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The efficacy and safety of ketorolac for postoperative pain management in lumbar spine surgery: a meta-analysis of randomized controlled trials. 酮咯酸治疗腰椎手术术后疼痛的有效性和安全性:随机对照试验荟萃分析。
IF 6.3 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1186/s13643-024-02685-z
Jianbin Guan, Ningning Feng, Kaitan Yang, Haimiti Abudouaini, Peng Liu
<p><strong>Background: </strong>Ketorolac is widely utilized for postoperative pain management, including back pain after lumbar spinal surgery. Several trials have assessed the efficacy of Ketorolac alone and in combination with other analgesics such as bupivacaine, morphine, epinephrine, paracetamol, and pregabalin. However, the effects and safety profile of ketorolac in these contexts remain controversial.</p><p><strong>Objective: </strong>We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of Ketorolac administration, both as a monotherapy and in combination with other analgesics, for managing postoperative pain in adults undergoing lumbar spinal surgery.</p><p><strong>Methods: </strong>We searched PubMed, EMbase, Web of Science, EBSCO, CNKI, WanFang, VIP, and Cochrane library databases through July 2024 for randomized controlled trials (RCTs) assessing the analgesic efficacy of Ketorolac administration for postoperative pain of lumbar surgery. The meta-analysis was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statements. Data were extracted and analyzed using open-source meta-analysis software OpenMeta-Analyst, focusing on outcomes such as VAS pain scores, postoperative morphine requirements (PMR), length of hospital stay (LOS), and adverse effects, such as nausea, vomiting, pruritus, and constipation. The quality of evidence was assessed using the Jada scale.</p><p><strong>Results: </strong>Thirteen RCTs comprising a total of 938 patients were included. The methodological quality of the studies was high, with three studies scoring 5, six studies scoring 4, and four studies scoring 3 on the Jadad scale. Ketorolac significantly reduced pain compared to controls at 0-6 h, with a mean difference (MD) of - 1.42 (95% CI: - 2.03 to - 0.80; P < 0.0001), exceeding the Minimal Clinically Important Difference (MCID) of 1.2 to 2.0 points on the Visual Analog Scale (VAS), indicating clinically meaningful pain relief. During the 6-12-h period, the pain reduction was significant (MD =  - 0.58; 95% CI: - 0.80 to - 0.35; P < 0.0001), though below the MCID threshold. In the 12-24-h period, Ketorolac continued to show significant pain reduction (MD =  - 0.48; 95% CI: - 0.68 to - 0.28; P < 0.0001), but this reduction was also below the MCID. Heterogeneity was low in the 12-24-h period (I<sup>2</sup> = 13%), indicating consistent results across studies. There was a significant reduction in PMR (SMD =  - 1.83; 95% CI =  - 3.42 to - 0.23; P < 0.0001), although with considerable heterogeneity among the studies (I<sup>2</sup> = 93%, heterogeneity P < 0.01). Ketorolac administration also significantly reduced the LOS compared to controls (MD =  - 0.45 days; 95% CI =  - 0.74 to - 0.16; P = 0.0001), though this reduction, which is less than a full day (0.45 days), may have limited clinical significance. The findings suggest that Ketorolac ef
背景:开托拉克被广泛用于术后疼痛治疗,包括腰椎手术后的背痛。多项试验评估了酮咯酸单独使用或与布比卡因、吗啡、肾上腺素、扑热息痛和普瑞巴林等其他镇痛药联合使用的疗效。然而,酮咯酸在这些情况下的效果和安全性仍存在争议:我们对随机对照试验(RCTs)进行了系统回顾和荟萃分析,以评估酮咯酸作为单药或与其他镇痛药联合应用治疗成人腰椎手术术后疼痛的有效性和安全性:截至 2024 年 7 月,我们在 PubMed、EMbase、Web of Science、EBSCO、CNKI、万方、VIP 和 Cochrane 图书馆数据库中检索了评估酮咯酸治疗腰椎手术术后疼痛的镇痛效果的随机对照试验 (RCT)。荟萃分析按照系统综述和荟萃分析首选报告项目(PRISMA)声明进行。使用开源荟萃分析软件 OpenMeta-Analyst 对数据进行提取和分析,重点关注 VAS 疼痛评分、术后吗啡需求量(PMR)、住院时间(LOS)以及恶心、呕吐、瘙痒和便秘等不良反应。证据质量采用 Jada 量表进行评估:结果:共纳入了 13 项 RCT 研究,包括 938 名患者。这些研究的方法学质量较高,其中 3 项研究的 Jadad 评分为 5 分,6 项研究的 Jadad 评分为 4 分,4 项研究的 Jadad 评分为 3 分。与对照组相比,酮咯酸能明显减轻0-6小时的疼痛,平均差(MD)为-1.42(95% CI:-2.03 至 -0.80;P 2 = 13%),表明各研究结果一致。PMR 明显下降(SMD = - 1.83;95% CI = - 3.42 至 - 0.23;P 2 = 93%,异质性 P 结论:无论是单独使用还是与其他镇痛药联合使用,酮咯酸都能有效减轻成人腰椎手术后的疼痛并减少阿片类药物的用量。与其他镇痛药或安慰剂相比,酮咯酸不会明显增加术后恶心和呕吐的发生率。虽然酮咯酸还能缩短手术时间,但其临床意义不大。然而,研究设计、剂量和联合疗法的差异性导致了结果的显著异质性。未来的研究应侧重于规范方案和探索最佳剂量策略。此外,还需要进行长期的安全性和有效性研究,以更好地了解酮咯酸在术后疼痛治疗中的作用。
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引用次数: 0
Semi-automated title-abstract screening using natural language processing and machine learning. 利用自然语言处理和机器学习进行标题-摘要半自动筛选。
IF 6.3 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-01 DOI: 10.1186/s13643-024-02688-w
Maximilian Pilz, Samuel Zimmermann, Juliane Friedrichs, Enrica Wördehoff, Ulrich Ronellenfitsch, Meinhard Kieser, Johannes A Vey

Background: Title-abstract screening in the preparation of a systematic review is a time-consuming task. Modern techniques of natural language processing and machine learning might allow partly automatization of title-abstract screening. In particular, clear guidance on how to proceed with these techniques in practice is of high relevance.

Methods: This paper presents an entire pipeline how to use natural language processing techniques to make the titles and abstracts usable for machine learning and how to apply machine learning algorithms to adequately predict whether or not a publication should be forwarded to full text screening. Guidance for the practical use of the methodology is given.

Results: The appealing performance of the approach is demonstrated by means of two real-world systematic reviews with meta analysis.

Conclusions: Natural language processing and machine learning can help to semi-automatize title-abstract screening. Different project-specific considerations have to be made for applying them in practice.

背景:编写系统综述时的标题-摘要筛选是一项耗时的工作。现代自然语言处理和机器学习技术可使标题-摘要筛选部分自动化。特别是,如何在实践中使用这些技术的明确指导具有重要意义:本文介绍了如何使用自然语言处理技术使标题和摘要可用于机器学习,以及如何应用机器学习算法充分预测出版物是否应转入全文筛选的整个流程。此外,还给出了该方法的实际使用指南:结果:通过两篇真实世界的系统综述和元分析,展示了该方法的吸引力:自然语言处理和机器学习有助于实现标题-摘要筛选的半自动化。在实际应用中,必须针对具体项目做出不同的考虑。
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引用次数: 0
Stroke patient and stakeholder engagement (SPSE): concepts, definitions, models, implementation strategies, indicators, and frameworks-a systematic scoping review. 卒中患者和利益相关者参与(SPSE):概念、定义、模式、实施策略、指标和框架--系统性范围界定综述。
IF 6.3 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-31 DOI: 10.1186/s13643-024-02686-y
Hamidreza Khankeh, Gordon Guyatt, Shima Shirozhan, Juliet Roudini, Torsten Rackoll, Ulrich Dirnagl

Background: Involving stroke patients in clinical research through patient engagement aims to ensure that studies are patient-centered, and may help ensure they are feasible, ethical, and credible, ultimately leading to enhanced trust and communication between researchers and the patient community. In this study, we have conducted a scoping review to identify existing evidence and gaps in SPSE.

Methods: The five-step approach outlined by Arksey and O'Malley, in conjunction with the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) guidelines, provided the structure for this review. To find relevant articles, we searched PubMed, Web of Science, and Embase databases up to February 2024. Additionally, the review team conducted a hand search using Google Scholar, key journals, and references of highly relevant articles. Reviewers screened articles, selecting eligible English-language ones with available full texts, and extracted data from them into a pre-designed table tested by the research team.

Result: Of the 1002 articles initially identified, 21 proved eligible. Stakeholder engagement primarily occurred during the design phase of studies and within the studies using qualitative methodologies. Although the engagement of stakeholders in the research process is increasing, practice regarding terminology and principles of implementation remains variable. Researchers have recognized the benefits of stakeholder engagement, but have also faced numerous challenges that often arise during the research process.

Conclusion: The current study identifies stakeholder groups and the benefits and challenges researchers face in implementing their engagement. Given existing challenges and limited specific models or frameworks, it is suggested to explore applied recommendations for stakeholder engagement in future studies, that may enhance stakeholder engagement, overcome obstacles, and unify researchers' understanding of engagement and implementation.

背景:通过患者参与让卒中患者参与临床研究旨在确保研究以患者为中心,并有助于确保研究的可行性、伦理性和可信性,最终增强研究者与患者群体之间的信任和沟通。在本研究中,我们进行了一次范围审查,以确定 SPSE 的现有证据和差距:方法:Arksey 和 O'Malley 概述的五步方法与范围界定综述首选报告项目 (PRISMA-ScR) 指南相结合,为本综述提供了结构。为了找到相关文章,我们检索了截止到 2024 年 2 月的 PubMed、Web of Science 和 Embase 数据库。此外,综述小组还使用谷歌学术、主要期刊和高度相关文章的参考文献进行了人工搜索。审稿人对文章进行了筛选,挑选出符合条件且有全文的英文文章,并将其中的数据提取到研究小组预先设计好的表格中进行测试:结果:在最初确定的 1002 篇文章中,有 21 篇符合条件。利益相关者的参与主要发生在研究的设计阶段和采用定性方法的研究中。虽然利益相关者在研究过程中的参与度在不断提高,但在术语和实施原则方面的做法仍不尽相同。研究人员已经认识到利益相关者参与的益处,但也面临着研究过程中经常出现的诸多挑战:本研究确定了利益相关者群体以及研究人员在实施参与过程中面临的益处和挑战。鉴于现有的挑战和有限的具体模式或框架,建议在今后的研究中探索利益相关者参与的应用建议,以加强利益相关者的参与、克服障碍并统一研究人员对参与和实施的理解。
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引用次数: 0
Toward a whole-of-virtual school framework for promoting student physical activity: a scoping review protocol. 促进学生体育活动的全虚拟学校框架:范围界定审查协议。
IF 6.3 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-31 DOI: 10.1186/s13643-024-02689-9
Chad M Killian, Eugenia Opuda, Collin A Webster, Taemin Ha, Brian Dauenhauer, Jennifer M Krause

Background: The advent of full-time virtual schooling presents unique challenges and opportunities for the promotion of physical activity (PA) among children and adolescents. Despite the recognized benefits of PA as an essential component for combating non-communicable diseases and ensuring holistic development, there is a notable gap in understanding how to effectively integrate PA within the digital learning environments of full-time virtual schools. Current efforts to promote student PA are targeted for implementation exclusively in contexts characterized by physical school campuses that are bound to their surrounding local communities. This is problematic given the digital, widely distributed, and contextually unmoored nature of virtual schooling. Our aim in this scoping review is to advance research on whole-of-school physical activity promotion within full-time virtual schools by examining the published literature on whole-of-school PA promotion within full-time virtual schools. Specifically, this review will map the literature, consolidate knowledge claims and practical implications, and identify evidence gaps that merit further investigation.

Methods/design: This review will be conducted using evidence-informed scoping review methodology and reporting guidelines. Articles will be included if they are peer-reviewed English-language research, commentary, practical, or grey literature and relate to the participation, support, design, development, and/or provision of remote online PA interventions delivered through primary/elementary and/or secondary/middle school/high schools. Searches will be conducted in PsycInfo, ERIC, SportDiscus, and Web of Science. Additional hand-searching, reference scans, and grey literature searches will also be performed. Two trained research assistants will independently complete study screening and selection and data charting with guidance from a senior author. Charted data will be displayed in table form, and depending on the results, data will also be synthesized through qualitative content analysis using the Active Schools guiding framework as an analytical and interpretive lens.

Discussion: This scoping review will serve as a guidepost for the application and advancement of research on whole-of-school PA promotion through full-time virtual schools. The results will address the increased importance of equitable online learning and PA promotion due to the expanding virtual education landscape, with implications for public health and education policy.

Systematic review registration: Open Science Framework:  https://osf.io/f6wau/ .

背景:全日制虚拟学校的出现为促进儿童和青少年的体育锻炼(PA)带来了独特的挑战和机遇。尽管体育锻炼是防治非传染性疾病和确保全面发展的重要组成部分,其益处已得到公认,但在如何将体育锻炼有效融入全日制虚拟学校的数字化学习环境方面仍存在明显差距。目前,促进学生体育锻炼的工作仅针对以实体校园为特点的实施环境,而实体校园又与周围的当地社区紧密相连。考虑到虚拟学校教育的数字化、广泛分布和与环境无关的性质,这种做法是有问题的。我们本次范围界定综述的目的是,通过研究已发表的有关在全日制虚拟学校内促进全校体育活动的文献,推动有关在全日制虚拟学校内促进全校体育活动的研究。具体而言,本综述将绘制文献地图,整合知识主张和实际影响,并确定值得进一步调查的证据缺口:本综述将采用循证范围界定综述方法和报告指南。如果文章是经同行评审的英文研究、评论、实践或灰色文献,且与通过小学/初级和/或中学/初中/高中提供的远程在线 PA 干预的参与、支持、设计、开发和/或提供有关,则将被纳入。检索将在 PsycInfo、ERIC、SportDiscus 和 Web of Science 中进行。此外,还将进行手工检索、参考文献扫描和灰色文献检索。两名训练有素的研究助理将在资深作者的指导下独立完成研究筛选和数据图表制作。图表数据将以表格形式显示,根据结果,还将使用 "积极学校 "指导框架作为分析和解释视角,通过定性内容分析对数据进行综合:本范围综述将为通过全日制虚拟学校促进全校 PA 研究的应用和发展提供指导。研究结果将探讨由于虚拟教育领域的不断扩大,公平在线学习和 PA 促进的重要性日益增加,对公共卫生和教育政策产生的影响:开放科学框架:https://osf.io/f6wau/ 。
{"title":"Toward a whole-of-virtual school framework for promoting student physical activity: a scoping review protocol.","authors":"Chad M Killian, Eugenia Opuda, Collin A Webster, Taemin Ha, Brian Dauenhauer, Jennifer M Krause","doi":"10.1186/s13643-024-02689-9","DOIUrl":"10.1186/s13643-024-02689-9","url":null,"abstract":"<p><strong>Background: </strong>The advent of full-time virtual schooling presents unique challenges and opportunities for the promotion of physical activity (PA) among children and adolescents. Despite the recognized benefits of PA as an essential component for combating non-communicable diseases and ensuring holistic development, there is a notable gap in understanding how to effectively integrate PA within the digital learning environments of full-time virtual schools. Current efforts to promote student PA are targeted for implementation exclusively in contexts characterized by physical school campuses that are bound to their surrounding local communities. This is problematic given the digital, widely distributed, and contextually unmoored nature of virtual schooling. Our aim in this scoping review is to advance research on whole-of-school physical activity promotion within full-time virtual schools by examining the published literature on whole-of-school PA promotion within full-time virtual schools. Specifically, this review will map the literature, consolidate knowledge claims and practical implications, and identify evidence gaps that merit further investigation.</p><p><strong>Methods/design: </strong>This review will be conducted using evidence-informed scoping review methodology and reporting guidelines. Articles will be included if they are peer-reviewed English-language research, commentary, practical, or grey literature and relate to the participation, support, design, development, and/or provision of remote online PA interventions delivered through primary/elementary and/or secondary/middle school/high schools. Searches will be conducted in PsycInfo, ERIC, SportDiscus, and Web of Science. Additional hand-searching, reference scans, and grey literature searches will also be performed. Two trained research assistants will independently complete study screening and selection and data charting with guidance from a senior author. Charted data will be displayed in table form, and depending on the results, data will also be synthesized through qualitative content analysis using the Active Schools guiding framework as an analytical and interpretive lens.</p><p><strong>Discussion: </strong>This scoping review will serve as a guidepost for the application and advancement of research on whole-of-school PA promotion through full-time virtual schools. The results will address the increased importance of equitable online learning and PA promotion due to the expanding virtual education landscape, with implications for public health and education policy.</p><p><strong>Systematic review registration: </strong>Open Science Framework:  https://osf.io/f6wau/ .</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":null,"pages":null},"PeriodicalIF":6.3,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The distribution of work-related musculoskeletal disorders among nurses in sub-Saharan Africa: a scoping review. 撒哈拉以南非洲护士中与工作有关的肌肉骨骼疾病的分布情况:范围界定审查。
IF 6.3 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-31 DOI: 10.1186/s13643-024-02687-x
Kagiso Kgakge, Mbuzeleni Hlongwa, Ugochinyere Ijeoma Nwagbara, Themba Ginindza

Background: Musculoskeletal injuries are noticeably high among the nursing fraternity, with lower back pain (LBP) being the most prevalent. Therefore, this study aimed to map evidence on the burden of occupational musculoskeletal disorders (MSD) among nurses in sub-Saharan Africa (SSA).

Methods: This scoping review was guided by Arksey and O'Malley's framework. We conducted a comprehensive literature search with no date limit from the following databases: Science Direct, PubMed, Sabinet (SA ePublications), EBSCOhost platform, World Health Organization (WHO) Library, Google Scholar, SCOPUS, Taylor and Francis, and WorldCat Academic Search with full text for published studies. The search took place from May 2022 to December 2022. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used for reporting the search results, and a thematic content analysis was used to present the emerging themes from the included studies.

Results: A total of 16,714 studies were identified after the database search. Only 29 studies met the inclusion criteria after full-article screening and were included for data extraction. The studies reported a total of 6343 participants from different regions in SSA. The 29 included studies showed evidence on the prevalence of MSD, associated risk factors of MSD and LBP among nurses in SSA with some recommendations on how to reduce the prevalence of MSD among nurses.

Conclusion: The study findings reveal that there is a high prevalence of MSD among nurses, especially LBP. The etiology of MSD among nurses is multifactorial, and multifaceted strategies to address MSD are recommended. Further research is recommended to explore strategies that can be used to curb the high prevalence of MSD among nurses.

背景:在护士群体中,肌肉骨骼损伤的发病率明显较高,其中以腰背痛(LBP)最为普遍。因此,本研究旨在绘制撒哈拉以南非洲(SSA)护士职业性肌肉骨骼疾病(MSD)负担的证据图:本次范围界定审查以 Arksey 和 O'Malley 的框架为指导。我们在以下数据库中进行了无日期限制的全面文献检索:Science Direct、PubMed、Sabinet (SA ePublications)、EBSCOhost 平台、世界卫生组织 (WHO) 图书馆、Google Scholar、SCOPUS、Taylor and Francis 和 WorldCat Academic Search(含已发表研究的全文)。检索时间为 2022 年 5 月至 2022 年 12 月。在报告检索结果时使用了系统综述和元分析首选报告项目(PRISMA),并使用了主题内容分析法来呈现所纳入研究的新主题:结果:经过数据库检索,共确定了 16714 项研究。经过全文筛选,只有 29 项研究符合纳入标准,并被纳入数据提取范围。这些研究共报告了来自撒哈拉以南非洲不同地区的 6343 名参与者。纳入的 29 项研究显示了 SSA 地区护士中 MSD 患病率、MSD 相关风险因素和 LBP 的证据,并就如何降低护士中 MSD 患病率提出了一些建议:研究结果表明,护士的 MSD 患病率很高,尤其是枸杞多糖症。护士 MSD 的病因是多因素的,建议采取多方面的策略来解决 MSD 问题。建议开展进一步研究,探索可用于遏制护士中 MSD 高流行率的策略。
{"title":"The distribution of work-related musculoskeletal disorders among nurses in sub-Saharan Africa: a scoping review.","authors":"Kagiso Kgakge, Mbuzeleni Hlongwa, Ugochinyere Ijeoma Nwagbara, Themba Ginindza","doi":"10.1186/s13643-024-02687-x","DOIUrl":"10.1186/s13643-024-02687-x","url":null,"abstract":"<p><strong>Background: </strong>Musculoskeletal injuries are noticeably high among the nursing fraternity, with lower back pain (LBP) being the most prevalent. Therefore, this study aimed to map evidence on the burden of occupational musculoskeletal disorders (MSD) among nurses in sub-Saharan Africa (SSA).</p><p><strong>Methods: </strong>This scoping review was guided by Arksey and O'Malley's framework. We conducted a comprehensive literature search with no date limit from the following databases: Science Direct, PubMed, Sabinet (SA ePublications), EBSCOhost platform, World Health Organization (WHO) Library, Google Scholar, SCOPUS, Taylor and Francis, and WorldCat Academic Search with full text for published studies. The search took place from May 2022 to December 2022. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used for reporting the search results, and a thematic content analysis was used to present the emerging themes from the included studies.</p><p><strong>Results: </strong>A total of 16,714 studies were identified after the database search. Only 29 studies met the inclusion criteria after full-article screening and were included for data extraction. The studies reported a total of 6343 participants from different regions in SSA. The 29 included studies showed evidence on the prevalence of MSD, associated risk factors of MSD and LBP among nurses in SSA with some recommendations on how to reduce the prevalence of MSD among nurses.</p><p><strong>Conclusion: </strong>The study findings reveal that there is a high prevalence of MSD among nurses, especially LBP. The etiology of MSD among nurses is multifactorial, and multifaceted strategies to address MSD are recommended. Further research is recommended to explore strategies that can be used to curb the high prevalence of MSD among nurses.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":null,"pages":null},"PeriodicalIF":6.3,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effects of physical therapy modalities for motor function, functional recovery, and post-stroke complications in patients with severe stroke: a systematic review update. 物理治疗模式对严重中风患者运动功能、功能恢复和中风后并发症的影响:系统综述更新。
IF 6.3 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-28 DOI: 10.1186/s13643-024-02676-0
Katrin Roesner, Bettina Scheffler, Martina Kaehler, Bianca Schmidt-Maciejewski, Tabea Boettger, Susanne Saal

Background: Physical therapy interventions play a crucial role in the daily care of patients recovering from severe stroke. However, the efficacy of these interventions and associated modalities, including duration, intensity, and frequency, have not been fully elucidated. In 2020, a systematic review reported the beneficial effects of physical therapy for patients with severe stroke but did not assess therapeutic modalities. We aim to update the current evidence on the effects of physical therapy interventions and their modalities in relation to the recovery phase in people with severe stroke in a hospital or inpatient rehabilitation facility.

Methods: We searched CENTRAL, MEDLINE, Web of Science, and three other relevant databases between December 2018 and March 2021 and updated the search between April 2021 and March 2023.

Clinicaltrials: gov and ICTRP for searching trial registries helped to identify ongoing RCTs since 2023. We included individual and cluster randomized controlled trials in the English and German languages that compared physical therapy interventions to similar or other interventions, usual care, or no intervention in a hospital or rehabilitation inpatient setting. We screened the studies from this recent review for eligibility criteria, especially according to the setting. Critical appraisal was performed according to the Cochrane risk-of-bias tool 2.0. The data were synthesized narratively.

Results: The update identified 15 new studies, cumulating in a total of 30 studies (n = 2545 participants) meeting the eligibility criteria. These studies reported 54 outcomes and 20 physical therapy interventions. Two studies included participants during the hyperacute phase, 4 during the acute phase,18 during the early subacute phase, and 3 in the late subacute phase. Three studies started in the chronic phase. Summarised evidence has revealed an uncertain effect of physical therapy on patient outcomes (with moderate to low-quality evidence). Most studies showed a high risk of bias and did not reach the optimal sample size. Little was stated about the standard care and their therapy modalities.

Discussion: There is conflicting evidence for the effectiveness of physical therapy interventions in patients with severe stroke. There is a need for additional high-quality studies that also systematically report therapeutic modalities from a multidimensional perspective in motor stroke recovery. Due to the high risk of bias and the generally small sample size of the included studies, the generalizability of the findings to large and heterogeneous volumes of outcome data is limited.

Systematic review registration: PROSPERO CRD42021244285.

背景:物理治疗干预在严重脑卒中患者的日常护理中起着至关重要的作用。然而,这些干预措施和相关模式(包括持续时间、强度和频率)的疗效尚未完全阐明。2020 年,一项系统性综述报告了物理治疗对严重脑卒中患者的益处,但并未对治疗方式进行评估。我们旨在更新当前的证据,说明物理治疗干预及其模式对医院或住院康复机构中重度脑卒中患者恢复阶段的影响:我们在 2018 年 12 月至 2021 年 3 月期间检索了 CENTRAL、MEDLINE、Web of Science 和其他三个相关数据库,并在 2021 年 4 月至 2023 年 3 月期间更新了检索。Clinicaltrials: gov 和 ICTRP 用于检索试验登记,有助于确定 2023 年以来正在进行的 RCT。我们纳入了在医院或康复住院环境中将物理治疗干预措施与类似或其他干预措施、常规护理或无干预措施进行比较的英语和德语单项和分组随机对照试验。我们筛选了这篇最新综述中的研究,以符合资格标准,尤其是根据环境进行筛选。根据 Cochrane 偏倚风险工具 2.0 进行了严格评估。结果:此次更新共发现 15 项新研究,符合资格标准的研究共计 30 项(n = 2545 名参与者)。这些研究报告了 54 项结果和 20 项物理治疗干预措施。其中 2 项研究的参与者处于超急性期,4 项研究的参与者处于急性期,18 项研究的参与者处于亚急性期早期,3 项研究的参与者处于亚急性期晚期。三项研究从慢性期开始。汇总的证据显示,物理治疗对患者预后的影响并不确定(证据质量为中低等)。大多数研究显示存在较高的偏倚风险,且未达到最佳样本量。关于标准护理及其治疗方式的说明很少:讨论:关于物理治疗干预对严重脑卒中患者的有效性,存在相互矛盾的证据。讨论:关于物理治疗干预对重度脑卒中患者的有效性,存在相互矛盾的证据,需要更多高质量的研究,从多维角度系统报告脑卒中运动恢复的治疗模式。由于偏倚风险较高,且纳入研究的样本量普遍较小,因此研究结果对大量异质性结果数据的普适性有限:系统综述注册:PREMCORD42021244285。
{"title":"Effects of physical therapy modalities for motor function, functional recovery, and post-stroke complications in patients with severe stroke: a systematic review update.","authors":"Katrin Roesner, Bettina Scheffler, Martina Kaehler, Bianca Schmidt-Maciejewski, Tabea Boettger, Susanne Saal","doi":"10.1186/s13643-024-02676-0","DOIUrl":"10.1186/s13643-024-02676-0","url":null,"abstract":"<p><strong>Background: </strong>Physical therapy interventions play a crucial role in the daily care of patients recovering from severe stroke. However, the efficacy of these interventions and associated modalities, including duration, intensity, and frequency, have not been fully elucidated. In 2020, a systematic review reported the beneficial effects of physical therapy for patients with severe stroke but did not assess therapeutic modalities. We aim to update the current evidence on the effects of physical therapy interventions and their modalities in relation to the recovery phase in people with severe stroke in a hospital or inpatient rehabilitation facility.</p><p><strong>Methods: </strong>We searched CENTRAL, MEDLINE, Web of Science, and three other relevant databases between December 2018 and March 2021 and updated the search between April 2021 and March 2023.</p><p><strong>Clinicaltrials: </strong>gov and ICTRP for searching trial registries helped to identify ongoing RCTs since 2023. We included individual and cluster randomized controlled trials in the English and German languages that compared physical therapy interventions to similar or other interventions, usual care, or no intervention in a hospital or rehabilitation inpatient setting. We screened the studies from this recent review for eligibility criteria, especially according to the setting. Critical appraisal was performed according to the Cochrane risk-of-bias tool 2.0. The data were synthesized narratively.</p><p><strong>Results: </strong>The update identified 15 new studies, cumulating in a total of 30 studies (n = 2545 participants) meeting the eligibility criteria. These studies reported 54 outcomes and 20 physical therapy interventions. Two studies included participants during the hyperacute phase, 4 during the acute phase,18 during the early subacute phase, and 3 in the late subacute phase. Three studies started in the chronic phase. Summarised evidence has revealed an uncertain effect of physical therapy on patient outcomes (with moderate to low-quality evidence). Most studies showed a high risk of bias and did not reach the optimal sample size. Little was stated about the standard care and their therapy modalities.</p><p><strong>Discussion: </strong>There is conflicting evidence for the effectiveness of physical therapy interventions in patients with severe stroke. There is a need for additional high-quality studies that also systematically report therapeutic modalities from a multidimensional perspective in motor stroke recovery. Due to the high risk of bias and the generally small sample size of the included studies, the generalizability of the findings to large and heterogeneous volumes of outcome data is limited.</p><p><strong>Systematic review registration: </strong>PROSPERO CRD42021244285.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":null,"pages":null},"PeriodicalIF":6.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Leveraging artificial intelligence to enhance systematic reviews in health research: advanced tools and challenges. 利用人工智能加强健康研究中的系统综述:先进工具与挑战。
IF 6.3 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-25 DOI: 10.1186/s13643-024-02682-2
Lixia Ge, Rupesh Agrawal, Maxwell Singer, Palvannan Kannapiran, Joseph Antonio De Castro Molina, Kiok Liang Teow, Chun Wei Yap, John Arputhan Abisheganaden

Artificial Intelligence (AI) is transforming systematic reviews (SRs) in health research by automating processes such as study screening, data extraction, and quality assessment. This perspective highlights recent advancements in AI tools that enhance efficiency and accuracy in SRs. It discusses the benefits, challenges, and future directions of AI integration, emphasising the need for human oversight to ensure the reliability of AI outputs in evidence synthesis and decision-making in healthcare.

人工智能(AI)通过实现研究筛选、数据提取和质量评估等流程的自动化,正在改变健康研究领域的系统综述(SR)。本视角重点介绍了人工智能工具的最新进展,这些工具提高了系统综述的效率和准确性。它讨论了人工智能整合的益处、挑战和未来方向,强调了人类监督的必要性,以确保人工智能在证据综合和医疗决策中输出的可靠性。
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引用次数: 0
Diagnostic point-of-care ultrasound in obstetric anesthesia and critical care: a scoping review protocol. 产科麻醉和重症监护中的护理点超声诊断:范围界定审查协议。
IF 6.3 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-24 DOI: 10.1186/s13643-024-02673-3
Ana Sjaus, Laura V Young

Background: Point-of-care ultrasound (POCUS) has gained popularity as a bedside diagnostic imaging modality. In obstetrical populations, particularly in acute care settings, POCUS serves as a valuable complement to clinical assessment. Despite its many applications, only a few have been defined and validated in the obstetric population. This scoping review aims to delineate literature on the diagnostic applications of POCUS in obstetric anesthesia and critical care.

Methods: This review will adhere to the Joanna Briggs Institute methodology for scoping reviews, as updated by Arksey and O'Malley and in stages elaborated by Levac et al. Relevant literature will be identified using Medical Subject Headings (MeSH), keyword, and proximity searches and combined using Boolean operators in PubMed, Embase, and Web of Science from January 1, 2000, to the present. Two independent reviewers will screen literature against predefined eligibility criteria in abstract and full-text forms. A third reviewer will be consulted if consensus cannot be reached. Data extraction will be systematic, focusing on pre-specified variables aligned with the review's aims. Descriptive statistical and thematic analysis will follow data extraction, with findings presented in graphical and tabular forms. The reporting will follow Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR).

Conclusion: This review will present the scope of the current literature on diagnostic POCUS in obstetric anesthesia and critical care, highlighting both strengths and gaps in existing knowledge. The insights gained will support future research, knowledge synthesis, and development of educational programs. The findings will be disseminated through peer-reviewed journal publications, conferences, and social media platforms.

Systematic review registration: Not applicable.

背景:床旁超声(POCUS)作为一种床旁诊断成像方式已越来越受欢迎。在产科人群中,尤其是在急症护理环境中,POCUS 是临床评估的重要补充。尽管 POCUS 应用广泛,但只有少数应用在产科人群中得到了定义和验证。本范围综述旨在对产科麻醉和重症监护中 POCUS 诊断应用的文献进行界定:本综述将遵循乔安娜-布里格斯研究所(Joanna Briggs Institute)的范围界定综述方法,该方法由 Arksey 和 O'Malley 更新,并由 Levac 等人分阶段阐述。相关文献将通过医学主题词表 (MeSH)、关键词和近似性检索来确定,并使用布尔运算符在 PubMed、Embase 和 Web of Science 中对 2000 年 1 月 1 日至今的文献进行合并。两名独立审稿人将根据预先定义的资格标准筛选摘要和全文形式的文献。如果无法达成共识,将咨询第三位审稿人。数据提取将采用系统化的方式,重点关注与综述目的相一致的预设变量。数据提取后将进行描述性统计分析和专题分析,并以图表形式呈现分析结果。报告将遵循《系统性综述和Meta分析扩展范围综述的首选报告项目》(PRISMA-ScR):本综述将介绍产科麻醉和重症监护中诊断性 POCUS 的现有文献范围,强调现有知识的优势和不足。所获得的见解将为未来的研究、知识综合和教育计划的开发提供支持。研究结果将通过同行评审期刊出版物、会议和社交媒体平台进行传播:不适用。
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引用次数: 0
Geospatial analysis of environmental atmospheric risk factors in neurodegenerative diseases: a systematic review update. 神经退行性疾病中环境大气风险因素的地理空间分析:系统综述更新。
IF 6.3 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-24 DOI: 10.1186/s13643-024-02637-7
Mariana Oliveira, André Padrão, Ana Cláudia Teodoro, Alberto Freitas, Hernâni Gonçalves

Following up the previously published systematic review on the same topic and realizing that new studies and evidence had emerged on the matter, we conducted an update on the same research terms. With the objective of updating the information relating environmental risk factors on neurodegenerative diseases and the geographic approaches used to address them, we searched PubMed, Web of Science and Scopus for all scientific studies considering the following three domains: neurodegenerative disease, environmental atmospheric factor and geographical analysis, using the same keywords as in the previously published systematic review. From February 2020 to February 2023, 35 papers were included versus 34 in the previous period, with dementia (including Alzheimer's disease) being the most focused disease (60.0%) in this update, opposed to multiple sclerosis on the last review (55.9%). Also, environmental pollutants such as PM2.5 and NO2 have gained prominence, being represented in 65.7% and 42.9% of the new studies, opposed to 9.8% and 12.2% in the previous review, compared to environmental factors such as sun exposure (5.7% in the update vs 15.9% in the original). The mostly used geographic approach remained the patient's residence (82.9% in the update vs 21.2% in the original and 62.3% in total), and remote sensing was used in 45.7% of the new studies versus 19.7% in the original review, with 42.0% of studies using it globally, being the second most common approach, usually to compute the environmental variable. This review has been registered in PROSPERO with the number CRD42020196188.

继之前发表的关于同一主题的系统综述之后,我们意识到在这一问题上又出现了新的研究和证据,因此对相同的研究术语进行了更新。为了更新与神经退行性疾病环境风险因素有关的信息以及解决这些问题的地理方法,我们在 PubMed、Web of Science 和 Scopus 上搜索了所有涉及以下三个领域的科学研究:神经退行性疾病、环境大气因素和地理分析,并使用了与之前发表的系统综述相同的关键词。从 2020 年 2 月到 2023 年 2 月,共收录了 35 篇论文,而上一期收录了 34 篇论文,其中痴呆(包括阿尔茨海默病)是本次更新中最受关注的疾病(60.0%),而上一期收录的是多发性硬化(55.9%)。此外,PM2.5 和二氧化氮等环境污染物也越来越受到重视,在新的研究中分别占 65.7% 和 42.9%,而在上一期研究中分别占 9.8% 和 12.2%,相比之下,阳光照射等环境因素在新的研究中占 5.7%,而在上一期研究中占 15.9%。最常用的地理方法仍然是患者的居住地(更新版中为 82.9%,原版中为 21.2%,总计为 62.3%),45.7% 的新研究使用了遥感技术,而原版中为 19.7%,42.0% 的研究在全球范围内使用遥感技术,遥感技术是第二常用的方法,通常用于计算环境变量。本综述已在 PROSPERO 登记,编号为 CRD42020196188。
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引用次数: 0
Adult day programs and their effects on individuals with dementia and their caregivers (ADAPT-DemCare): a realist synthesis to develop program theories on the how and why. 成人日间项目及其对痴呆症患者及其照顾者的影响(ADAPT-DemCare):一项现实主义综合研究,旨在就如何以及为何开展项目提出理论。
IF 6.3 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-23 DOI: 10.1186/s13643-024-02683-1
Hung Nguyen, Atiqur Rahman, Andrea Ubell, Zahra Goodarzi, Colleen J Maxwell, Saleema Allana, Kaitlyn Tate, Holly Symonds-Brown, Lori Weeks, Sienna Caspar, Jim Mann, Matthias Hoben

Background: Adult day programs aim to facilitate aging in place by supporting the health and well-being of persons with dementia and providing respite to their caregivers. However, studies on the effects of day programs are inconclusive, and we especially lack insights into the context conditions and mechanisms of day programs that may produce different outcomes for different groups of persons with dementia and their caregivers. Our objective was to conduct a realist review, synthesizing research on day programs to develop program theories explaining how and why day programs do or do not produce positive or negative outcomes for different groups of persons with dementia, and caregivers.

Methods: We identified 14 literature reviews (including 329 references published between 1975 and 2021) on adult day programs. From this initial pool of studies, we will include those that focused on day program attendees with dementia or meaningful cognitive impairment, and/or their caregivers, and that report how day program contexts (C) and mechanisms (M) bring about outcomes (O) for attendees and caregivers. We will extract CMO statements (i.e., narratives that explain how and why day programs do or do not bring about certain outcomes for whom and under what circumstances). Using additional focused searches, citation mapping, citation tracking, and discussions with our researcher and expert team members, we will identify additional references. CMO statements will be synthesized, transformed into hypotheses, and linked and visualized to form program theories. Using focus groups and the James Lind Alliance Priority Setting Partnership method, we will discuss and prioritize our CMO statements and refine our program theories with 32 experts (older adults, caregivers, Alzheimer societies, caregiver organizations, day program staff and managers, and health system and policy decision makers).

Discussion: By identifying essential elements and processes of day programs and related knowledge gaps, this study will generate much-needed knowledge to leverage the full potential of day programs so they can provide appropriate care, preventing premature institutionalization, and unnecessary acute and primary care use. This will ultimately improve the quality of life of persons with dementia and their caregivers, alleviate caregiver burden, and reduce social costs.

Systematic review registration: PROSPERO CRD42024504030.

背景:成人日间项目旨在通过支持痴呆症患者的健康和福祉,并为其照顾者提供喘息机会,从而促进居家养老。然而,有关日间项目效果的研究尚无定论,我们尤其缺乏对日间项目背景条件和机制的深入了解,而这些条件和机制可能会对不同群体的痴呆症患者及其照顾者产生不同的效果。我们的目标是进行一次现实主义综述,综合有关日间项目的研究,发展项目理论,解释日间项目如何以及为何对不同群体的痴呆症患者及其照护者产生或积极或消极的结果:我们确定了 14 篇关于成人日间项目的文献综述(包括 1975 年至 2021 年间发表的 329 篇参考文献)。从这些初步研究中,我们将纳入那些以患有痴呆症或严重认知障碍的日间项目参加者和/或其照顾者为研究对象的研究,并报告日间项目的环境(C)和机制(M)如何为参加者和照顾者带来结果(O)。我们将提取 CMO 声明(即解释日间项目如何以及为什么在什么情况下为谁带来或没有带来某些结果的叙述)。通过额外的重点搜索、引文映射、引文跟踪以及与我们的研究人员和专家团队成员的讨论,我们将确定更多的参考文献。我们将对 CMO 的陈述进行综合,将其转化为假设,并将其联系起来,形成可视化的计划理论。我们将利用焦点小组和詹姆斯-林德联盟优先事项设定合作方法,与 32 位专家(老年人、护理人员、阿尔兹海默病协会、护理人员组织、日间项目工作人员和管理人员以及卫生系统和政策决策者)讨论 CMO 声明并确定其优先次序,完善我们的项目理论:通过确定日间项目的基本要素和流程以及相关的知识差距,本研究将产生急需的知识,以充分发挥日间项目的潜力,使其能够提供适当的护理,防止过早入院以及不必要的急性病和初级保健的使用。这最终将改善痴呆症患者及其护理者的生活质量,减轻护理者的负担,并降低社会成本:系统综述注册:PREMCORD42024504030。
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