Systematic Review Guidelines Research Articles

Stop the bleed " - Prehospital bleeding control in patients with multiple and/or severe injuries - A systematic review and clinical practice guideline - A systematic review and clinical practice guideline.

Our aim was to develop new evidence-based and consensus-based recommendations for bleeding control in patients with multiple and/or severe injuries in the prehospital setting. This guideline topic is part of the 2022 update of the German Guideline on the Treatment of Patients with Multiple and/or Severe Injuries. MEDLINE and Embase were systematically searched until June 2021. Further literature reports were obtained from clinical experts. Randomised controlled trials, prospective cohort studies, and comparative registry studies were included if they compared interventions for bleeding control in the prehospital setting using manual pressure, haemostatic agents, tourniquets, pelvic stabilisation, or traction splints in patients with multiple and/or severe injuries. We considered patient-relevant clinical outcomes such as mortality and bleeding control. Transfusion requirements and haemodynamic stability were surrogate outcomes. Risk of bias was assessed using NICE 2012 checklists. The evidence was synthesised narratively, and expert consensus was used to develop recommendations and determine their strength. Fifteen studies were identified. Interventions covered were pelvic binders (n = 4 studies), pressure dressings (n = 1), tourniquets (n = 6), traction splints (n = 1), haemostatic agents (n = 3), and nasal balloon catheters (n = 1). Fourteen new recommendations were developed. All achieved strong consensus. Bleeding control is the basic objective of treatment. This can be easily justified based on empirical evidence. There is, however, a lack of reliable and high-quality studies that assess and compare methods for bleeding control in patients with multiple and/or severe injuries. The guideline provides reasonable and practical recommendations (although mostly with a low grade of recommendation) and also reveals several open research questions that can hopefully be answered when the guideline is revised again.

Prognostic Utility of Autophagy Marker Beclin1 in Oral Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis.

Autophagy is involved in several critical cellular processes regulating cell survival and death. Past research suggests that it may either act as a tumor suppressor or promote tumor progression. The purpose of this systematic review and meta-analysis was to evaluate the clinical and prognostic utility of a significant autophagy related protein-Beclin1, in oral squamous cell carcinoma (OSCC). Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed. Relevant literature was retrieved from PubMed, ScienceDirect and Google Scholar database. After removal of duplicates quality of the studies was assessed using Newcastle-Ottawa Scale. Heterogeneity was assessed using I2 index. Random effect model was used if I2 was more than 50% else fixed effect model was selected. Meta-analysis was carried out using Review Manager (RevMan; Version 5.4). Five studies with 494 cases were included in this meta-analysis. Beclin1 expression in OSCC was not significantly associated (p > 0.05) with gender, age, tumor size, lymph node metastasis, histological differentiation and overall survival. Nevertheless, a trend for low Beclin1 expression favoring tumor progression was observed. Sensitivity analysis revealed significant nodal positivity related to low Beclin1 expression. This study provided an overview of Beclin1 expression in OSCC and highlighted additional evaluations while its use as a prognostic marker. It is suggested that future studies should assess both nuclear as well as cytoplasmic expression of Beclin1 and report intra- and inter-tumor variations in its expression relating to clinicopathological parameters.

Advanced Practice Nurses' Roles and Responsibilities in Advance Care Planning for Older Persons-A Mixed Methods Systematic Review.

To systematically identify, evaluate and synthesise the research literature about (a) the roles and responsibilities of advanced practice nurses (APNs) in the context of advance care planning (ACP) for older persons, (b) the characteristics of APNs' ACP practices and (c) the facilitators and barriers influencing APNs' involvement in ACP. Mixed-methods systematic review. Followed the mixed methods systematic review guidelines outlined by the Joanna Briggs Institute. Three researchers independently screened studies for eligibility using the Covidence Screening Application. The screening involved two stages: titles and abstracts, followed by full-text evaluation. The Mixed Methods Appraisal Tool was used for quality assessment. A convergent integrated synthesis combined quantitative and qualitative data by 'qualitising' quantitative findings into text, enabling integration and thematic analysis to synthesise the results. Medline, CINAHL and Embase were searched from 2012 to 2024 for original research in English, focusing on APNs involved in ACP for individuals aged 65 or older, using qualitative, quantitative or mixed method designs. The review included 19 studies: seven qualitative, nine quantitative and three mixed method designs. Thematic analysis revealed that APNs play a key role in ACP, aligning care with patient preferences through discussions and documentation. Studies from the United States (12), United Kingdom (4), Canada (2) and Australia (1) show varying APN roles and responsibilities. APNs are crucial to ACP, but barriers limit their impact. Overcoming these is key to improving outcomes. APNs clinical expertise and close patient relationships are crucial for aligning care with patient preferences and needs in ACP. However, to fully maximise their contribution, it is essential to overcome barriers such as time constraints, lack of role recognition and insufficient training. Addressing these challenges will enhance the effectiveness of APNs in providing person-centred care. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. No patient or public contribution.

Effect of micro and nanoemulsions on wound healing: a review

Emulsions, categorised by their particle size into microemulsions (<100 nm) and nanoemulsions (<200 to <100 nm), hold a position of burgeoning significance in the field of wound healing. Beyond their established role in diverse medical domains, emulsions have emerged as promising agents for drug delivery with wound-healing properties. This review explores a comprehensive analysis of the available literature to shed light on the impact of micro and nanoemulsions on wound healing. Covering research articles published from 2011 to 2022, this study meticulously follows the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines while employing bibliometric analysis tools, PRISMA, and VOSviewer. Through an extensive exploration of databases such as PubMed, Scopus, and ScienceDirect, this study identifies and includes 26 articles that align with the rigorous criteria for investigating emulsions in wound healing. Our bibliometric analysis underscores 'wound healing' as the most prominent keyword in this corpus. In conclusion, this study contributes substantially to the research by combining insights into the effects of nano and microemulsions on wound healing, offering a foundation for future investigations and applications within emerging nanotechnology.

How Nurses' Interventions Promote Health Literacy in Patients With Non-Communicable Diseases: A Systematic Review.

More than one-third of all diseases in the world are non-communicable diseases (NCDs), and poorer health outcomes are linked to low health literacy (HL), in which nurses have a significant role to play. Various studies have confirmed that there is an association between HL and NCDs. However, less is known about how nurses can intervene in the development of HL in patients with NCDs. This systematic review was carried out to explore, in a comprehensive way, nursing interventions that could promote HL in patients with NCDs. A systematic review (PROSPERO registration number: CRD370625) was carried out on five databases (PubMed MEDLINE, Web of Science, Scopus, ScienceDirect and JSTOR). Sequences that provided information for our study topic were retrieved and analysed following PRISMA guidelines for systematic reviews. In total, 1915 titles and abstracts were screened, 71 articles were assessed in full-text screening and 25 studies were included in the review. Around 23 different nurse-led intervention strategies were identified, but only 11 major ones were explored in detail. The majority of them prioritised communication (teach-back), self-management programs, counselling and education. In the majority of the trials, a significant positive outcome was discovered. Both nurses and patients needed to devote time and attention to the complex nurse-led HL interventions. Nurses' HL interventions have shown promise in promoting HL and other health outcomes in people with NCDs, but they need to be tailored to fit specific patients. Nursing programs should include more than just patient teaching strategies. Nurses' HL efforts hold potential for enhancing HL in NCD patients, provided they are customised to individual needs.

Risk Factors and Predictors for Persistent Dyspnea Post-COVID-19: A Systematic Review.

The most frequently reported post-coronavirus disease of 2019 (COVID-19) symptoms include shortness of breath, fatigue, and cognitive disturbances, with reports of persistent dyspnea ranging between 26% and 41%. There is an urgent need to understand the risk factors and predictors for persistent COVID-19 dyspnea in individuals at all levels of COVID-19 illness severity, to enable the implementation of targeted interventions for those likely to be most affected with persistent dyspnea. Thus, the purpose of this systematic review is to explore the risk factors and predictors that are associated with persistent dyspnea in the post-COVID-19 population. This review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and registered prospectively in PROSPERO as CRD42023466713. A search strategy was conducted across PubMed, CINAHL, Web of Science, and EMBASE databases, that included studies conducted from 2020 to March 2024. The Covidence platform was used for screening studies, scoring methodologic quality, and performing data extraction using a two-step independent review process. This review included 33 studies, addressing 83,920 participants across 20 countries. The strongest predictive risk factors for persistent dyspnea included the following: female sex, elevated body mass index, pulmonary comorbidities, pre-existing anxiety and depression, pre-COVID-19 physical limitations, the severity of the COVID-19 illness, and socioeconomic differences. Potential risk factors included increased age, smoking history, and COVID-19 variant type. The presence of biomarkers for persistent dyspnea in the post-COVID-19 population can be used by clinicians to prospectively identify those individuals who should be flagged. Early identification may then be leveraged for timely referral for prophylactic and rehabilitative interventions for dyspnea. A personalized plan to target those risk factors that are modifiable should follow.

Exploring the impact of xenobiotic drugs on forensic entomology for accurate post-mortem interval estimation

Forensic entomotoxicology is an emerging field within forensic entomology that investigates the effects of chemicals, drugs, and toxins on insect development and their implications for postmortem interval (PMI) estimation. This systematic overview delves into the influence of drugs such as Morphine, heroin, Opiates, and cocaine on the variables affecting the use of forensically significant insects as evidence tools. Notably, it has been observed that the presence of drugs does not appear to alter the progression of the lifecycle from the first instar to the emergence of flies, indicating that PMI estimations based on fly emergence remain unaffected by drugs. However, larvae treated with drugs frequently show delayed pupation, suggesting the need for further research into the impact of different compounds on various insect species over more extended observation periods. Additionally, conflicting results have been noted regarding how toxins can influence the developmental process in larvae, underscoring the necessity to assess the effect of different classes of compounds on other insect species. The study also recommends exploring factors such as the samples’ collection site and the drugs’ pathological implications to inspire future research. Furthermore, the paper underscores the potential for varying drug effects across insect species, emphasizing the complexity of interpreting drug impacts on PMI estimations. This systematic review was conducted by the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines.

Gender exclusion in succession on family business: a deeper look

Purpose This study aims to discern and examine the primary themes associated with gender and succession within family business by using bibliometric methodologies, including coauthorship analysis and co-word analysis. These techniques are used to pinpoint the predominant subject matters within this domain. Design/methodology/approach A data set of 74 articles published between 2000 and 2021 was gathered from the Web of Science database. These articles were selected based on bibliographical records following the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Subsequently, VOSviewer was employed to conduct a landscape analysis of the research pertaining to gender and succession in family businesses. Findings The analysis unveiled several noteworthy findings. Campopiano and McAdam emerged as notable contributors in this field, while Bertoni and Cavicchioli received the highest number of citations. The USA and Italy were identified as primary hubs of research activity, with significant contributions also stemming from other European nations. However, research originating from the Asian region appeared relatively sparse. Co-citation analysis underscored the influential works of Bennedsen et al. (2007) and Vera and Dean (2005) within this domain. In addition, the Family Business Review emerged as the most cited journal source for gender and succession research within family businesses. Research limitations/implications The data used in this study were only obtained from the Web of Science database collection, which may not include all of the available literature on this research topic. Future research should consider augmenting this data set with additional credible international databases to gain a more comprehensive understanding of gender and succession discourses in family businesses and their dynamics. Practical implications The outcomes of this research provide actionable insights for practitioners and leaders in family businesses. Recognizing the nuances of gender dynamics in succession is essential for making informed decisions about successor selection and developing effective strategies. The insights derived from this study can assist managers and founders in addressing succession challenges more effectively and optimizing succession processes within their family enterprises. Understanding these dynamics can contribute to more inclusive and successful succession outcomes. Social implications From a societal perspective, this research contributes to broader dialogues concerning gender equality and the dynamics of family businesses. By illuminating gender-related issues within succession processes, this study underscores the critical need to address gender biases and promote inclusivity within family enterprises. These efforts are pivotal in fostering more equitable and sustainable business practices. Originality/value These insights provide valuable perspectives on the contemporary research landscape concerning gender and succession within family enterprises, highlighting influential scholars and regional patterns. This study offers guidance for future research endeavors, particularly in addressing gaps in underrepresented regions and advancing the comprehension of gender dynamics in family business succession. The practical significance of this research extends to managers and founders of family businesses, aiding in the selection of future successors. Furthermore, it contributes to scholars by enhancing the understanding of succession strategies, processes and dynamics, especially those pertaining to gender considerations.

Drug Induced Sleep Endoscopy-Directed Tongue Surgery to Treat Persistent Pediatric Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis.

To systematically review the literature for articles evaluating outcomes of drug-induced sleep endoscopy (DISE) directed tongue surgery in children with prior adenotonsillectomy and persistent or recurrent obstructive sleep apnea (OSA), and to perform a meta-analysis on the polysomnographic (PSG) data. Systematic review and metanalysis in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement guidelines. Primary, post-operative apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT); Secondary, surgical response rate. Seven studies (283 patients) met criteria and reported PSG outcome data for the systematic review. The mean ± standard deviation surgical response rate was 70.0% ± 17.0% [95% CI 67.6, 71.6]. Six of the seven studies (270 patients) reported specific pre- and post-operative PSG data included in our meta-analysis. The pre- and post-operative AHI decreased from 9.5 ± 12.1 to 4.2 ± 6.9 events/h (p < 0.04) with a mean difference (MD) of -5.13 [95% CI -7.13, -3.13], Z-score 5.02 (p < 0.00001). LSAT improved from 87.8 ± 5.7 to 90.1% ± 5.1% (p < 0.02) with a MD of 2.71 [95% CI 1.53, 3.89], Z-score 4.51 (p < 0.0001). Existing literature demonstrates DISE-directed tongue surgery in children with persistent OSA can reduce AHI by approximately 50%, improve LSAT by nearly 3%, and have an overall positive response to surgery rate of 70%. There is collective evidence that DISE-directed tongue surgery is effective; limitations include heterogeneity in reported outcomes influenced by confounding factors.

The Role of Convolutional Neural Network (CNN) Based on Dermoscopy Imaging for Early Detection of Melanoma: A Systematic Review

Background: AI systems for melanoma detection have shown considerable potential. Although, dermoscopy has become a widely utilized non-invasive method for diagnosing skin tumors. However, the variability in diagnosis caused by subjective interpretation of dermatological findings can affect both accuracy and consistency. Therefore, we conducted this study to review the accuracy, sensitivity, and specificity of Convolutional Neural Network (CNN) based on dermoscopy imaging in diagnosing melanoma. Method: This systematic review was conducted in accordance with the Preferred Reporting Items of Systematic Reviews (PRISMA) guidelines. We limited the studies from 2019 until 2024. All studies that assessed diagnostic accuracy of CNN in diagnosing melanoma were analyzed. QUADAS (Quality Assessment of Diagnostic Accuracy Studies) is used to assess the quality of diagnostic accuracy studies. Results: Eleven studies were eligible to be included in this study. The Area Under Curve (AUC) among the studies varied between 81.3% and 92.6%. Sensitivity varied between 69.1% and 94.2%. Specificity varied between 65% and 84.63%. Conclusion: The AUC, sensitivity, and specificity showed good results compared to dermoscopy alone. However, the usage of artificial intelligence was as an adjunctive tool, not as a replacement for dermatologists.

The impact of preexisting psychiatric disorders on patient outcomes following primary total shoulder arthroplasty: A systematic review and quantitative synthesis.

To summarize complication rates, reoperation rates, length-of-stay (LOS), patient-reported outcome measures (PROMs), and range of motion following total shoulder arthroplasty (TSA) in patients with preexisting psychiatric disorders (PDs) compared to controls. Three databases (MEDLINE, PubMed, and EMBASE) were searched from inception to 4 March 2024 to identify studies comparing outcomes between patients undergoing anatomic (aTSA) or reverse TSA (rTSA) with or without a preexisting psychiatric condition. The authors adhered to the preferred reporting items for systematic reviews and meta-analyses and revised assessment of multiple systematic review guidelines. Data on demographics, as well as postoperative complication rates, reoperation rates, LOS, PROMs, and range of motion were extracted from included studies. PROMs included the American Shoulder and Elbow Surgeons (ASESs) score, and visual analogue scale (VAS) pain score. Meta-analyses were conducted for outcomes reported by multiple studies, with odds ratios (ORs) and mean differences (MDs) as effect measures for continuous and dichotomous outcomes, respectively. Thirteen studies were included in this review, comprising a total of 820,831 TSA patients. The PD group (71.0% female) consisted of 150,432 patients (mean age: 67.6 ± 9.9) with a mean follow-up time of 34.1 ± 30.1 months. The control group (58.1% female) consisted of 670,399 patients (mean age: 69.4 ± 10.7) with a mean follow-up time of 39.1 ± 36.0 months. The PD group had significantly higher rates of complications and reoperation. The PD group also reported significantly lower postoperative ASES scores, higher postoperative VAS scores, and inferior postoperative abduction. There were no significant differences in postoperative LOS, forward flexion, internal rotation, or external rotation. Patients with preexisting PDs may have a one-and-a-half times higher odds of postoperative complication or reoperation, as well as significantly worse postoperative pain and PROMs. Identification of at-risk individuals with preexisting psychiatric conditions and preoperative referral to a mental health specialist to optimize psychiatric conditions may benefit this patient cohort ahead of their shoulder arthroplasty procedure. IV.

Effect of sarcopenic obesity on treatment results in patients with malignant tumors of the gastrointestinal tract: systematic review

Background. Tumors of the gastrointestinal (GI) tract are characterized by high morbidity and poor prognosis. Over the past decade, sarcopenia (skeletal muscle depletion), myosteatosis, sarcopenic obesity were all shown to have negative prognostic effect in patients with various GI malignancies. However, the role of sarcopenic obesity (SO) in patients with GI tumors remains controversial. We have summarized clinical trial data on the effect of SO on treatment results in patients with malignant GI tumors who underwent surgical and/or drug antitumor treatment.Materials and methods. Thisstudy was conducted in comliance with the Preferred Reporting Itemsfor Systematic Review and Meta-Analyses (PRISMA) guidelines. PubMed and Cochrane Library databases were searched for relevant original studies published between January 2009 and December 2022 reporting postoperative complication rate and mortality, long-term survival and chemotherapy toxicity in SO patients with GI cancers.Results. Twenty four studies with 9,601 patients were included. The percentage of SO patients ranged from 2.6 to 51 %. Due to significant heterogeneity of SO determination methods and varying threshold values, the association between SO and outcomes of interest was inconsistent. SO was significantly associated with development of major postoperative complications in six studies. In contrast, three studies did not show any effect of SO on postoperative complications. Only two studies demonstrated that the mortality rate was significantly higher among patients with SO compared to those without SO. Four studies using multivariate analysis showed statistically significant effect of SO on long-term survival, one study – on disease-free survival. However, three trials contradicted this finding and reported that SO was not a negative prognostic factor of long-term survival in GI cancer patients. Three studies investigating SO effect on the outcomes of drug antitumor treatment showed negative effect of SO on chemotherapy toxicity.Conclusion. There is considerable heterogeneity in methods used to define SO in the literature, and current data is limited. Standardized terminology and deeper understanding of sarcopenic obesity pathophysiology is needed to further understand the effect of obesity and sarcopenia on clinical trajectory of patients with GI cancer.

Recommendations for the primary prevention of atherosclerotic cardiovascular disease in primary care: a systematic guideline review.

This study systematically reviews and synthesizes recommendations from national and international clinical practice guidelines (CPGs) regarding the primary prevention of atherosclerotic cardiovascular disease (ASCVD) in adults in primary care settings. CPGs were retrieved from MEDLINE, Trip, guideline repositories, and websites of guidelines-producing societies. Two reviewers independently screened the guidelines for eligibility, assessed their quality, and extracted study characteristics and relevant recommendations for further consistency analysis. Recommendations, with their strength and evidence level, were thematically coded and clustered around clinical questions using ATLAS.ti. We included 26 CPGs from which we extracted 581 recommendations on risk assessment, non-pharmacological, and pharmacological interventions. Twenty-one guidelines (81%) were rated as having "very good" methodological quality. We categorized the recommendations into 124 clusters. Forty-four clusters (35%) included consistent recommendations, but only four of them (3%) included highly consistent recommendations. These clusters emphasized avoiding routine prescriptions of nicotinic acid, aspirin, and fibrates for primary ASCVD prevention alone, and recommending 20 mg/day of atorvastatin for high-risk ASCVD patients. The recommendations also highlighted the importance of adhering to a Mediterranean-type diet, patient-centered counseling, and standardized risk assessment for patients over the age of 40. This review underscores the heterogeneity in primary ASCVD prevention recommendations and the importance of personalized strategies for at-risk individuals. PROSPERO, CRD42023394605, available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023394605.

Safety profiles of fondaparinux in pregnant women: a systematic review and meta-analysis.

The prevalence of conditions necessitating anticoagulation therapy among pregnant women has been steadily increasing. Although low-molecular-weight heparin (LMWH) is commonly used, several studies have investigated the use of fondaparinux in pregnant women. However, the safety profile of fondaparinux in this population remains to be fully elucidated. A comprehensive literature search across ten databases was conducted in September 2024. This meta-analysis was conducted following the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines for systematic reviews of observational studies. Dichotomous data from eligible studies were combined using the Mantel‒Haenszel model. Standard mean differences with 95% confidence intervals were assessed. Heterogeneity was evaluated using I2 statistics and the Cochran Q test, and the quality of evidence was appraised using Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Nine studies met the inclusion criteria. Based on the GRADE approach, the quality of evidence ranged from very low to low. Fondaparinux did not increase the incidence of bleeding-related adverse events (vaginal bleeding: OR = 0.99, 95% CI 0.43-2.30, P = 0.98; postpartum haemorrhage: OR = 0.35, 95% CI 0.07-1.73, P = 0.20). Fondaparinux was associated with reduced risks of hepatic transaminase elevation (OR = 0.20, 95% CI 0.08-0.49, P < 0.01), gastrointestinal reactions, allergies, and injection site skin reactions (OR = 0.19, 95% CI 0.09-0.41, P < 0.01). The findings of this systematic review and meta-analysis suggest that the use of fondaparinux among pregnant women has certain advantages. However, these conclusions warrant further validation through high-quality, large-scale studies conducted in multiple countries. (PROSPERO-CRD42024591579).

Rigour of Development of European Society of Cardiology, American College of Cardiology and American Heart Association guidelines over a 12-year period (2013-2024): a systematic review of guidelines.

The ESC and ACC/AHA regularly publish guidelines for the management of cardiovascular disease. By definition, a guideline should follow strict methodological criteria, and have a transparent, traceable and reproducible development process. We aimed to assess the overall strength of the recommendations and rigour of methodological development in ESC and ACC/AHA guidelines. A systematic review of the ESC and ACC/AHA guidelines published from 2013 to 2024 was conducted. Documents Class of Recommendation (COR) and Level of Evidence (LOE) of recommendations were included. For each document, data regarding citation count (ISI and Scholar), and COR and LOE of the recommendations were extracted. Guidelines were assessed for rigour of methodological development using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. Among the 76 included guidelines, the average citation-per-year was 344 (ISI) and 681 (Scholar). Forty-nine % of the recommendations were classified as COR I (strong recommendations), while 46% were based solely on expert opinion (LOE C). The overall AGREE II methodology domain score was 29±6 (range 7-56), with lowest performance for the domains of systematic search of evidence, use of predefined criteria for selecting the evidence and external review. Both the strength of the recommendations and rigour of development showed a stable trend over the past 12 years. The ACC/AHA guidelines followed more rigorous development methods compared to ESC (AGREE II 36±3vs. 24±3). Clinical guidelines from the main European and American cardiovascular societies are highly cited but show significant limitations in methodological rigour.

Benefits of Remote-Based Mindfulness on Physical Symptom Outcomes in Cancer Survivors: Systematic Review and Meta-Analysis.

Many cancer survivors experience a wide range of symptoms closely linked to psychological problems, highlighting the need for psychological treatment, one of the most popular being mindfulness. The use of the internet has greatly increased in the last decade, and has encouraged the use of remote-based interventions to help people living with cancer access treatment remotely via devices. The primary aim of this study was to explore the efficacy of internet-based mindfulness interventions on the physical symptoms of people living with cancer, where physical symptoms are defined as distressing somatic experiences (eg fatigue, insomnia, and pain) regardless of the underlying cause. The secondary aim was to investigate interventions for the quality of life (QoL). This study followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Relevant articles were systematically searched using electronic databases, namely Scopus, Medline through PubMed, Cumulated Index in Nursing and Allied Health Literature (CINAHL) through EBSCOhost, and Cochrane Central Database. Randomized controlled and pilot trials involving adults and/or older adults with cancer and using remote-based mindfulness interventions compared to usual care were included. The quality of the trials included in this study was assessed using the revised Cochrane risk of bias, version 2.0. This study estimated the standardized mean difference (SMD) and mean difference (MD) with 95% CI. The I2 test was used to identify potential causes of heterogeneity. Publication bias was assessed using contour-enhanced funnel plots and the Egger linear regression test to reveal a small study effect. The initial search yielded 1985 records, of which 13 studies were ultimately included. After treatment, remote-based mindfulness significantly reduced fatigue (SMD -0.94; 95% CI: -1.56 to -0.33; P=.002), sleep disturbance (SMD -0.36; 95% CI: -0.60 to -0.12; P=.004), and improved physical function (SMD .25; 95% CI: 0.09 to 0.41; P=.002) compared to that observed before treatment. However, compared with usual care, remote-based mindfulness showed a statistically significant reduction only in sleep disturbance (SMD: -0.37; 95% CI: -0.58 to -0.16; P=.0006) after treatment. Moreover, remote-based mindfulness was not statistically significant in reducing pain both within and between groups. Remote-based mindfulness shows promise in reducing sleep disturbances; however, its impact on fatigue, pain, and physical function may be limited.

PLA2R autoantibodies, a multifaceted biomarker in nephrotic syndrome and membranous nephropathy.

The PLA2R antibody test is a valuable first-line diagnostic tool for primary membranous nephropathy (MN), helping to identify PLA2R-related MN and potentially eliminating the need for a kidney biopsy in some individuals. By reducing the reliance on biopsies, the test streamlines diagnosis and improves patient care. However, determining the optimal PLA2R measurement method and cut-off is critical to maximising the benefits of the test and minimising any harms. A systematic review and meta-analysis were performed to evaluate serum- and urine-based biomarkers for distinguishing between PLA2R-related MN and non-PLA2R MN. Searches were conducted in databases including Medline, Embase, Cochrane Library, Scopus, Web of Science, INAHTA, and ClinicalTrials.gov. The methodology followed Cochrane-recommended guidelines for systematic reviews and meta-analyses, and the QUADAS-2 tool was utilised to assess the overall risk of bias. Ninety one studies met the eligibility criteria for inclusion in the review. Of these, 38 studies reporting the accuracy of the PLA2R-Ab test using the EUROIMMUN ELISA method and 27 using the EUROIMMUN IF method were suitable for meta-analysis.. The pooled sensitivity and specificity of EUROIMMUN ELISA at a cut-off value of 20 RU/ml were 0.64 (95% CI: 0.56, 0.72) and 94.7% (95% CI: 90.5 - 97.1%), respectively. The pooled sensitivity and specificity of EUROIMMUN IF at a threshold of 1:10 was 0.69 (95% CI: 0.637 - 0.739) and 0.98 (95% CI: 0.931 - 0.994), respectively. Risk of bias was higher for studies evaluating the IF compared to ELISA test. We also explored whether the timing of the index test had an impact on the pooled diagnostic accuracy results; no significant differences were found. By evaluating the specificity and sensitivity of EUROIMMUN ELISA PLA2R-Ab and immunofluorescence (IF), we demonstrate that at ELISA levels ≥20 RU/mL, alongside thorough secondary screening, a kidney biopsy may be unnecessary. However, lower or negative levels still warrant a biopsy.

Improving large language model applications in biomedicine with retrieval-augmented generation: a systematic review, meta-analysis, and clinical development guidelines.

The objectives of this study are to synthesize findings from recent research of retrieval-augmented generation (RAG) and large language models (LLMs) in biomedicine and provide clinical development guidelines to improve effectiveness. We conducted a systematic literature review and a meta-analysis. The report was created in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 analysis. Searches were performed in 3 databases (PubMed, Embase, PsycINFO) using terms related to "retrieval augmented generation" and "large language model," for articles published in 2023 and 2024. We selected studies that compared baseline LLM performance with RAG performance. We developed a random-effect meta-analysis model, using odds ratio as the effect size. Among 335 studies, 20 were included in this literature review. The pooled effect size was 1.35, with a 95% confidence interval of 1.19-1.53, indicating a statistically significant effect (P = .001). We reported clinical tasks, baseline LLMs, retrieval sources and strategies, as well as evaluation methods. Building on our literature review, we developed Guidelines for Unified Implementation and Development of Enhanced LLM Applications with RAG in Clinical Settings to inform clinical applications using RAG. Overall, RAG implementation showed a 1.35 odds ratio increase in performance compared to baseline LLMs. Future research should focus on (1) system-level enhancement: the combination of RAG and agent, (2) knowledge-level enhancement: deep integration of knowledge into LLM, and (3) integration-level enhancement: integrating RAG systems within electronic health records.

The Impact of Sinus Surgery for Chronic Rhinosinusitis on Concomitant Depression and Anxiety Symptoms: A Systematic Review and Meta-analysis.

Both anxiety and depression are prevalent among patients with chronic rhinosinusitis (CRS) and associated with poorer outcomes following treatment for CRS. However, the impact of treatment on CRS on mental health remains uncertain. Therefore, this study seeks to evaluate if surgical intervention for CRS may alleviate comorbid depression and anxiety. PubMed, Embase, and Scopus databases were searched for retrospective and prospective cohort studies, cross-sectional studies, and randomized controlled trials relating to CRS treatment using sinus surgery from inception to April 30, 2024, using the Population, Intervention, Comparison, and Outcomes (PICO) framework. Three blinded reviewers selected observational studies and randomized controlled trials investigating levels of depression and anxiety pre- and post-surgical treatment of CRS. Eleven studies comprising 3067 patients were included, of which five studies were quantitatively analyzed. After which, data were extracted from included articles into a structured proforma and the Newcastle-Ottawa Scale was used to evaluate study bias, following Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines and a PROSPERO-registered protocol (CRD42022351855). Meta-analyses of the ratio of means were conducted in a random-effects model. Overall, sinus surgery was associated with significant improvement in test scores of depression (ratio of means (ROM) = 1.47, 95% confidence interval [CI] = 1.03‒2.10), anxiety (ROM = 1.10, 95% CI = 0.81‒1.49), and quality of life markers, which are closely correlated to mental health outcomes. Sinus surgery for CRS may improve mental health outcomes (both depression and anxiety) for patients.

Lived experiences of people with chronic kidney disease on maintenance dialysis: a systematic review and thematic synthesis of qualitative studies

AimChronic Kidney Disease (CKD) has emerged as a global public health concern. People with the most advanced stage of CKD require renal replacement therapies, either dialysis (the focus of this study) or a kidney transplant. Research on CKD has primarily focused on its clinical, epidemiological, and public health aspects. However, studies exploring the lived experiences of individuals on dialysis and the key factors influencing these experiences are limited, particularly in low- and middle-income settings. Therefore, this study aims to synthesize the existing literature on the illness experience of people living with CKD who are on maintenance dialysis across different country contexts.MethodsAdhering to PRISMA and PiCO guidelines for systematic review, we identified original studies published between 2000 and 2024, focusing on the lived experience of patients with CKD on dialysis, across PubMed, Web of Science, and Scopus databases. A thematic analysis was conducted based on two frameworks: Michael Bury’s biographical disruption model of chronic illness, and the framework on internal and external factors affecting self-care.ResultsA total of 59 studies were included, and the following key themes were identified: 1) disrupted biographies among people on dialysis, which included: (a) diagnosis and initiation of dialysis, (b) disabling physical symptoms and functional limitations, (c) impaired socio-occupational functioning, (d) uncertainty and psychological distress, and (e) changes in self-image and identity; and 2) biographical repair, which included: (a) coping with CKD and dialysis, (b) coping styles, and (c) coping strategies. The key internal factors influencing the lived experiences were personal beliefs and misconceptions about CKD, feelings of shame and guilt, financial constraints, and spirituality. The external factors included family and social support, information and treatment received from the clinical team, social stigma, availability and quality of dialysis services, and access to health insurance.ConclusionsThis review deepens our understanding of the lived experiences of individuals undergoing maintenance dialysis across diverse settings and illuminates the internal and external factors that shape these experiences. Our findings emphasize the necessity of a holistic and person-centred approach to dialysis care and highlight the need to make dialysis services more accessible and affordable in low- and lower-middle-income countries.