0.53, 0.89),I2=26%;P=0.24). In addition, heart rate (HR) was statistically significantly lower with a standardized mean difference (SMD) of -22.39 (95% CI: -24.71, –20.06) among the beta-blockers group than the control group. The SMD for hospital length of stay and the inotropes requirement were not statistically different between the two groups (SMD (95%CI): -0.57 (-2.77, 1.64), and SMD (95%CI): 0.08 (-0.02, 0.19), respectively). ConclusionThe use of ultra short beta-blockers concomitantly with either epinephrine or norepinephrine in critically ill patients with septic shock was associated with better heart rate control and survival benefits without increment in the inotropes and vasopressors requirement.

THE EFFECTS OF EXERCSE ON PSYCHOLOGICAL HEALTH AND WELLBEING IN PEOPLE DIAGNOSED WITH CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS

INTRODUCTION &amp; AIMS The high psychological burden reported by adults diagnosed with cancer has a large impact on overall and cancer-specific health outcomes. Accumulating evidence indicates that psychological distress may accelerate tumour progression and increase risk of cancer mortality. Research has highlighted that exercise interventions are safe, feasible, and effective at improving both physical and psychological health for adults diagnosed with cancer. However, there are few systematic reviews that have evaluated psychological health as a primary outcome of interest or analysed the effects of different exercise prescriptions on specific psychological health outcomes. This systematic review aims to meta-analyse the available evidence and determine the effects of exercise on psychological health in individuals diagnosed with cancer. METHODS Systematic review with meta-analysis utilising a random effects model. Subgroups analysis was included, defined by psychological health outcomes and further stratified by the FITT principle: Frequency; Intensity; Time; and Type of exercise. RESULTS Seventy-eight studies met the inclusion criteria. One hundred and eighty-three individual effect sizes were obtained, which demonstrated small to moderate combined effects of exercise (d = 0.30, 95%CI 0.20; 0.40) across all psychological health outcome measures. CONCLUSION Exercise is an effective intervention to improve psychological health in adults diagnosed with cancer. The subgroup analysis revealed consistent effects across a range of specific psychological health outcomes, differences were observed between exercise prescriptions, thus highlighting a need for targeted exercise for each psychological health outcome.