Systematic Reviews最新文献

Introduction: Empathy is a crucial skill that enhances the quality of patient care, reduces burnout among healthcare professionals, and fosters professionalism in medical students. Clinical practice and standardized patient-based education provide opportunities to enhance empathy, but a lack of consistency and reproducibility as well as significant dependency on resources are impediments. The COVID-19 pandemic has further restricted these opportunities, highlighting the need for alternative approaches. Virtual patients through standardized scenarios ensure consistency and reproducibility while offering safe, flexible, and repetitive learning opportunities unconstrained by time or location. Empathy education using virtual patients could serve as a temporary alternative during the COVID-19 pandemic and address the limitations of traditional face-to-face learning methods. This review aims to comprehensively map existing literature on the use of virtual patients in empathy education and identify research gaps.

Methods: This scoping review will follow the Joanna Briggs Institute's guidelines and be reported according to PRISMA-P. The search strategy includes a comprehensive search across databases such as PubMed (MEDLINE), CINAHL, Web of Science, Scopus, ERIC, Google, Google Scholar, and Semantic Scholar, covering both published and gray literature without language restrictions. Both quantitative and qualitative studies will be included. Two independent researchers will screen all titles/abstracts and full texts for eligibility. Data will be extracted to summarize definitions of empathy, characteristics of virtual patient scenarios, and methods for measuring their impact on empathy development. Results will be presented in narrative and tabular formats to highlight key findings and research gaps.

Discussion: As this review analyzes existing literature, ethical approval is not required. Findings will be actively disseminated through academic conferences and peer-reviewed publications, providing educators and researchers with valuable insights into the potential of virtual patients to enhance empathy in medical education. This study goes beyond the mere synthesis of academic knowledge by contributing to the advancement of medical education and clinical practice by clarifying virtual patient scenario design and evaluation methods in empathy education. The findings provide a critical foundation for our ongoing development of a medical education platform aimed at enhancing empathy through the use of virtual patients.

Background: Research priority setting has the potential to bridge knowledge gaps, optimize resource allocation, foster collaborations, and inform funding directions for implementation science and practice when these priorities are properly acted upon. This systematic review aims to determine the extent of research in priority setting for implementation science and practice, examine the methodologies employed, synthesize these research priorities, and identify strategies for evaluating and implementing these priorities.

Methods: We will conduct a living systematic review following the Cochrane guidance. We will search literature from six databases, the website of James Lind Alliance, five implementation science-focused journals and several related journals, Google Scholar, and the reference lists of included studies. Two reviewers will independently screen studies based on the eligibility criteria. The characteristics of the included documents, their prioritization methods, and outcomes, as well as the evaluation and implementation strategies, will be extracted. We will critically appraise these documents using the nine common themes of good practice for research priority setting, and synthesize data using a narrative approach. We will re-run the search 12 months after the original search date to monitor the development of new literature and determine the time to update the review.

Discussions: By conducting this living systematic review, we will gain a comprehensive and dynamic understanding of the potential research gaps and hotspots in implementation science as perceived by researchers and practitioners. The findings of this review will inform the future research directions of implementation science and practice.

Systematic review registration: This review has been registered with the Open Science Framework ( https://osf.io/sr69k ).

Background: Gestational diabetes mellitus (GDM) is a transitory form of diabetes occurring in pregnancy with maternal and neonatal health consequences if left untreated. GDM can, in most instances, be managed non-medically through self-care practices, such as eating healthy or engaging in physical activity. This is especially relevant in a global health context with scarce resources. There is no official definition of "GDM self-care"; hence, the content and delivery modes of such interventions may vary greatly. Therefore, this study aimed to landscape GDM self-care interventions in low- and middle-income countries according to the WHO's three dimensions of health.

Methods: PubMed, Embase, Global Health Library, and Web of Science were searched for published intervention studies that compared the effect of a self-care intervention to standard care or had no comparator. Studies that targeted women with GDM that reported maternal health and/or neonatal health outcomes (physical, mental, and social health outcomes) and were conducted in low- and middle-income countries were included in the review.

Results: Twenty-nine studies (randomised controlled trials and non-randomised studies) were included in the review. No studies were conducted in low-income countries, and studies were primarily conducted in Asia. Most interventions were complex and contained several interacting elements in relation to content, delivery mode, duration, and modality. Most interventions aimed to improve the physical health dimension (n = 28; 96.6%), whilst the mental health (n = 11; 37.9%) and social health dimensions (n = 9; 31.0%) were addressed to a lesser extent.

Conclusions: Current GDM self-care interventions in LMICs are complex, and the content of self-care interventions overlaps with lifestyle and non-pharmaceutical interventions. It is recommended that the scientific community use a standardised terminology for such interventions and that future GDM intervention studies, as a minimum, use the core outcome set for GDM when developing future studies.

Systematic review registration: OSF Registries (2 December 2022) [ https://doi.org/10.17605/OSF.IO/PJZQ3 ].

Introduction: Understanding the genuine experiences and requirements of caregivers and implementing targeted interventions can have a positive impact on the physical and mental well-being of caregivers with children diagnosed with rheumatic diseases, ultimately reducing their burden and enhancing their quality of life. While there has been a gradual increase in research in this area in recent years, there remains a gap in the evidence that comprehensively and systematically reflects the actual experiences and needs of caregivers. We will employ a mixed-methods approach to evaluate the real-life experiences and requirements of caregivers for children diagnosed with rheumatic diseases to provide insights for both research and clinical interventions. METHODS AND ANALYSIS: All types of studies (quantitative, qualitative, and mixed-methods) involving caregivers of children aged 0 to 18 with rheumatic diseases will be included. We will conduct a comprehensive search across multiple databases, including MEDLINE (PubMed), Embase (Ovid), PsycINFO (Ovid), CINAHL (EBSCO), Cochrane Central Register of Controlled Trials (CENTRAL), CNKI, WanFang, and VIP, as well as the grey literature, to identify primary studies published in either English or Chinese since 2000. Two independent reviewers will conduct the selection process and cross-check the data extraction. The focus of interest will be on understanding the experiences and needs of caregivers for pediatric rheumatic disease patients. In our systematic review, we will employ the 2018 version of the Mixed Methods Assessment Tool (MMAT) to evaluate study quality, and we will apply a convergent integration approach to synthesize the data.

Ethics and dissemination: Ethical approval is not needed, as no primary data will be collected. The results will be made available through a peer-reviewed publication.

Systematic review registration: PROSPERO 42023465302.

Objective: This study aimed to systematically evaluate the safety and effectiveness of repetitive transcranial magnetic stimulation (rTMS) in treating motor dysfunction in stroke patients.

Methods: A systematic search was conducted in five online databases, namely, Medline, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, and SPORTDiscus, from their inception to July 29, 2024. Studies meeting the predetermined inclusion criteria were included. The data were analyzed using RevMan 5.4.1 software and Stata 15.0. The subgroup analysis was conducted based on various disease stages and intervention frequencies. The overall effects were estimated using either the fixed effects model or the random effects model, with standardized mean differences (SMDs). The level of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework.

Results: A total of 70 studies encompassing 2951 stroke survivors were included. The results of the quantitative analysis revealed that the application of 1 Hz rTMS over the contralesional primary motor cortex (M1) significantly improved motor function during both the early stage (< 1 month) with moderate effect size (n = 443, SMD = 0.44, 95% CI 0.24 to 0.63, P < 0.00001, I² = 47%, fixed-effect model) and recovery period (1-6 months) with moderate effect size (n = 233, SMD = 0.61, 95% CI 0.34 to 0.87, P < 0.0001, I² = 33%, fixed-effect model). In the context of activities of daily living (ADLs), the application of 1 Hz rTMS over the contralesional M1 can lead to improvements in ADLs among individuals in the early stages of stroke with moderate effect size (n = 343, SMD = 0.67, 95% CI 0.44 to 0.89, I² = 79%, P < 0.00001, fixed-effect model). However, evidence to support that 1 Hz rTMS over contralesional M1 can improve motor dysfunction in the chronic phase of stroke (> 6 months) is insufficient.

Conclusion: Moderate- to high-quality evidence suggests that 1 Hz rTMS over the contralesional M1 may enhance motor function and independence in ADL during the early stages of stroke and the recovery period (within 6 months) with moderate effect. Nonetheless, as for the efficacy of 3, 5, 10, and 20 Hz rTMS in the treatment of motor dysfunction after stroke, it needs to be further determined. It is important to interpret these findings with caution in clinical practice due to the small sample sizes and low quality of the studies reviewed.

Systematic review registration: INPLASY, Registration number is INPLASY202360042. DOI number is https://doi.org/10.37766/inplasy2023.6.0042 .

Background: Haemorrhagic transformation (HT) is a severe complication after ischaemic stroke, but identifying patients at high risks remains challenging. Although numerous prediction models have been developed for HT following thrombolysis, thrombectomy, or spontaneous occurrence, a comprehensive summary is lacking. This study aimed to review and compare traditional and machine learning-based HT prediction models, focusing on their development, validation, and diagnostic accuracy.

Methods: PubMed and Ovid-Embase were searched for observational studies or randomised controlled trials related to traditional or machine learning-based models. Data were extracted according to Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) checklist and risk of bias was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). Performance data for prediction models that were externally validated at least twice and showed low risk of bias were meta-analysed.

Results: A total of 100 studies were included, with 67 focusing on model development and 33 on model validation. Among 67 model development studies, 44 were traditional model studies involving 47 prediction models (with National Institutes of Health Stroke Scale score being the most frequently used predictor in 35 models), and 23 studies focused on machine learning prediction models (with support vector machines being the most common algorithm, used in 10 models). The 33 validation studies externally validated 34 traditional prediction models. Regarding study quality, 26 studies were assessed as having a low risk of bias, 11 as unclear, and 63 as high risk of bias. Meta-analysis of 15 studies validating eight models showed a pooled area under the receiver operating characteristic curve of approximately 0.70 for predicting HT.

Conclusion: While significant progress has been made in developing HT prediction models, both traditional and machine learning-based models still have limitations in methodological rigour, predictive accuracy, and clinical applicability. Future models should undergo more rigorous validation, adhere to standardised reporting frameworks, and prioritise predictors that are both statistically significant and clinically meaningful. Collaborative efforts across research groups are essential for validating these models in diverse populations and improving their broader applicability in clinical practice.

Systematic review registration: International Prospective Register of Systematic Reviews (CRD42022332816).

Background: Diabetic retinopathy (DR) is a leading cause of vision impairment and blindness among individuals with diabetes. Traditional Chinese medicine (TCM) has been explored as an alternative treatment for DR, but the quality of evidence remains uncertain. A comprehensive evidence mapping study is necessary to synthesize existing SRs, identify gaps in the literature, and highlight areas requiring further research.

Objective: This study aims to evaluate the reporting and methodological quality of SRs on TCM for DR and to assess the effectiveness of TCM interventions using an evidence-mapping approach.

Methods: A comprehensive search of major biomedical databases to identify relevant SRs published up to November 2023. The reporting quality of the included SRs was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, while the methodological quality was evaluated using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) tool.

Results: A total of 51 SRs involving 131,084 participants were included in the analysis. Evidence mapping indicated that TCM is relatively effective in treating DR. However, the methodological quality and reporting standards of these SRs were generally suboptimal. According to the AMSTAR 2 assessment, only one SR (2%) was rated as high quality, 29 SRs (56.9%) were of moderate quality, 20 SRs (39.2%) were of low quality, and one SR (2%) was of critically low quality. While all studies adequately reported the PICO components, risk of bias assessment, and statistical methods, none provided information on funding sources. Furthermore, only one study (2%) included a list of excluded studies with reasons, and eight SRs (15.7%) documented pre-specified protocols. Common reporting deficiencies included incomplete protocol and registration details, unclear review rationales, and insufficient presentation of relevant outcome data.

Conclusion: This evidence mapping study highlights the potential benefits of TCM for treating DR while identifying significant gaps in the existing literature. Although TCM interventions show potential benefits for treating DR, the overall quality of SRs is suboptimal. Future research should focus on addressing these gaps, particularly in areas such as funding disclosure and methodological rigor, to enhance the reliability of evidence on TCM interventions for DR.

Background: Sedation is a landmark treatment in the intensive care unit; however, the disadvantages of intravenous sedative drugs are increasingly prominent. Volatile sedation is becoming increasingly popular in ICUs due to fewer technical issues with the development of anaesthesia reflectors.

Objective: To explore the safety and effectiveness of inhaled sedation in critically ill patients.

Search methods: We searched the PubMed, Embase, and Web of Science databases for all randomized trials comparing awakening and extubation times, ICU length of stay, and side effects of different inhaled sedative drugs using an anaesthetic-conserving device (ACD) with intravenous sedation.

Selection criteria: The inclusion criteria were formulated in accordance with the PICOS: P, use of sedatives after admission to the ICU, aged > 18 years; I, intravenous sedatives; C, use of volatile sedatives (heptafluoride, sevoflurane, isoflurane, or desflurane) by AnaConDa or Mirus reflector; O, at least one primary outcome (awakening time, extubation time, ICU length of stay) or secondary outcome (postoperative nausea and vomiting, PONV) or incidence of delirium was reported; and S, RCT. The extubation time was defined as time from ICU admission to extubation.

Data collection and analysis: Two researchers independently conducted literature screening, data extraction, and literature quality evaluation and reached a consensus after cross-checking.

Main results: Fifteen trials with a total of 1185 patients were included, including 568 in the inhaled sedation group and 617 in the intravenous sedation group. Compared with intravenous sedation, inhaled sedation administered through an ACD shortened the awakening time and extubation time. There were no differences in the occurrence of postoperative nausea and vomiting (PONV) between the two groups.

Conclusion: Inhaled sedation has advantages over intravenous sedation in terms of awakening time, extubation time, and ICU LOS (non-cardiac ICU); however, there is no significant difference in the incidence of PONV. Inhaled sedation may be safe and effective for critically ill patients.

Background: Every 7 out of 10 people will experience neck pain at some point during their lifetime. A large proportion of these cases will develop into recurrent or chronic conditions. Typically, physical exercise for neck pain seems to be modestly beneficial, but differential effects across participants of randomised trials have not yet been appropriately considered. This individual participant data meta-analysis (IPD MA) will provide a consolidated synthesis of randomised controlled trials (RCTs) that have been conducted to date. We aim to investigate the effectiveness of exercise therapy for chronic non-specific neck pain.

Methods/design: This study will address the following research questions: (1) what are the effects of exercise therapy compared to no intervention or control interventions on neck pain intensity, pain-related disability, and quality of life? (2) What are the responder and non-responder rates for exercise therapy? (3) What participant characteristics are associated with a clinically meaningful response to exercise therapy? (4) What are the minimal clinically important difference (MCID) and/or minimal detectable change (MDC) values for neck pain intensity, pain-related disability, and quality of life?. This study will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The raw data will be requested from the primary authors of included RCTs. The received original data will be collated into a main datasheet with all the details on every single study, including study details, methodological details, participant demographics, details about intervention and comparison groups, treatment effect modifiers (e.g. workload, medicine usage), and the main outcome measures: pain intensity, pain-related disability, and quality of life. This IPD MA will be performed following a one-step approach, where data from all studies are analysed together while considering the grouping of participants within each study. Risk of bias of included RCTs will be evaluated using the ROB 2.0 tool, and the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach will be used to assess the certainty of evidence.

Discussion: We will analyse IPD of available RCTs exploring the exercise effectiveness for chronic non-specific neck pain. The expected large sample size and consistent presentation of data will allow for further analyses to investigate patient-level heterogeneity in treatment outcomes and the prognosis of chronic non-specific neck pain.

Systematic review registration: PROSPERO CRD42022323359.