Systematic Reviews最新文献

Background: Amphetamine-type stimulant use disorder (ATSUD) contributes to the global burden of disease, notably due to its social, physical, and psychological consequences. Psychiatric disorders are frequently observed among people with ATSUD, while we still do not know their exact global prevalence because of multiple sources of heterogeneity. Here, we propose a protocol for a systematic review and a series of meta-analyses to describe the global prevalence of psychiatric disorders observed in individuals living with ATSUD.

Methods: A pilot systematic search was conducted to develop a protocol for a systematic review and a series of meta-analyses. A final systematic search will be conducted in MEDLINE, Embase, PsycINFO, and CINAHL to retrieve, among articles indexed since 1999, prevalence estimates of psychiatric disorders within individuals living with ATSUD. The final systematic review will support multiple separate meta-analyses, each investigating one or more concomitant psychiatric disorders. Diagnosis proportions of psychiatric disorders will be obtained using DSM-IV, DSM-5, ICD-10, and ICD-11 criteria or validated psychometric methods. Risk of bias will be assessed using the prevalence studies checklist from the Joanna Briggs Institute's critical appraisal tool. Proportions of diagnoses will be pooled using random-effect meta-analysis for each psychiatric disorder. Heterogeneity linked to methodological, sociodemographic, and spatiotemporal characteristics will be assessed using subgroup analyses and meta-regressions.

Discussion: The pilot search allowed the identification of 10 psychiatric disorders associated with ATSUD and refinement of the final search and meta-analysis protocol. This project will provide one of the first global and comprehensive syntheses of psychiatric disorders' prevalence in people with ATSUD to date, a set of evidence that will contribute to a more adapted and equitable public health response to this epidemic.

Systematic review registration: Open Science Framework Repository (https://doi.org/10.17605/OSF.IO/FKDJY).

Objective: This scoping review aims to provide an overview of documents describing the preparation of policy briefs from academic health science researchers for policy-making.

Introduction: Not considering research evidence sufficiently may engender inefficient resource allocation and an inadequate response to public issues. Policy briefs are aimed at bridging this gap and assisting policy-makers in making evidence-informed decisions, yet they lack standardization.

Methods: A scoping review following JBI methodology was conducted. We aimed at summarizing recommendations and guidelines for policy briefs from health science academia, focusing on formal criteria and contextual considerations. We included documents describing the preparation of policy briefs from academia to policy-making, as well as those that are usable for various addressees. Documents needed to be published in German, English, French, or Spanish and available in full text. Searches were conducted in PubMed, Embase, Web of Science, LIVIVO (SOMED), and additional sources up to December 01, 2025, resulting in 67 included records out of 1395 scientific publications and 81 grey literature sources.

Results: The structure of policy briefs varied, with layout and language being the only consistent elements. Guidelines exhibited diversity in length, target groups, references, and timing, with discernible tendencies. Contextual considerations also varied across articles, indicating inconsistency in definitions and frequencies.

Conclusion: Variability in policy brief design guidance poses challenges for both researchers and end-users, potentially hindering effective evidence communication. Enhanced efforts of co-creation, shared minimum standards, and evaluation may mitigate these challenges. Still, complete standardization may be unattainable, necessitating flexibility to cater to diverse audience needs, priorities, and perspectives. Transparent acknowledgement of such situations is crucial.

Systematic review registration: https://doi.org/10.17605/OSF.IO/HTJMW.

Background: To support the development of a national guideline on stem cell therapy, the Department of Health Research, India, commissioned this systematic review to evaluate the efficacy and safety of various stem cell types in patients with type 1 and type 2 diabetes mellitus (DM), focusing on patient-important outcomes.

Methods: Following PRISMA guidelines, a literature search was conducted in PubMed, Embase, Web of Science, and Cochrane databases from inception to August 30, 2024. Critical outcomes for type 1 DM included insulin-free periods, hypoglycemic episodes, quality of life, and serious adverse events. For type 2 DM, outcomes included HbA1c, insulin requirements at 6, 12, and 24 months, and serious adverse events. Meta-analyses used random- or fixed-effects models based on heterogeneity (Chi-square test and I²). Risk of bias was assessed using the Cochrane Risk of Bias Tool 2.0, and evidence certainty was evaluated with GRADE.

Results: The search identified 11,026 articles, of which 20 randomized controlled trials (RCTs) were included, encompassing 427 and 351 patients in the intervention and control groups, respectively, with follow-ups ranging from 3 to 96 months. Predominantly studied therapies included mesenchymal and bone marrow mononuclear stem cells. In type 1 DM, stem cell therapy showed no significant improvement in quality of life [MD: 3.15% (95% CI: -0.80 to 7.10); 2 trials, n = 63 participants; I² = 0%; GRADE: very low certainty] or reduction in hypoglycemic episodes [RR: 0.90 (95% CI: 0.56 to 1.45); 3 trials, 68 participants; I² - 0%; GRADE: very low. In type 2 DM, stem cell therapy significantly reduced insulin requirements at 6, 12, and 24 months, with MDs in IU/day of -14.42 (95% CI: -24.25 to -4.59); 6 trials, n = 167 participants; I² = 91.64%; GRADE: low certainty; -17.79 (95% CI: -26.39 to -9.18); 6 trials, n = 212 participants; I² = 70.96%; GRADE: low certainty; and -35.73 (95% CI: -40.82 to -30.64); 1 trial, n = 61 participants; I² = NA; GRADE: very low certainty, respectively, with a low certainty of evidence.

Conclusion: Stem cell therapy did not achieve an insulin-free state or improved quality of life in type 1 DM patients. However, it reduced insulin requirements by 14-36 units over 6-24 months in type 2 DM patients, without significant glycemic control. Larger, high-quality RCTs with extended follow-ups are essential to determine the therapeutic potential of stem cell therapy in diabetes mellitus.

Systematic review registration: PROSPERO ID: CRD42023451602.

Background: Rare diseases (i.e., incidence of <1/2000) are individually uncommon, but collectively these 10,000 conditions affect an estimated 473 million people globally, and approximately 70% of rare diseases manifest in childhood. Despite this global impact, 90% of rare diseases lack effective treatment. Treatments for rare diseases are often identified through clinical trials. Identifying parents' knowledge needs and preferences regarding pediatric rare disease clinical trials is an important aspect of empowering parents, improving clinical research practices, and potentially improving recruitment to these vital trials. The aim of the scoping review is to determine the extent, range, and characteristics of the evidence on the knowledge needs and preferences of parents regarding pediatric rare disease clinical trials.

Methods: A scoping review will be conducted to identify sources of literature on the topic. A systematic search strategy co-developed with a research librarian will be conducted in six databases (Medline, EMBASE, CINAHL, Scopus, Web of Science, and PsycINFO). Gray literature will be searched via Google, Perplexity AI, the ProQuest Dissertations & Theses Global database, and relevant rare disease organizational websites. Abstract and full-text screening will be conducted by two reviewers independently. Studies in English will be included regardless of study design, date of publication, or location of study/publication. Study quality will be appraised using the Mixed Methods Appraisal Tool. Data will be extracted including study characteristics, population, phenomena under investigation, and knowledge needs and preferences identified. Analysis will involve a descriptive numerical summary and qualitative content analysis. Findings will be presented in evidence tables, and patterns, themes, and gaps across the data will be reported using a narrative approach.

Discussion: This review will provide an overview of the existing literature regarding parents' knowledge needs and preferences about pediatric rare disease clinical trials. The findings of this review will inform future research and the development of knowledge translation resources for parents of children with rare diseases.

Systematic review registration: This protocol has been registered in Open Science Framework (registration: https://doi.org/10.17605/OSF.IO/QXR8G).

Background: The implementation of interventions in clinical practices is a challenge in healthcare settings, particularly in the field of habilitation. Although research on interventions in this area has increased, research on the implementation of these interventions has been slow. Exploring staff experience of implementation is therefore crucial to optimize the likelihood that interventions will be adopted and sustained in habilitation settings. The purpose of this systematic review is to synthesize the experiences of staff in implementing interventions for adults with congenital disabilities into a comprehensive overview.

Methods: Studies were included if they provided empirical data on staff experiences of implementing interventions for adults with congenital disabilities in health and social care settings, regardless of study design. Non-empirical studies and grey literature were excluded. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, we conducted a search using the Medline, CINAHL, PsycInfo, Sociological Abstract, Applied Social Sciences Index and Abstracts (ASSIA), and Web of Science databases. The last search update was conducted in February 2024. The Critical Appraisal Skills Program (CASP) tool was used for qualitative studies, and the Mixed-Method Assessment Tool (MMAT) for the quantitative and mixed-method studies. The Convergent Integrated Approach (CIA) was employed to synthesize the data.

Results: Of the 5855 studies initially retrieved, eight met the inclusion criteria. The analysis and integration of all included studies were categorized into three themes: (1) conditions for implementation, (2) acceptability of the intervention, and (3) approaches for change. The results underscore the importance of organizational resources, vision, and collaboration in successful implementation.

Conclusions: Active participation of professionals and alignment of interventions with existing practices were identified as key factors for success. The consideration of external factors that can influence the implementation of interventions is also important. In general, these findings provide information to guide future planning and implementation of interventions within habilitation settings.

Systematic review registration: Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/SBV9E.

Background: The demand for end-of-life care will rise significantly in coming decades due to increasing life expectancy and the growing burden of chronic diseases. Palliative care aims to support patients' preferences to remain at home (both for ongoing care and, when possible, to die). The feasibility of dying at home is shaped by a complex interplay of patient factors, the capacity of family caregivers, and the availability of home care teams and community resources. Healthcare professionals, especially nurses, are pivotal in accommodating patient preferences, and are uniquely positioned to influence the quality and feasibility of end-of-life care. A deeper understanding of their specific interventions, particularly for patients in their last days and their families, is essential to inform practice, education, and policy. This review aims to synthesise the available evidence, identify effective nursing interventions, highlight knowledge gaps and inform nursing practice, education and policy at an international level.

Methods: This mixed-methods systematic review will be conducted according to the updated methodology of the Joanna Briggs Institute and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search will be conducted in PsycINFO, MEDLINE, CINAHL ULTIMATE, Web of Science and Mediclatina, with no date or language restrictions. Two reviewers will independently screen data, assess methodological quality using appropriate appraisal tools, and extract data using standardized forms. Quantitative and qualitative findings will be integrated through a convergent approach.

Discussion: Nursing interventions in the last days of life are complex and multifaceted, critically influencing patient's comfort, dignity and quality of life, as well family experience. However, accurately identifying and defining is challenging due to variability in terminology and conceptual boundaries, particularly in studies that focus on the "last days of life". This variability may limit comparability across studies and highlight the need for greater conceptual clarity to guide research, practice, and policy.

Trial registration: Systematic review registration: PROSPERO CRD420251112044.

Background: The National Early Warning Score (NEWS), and updated NEWS2, is used to detect all-cause deterioration, based on clinical observations. Many studies have validated the prognostic accuracy of NEWS/NEWS2, but few have investigated whether its use improves patient outcomes. This systematic review aims to bring together all evidence evaluating the effectiveness of using NEWS/NEWS2, compared to not using NEWS/NEWS2, on patient outcomes.

Methods: We searched Embase, MEDLINE, CINAHL, The Cochrane Library, and international trial registries from January 2012 (when NEWS was developed) to October 2024, for all records which mentioned NEWS/NEWS2 in their title or abstract. All comparative studies with interventions which included NEWS/NEWS2, and comparator areas, regions, organisations, time points, or settings which did not, were included. The target population was all non-maternity patients aged 16+ years treated in healthcare settings. Where possible, studies were synthesised by outcome using random-effects meta-analyses. Risk of bias was assessed using ROB2 and ROBINS-I v2; certainty of evidence was assessed using GRADE. PROSPERO registration CRD42023442061.

Results: We screened 2814 records and included 20 studies (in 32 records), with 18 presenting data for our outcomes. Sample sizes ranged from 66 to 13,059,865 participants. There was low certainty evidence that using NEWS/NEWS2 reduced in-hospital mortality (summary odds ratio [OR] from eleven studies 0.79, 95% confidence interval [CI] 0.66 to 0.94). There was also a little low certainty evidence of a reduction in hospital length of stay (two of four studies) and cardiac arrests (three of seven studies), and a potential reduction in intensive care admissions (summary OR from seven studies 0.63, 95% CI 0.36 to 1.09). Most included studies had a serious/high (12/18; 67%) or moderate (5/18; 28%) risk of bias.

Conclusions: This review highlights a lack of large scale, high-quality studies exploring the effectiveness of NEWS/NEWS2. No included studies reported negative clinical impacts of using NEWS/NEWS2 on any outcomes presented in this review. However, there is still further work required to ascertain whether the use of NEWS/NEWS2 improves patient outcomes.

Systematic review registration: PROSPERO CRD42023442061.

Background: Chronic hepatitis C virus infection presents a substantial global health burden, frequently resulting in severe liver conditions. Hepatitis C virus (HCV) therapy requires complex decision-making. Direct-acting antivirals (DAAs) offer a potential solution by targeting viral proteins to inhibit replication. Understanding DAAs real-world effectiveness and how they impact long-term outcomes beyond clinical trials is essential. We aim to comprehensively evaluate the benefits and harms of DAAs in individuals with chronic HCV infection, reported in observational studies.

Methods: We will consider for inclusion prospective and retrospective observational studies with quasi-randomised, cohort, case-control, controlled before-and-after, and cross-sectional designs. Our experimental interventions will be any class of DAAs available on the market or in development. DAAs could have been administered alone, in combination, or with other medical co-interventions. Our control interventions will be untreated chronic HCV conditions, with or without placebo. Participants will be adults, regardless of demographics, treatment history, or healthcare setting. Our primary outcomes will be participants experiencing hepatitis C-related morbidity or all-cause mortality, serious adverse events, and health-related quality of life. Secondary outcomes will include all-cause mortality, cirrhosis, variceal bleeding, hepato-renal syndrome, hepatocellular carcinoma, hepatic encephalopathy, non-serious adverse events, liver transplantation, lack of sustained virological response, histological improvement, and decreases in alanine aminotransferase and aspartate aminotransferase levels. We will apply search strategies to search MEDLINE, Embase, Web of Science, grey literature, and trial registers. We will use Covidence® to screen the result, including citations. Individual double-data extraction will include study details and outcomes, with independent review authors resolving discrepancies. We will assess bias using the ROBINS-I tool. Meta-analyses will employ random-effects models for both dichotomous and continuous outcomes, assessing heterogeneity. Subgroup and sensitivity analyses will explore effect modifications and address missing data. Trial Sequential Analysis will control type I and type II errors. We will evaluate publication bias using funnel plots and Egger's regression test and assess certainty of evidence using GRADE.

Discussion: The findings will inform clinical decisions and benefit those affected by HCV, healthcare professionals, and policymakers.

Systematic review registration: PROSPERO: CRD42023494844.

Background: Depression and anxiety are among the most common mental health problems affecting children and adolescents worldwide. Exercise is a widely used and potentially cost-effective non-pharmacological approach that may improve mood and mental health. However, the optimal exercise modalities and doses for alleviating depressive and anxiety symptoms in children and adolescents remain uncertain. Previous evidence has primarily relied on pairwise meta-analyses or conventional network meta-analyses: the former are unable to compare multiple exercise formats simultaneously, while the latter, although capable of integrating different interventions, have not quantified dose characteristics such as intensity, frequency, and duration. Consequently, systematic dose-response evidence regarding depressive and anxiety symptoms in children and adolescents is lacking. This study aims to examine the quantitative relationship between exercise dose and changes in depressive and anxiety symptoms.

Methods: This protocol outlines a systematic review and Bayesian model-based dose-response network meta-analysis. A systematic search will be conducted of PubMed, Embase, Web of Science, the Cochrane Library, Scopus, PsycINFO, SPORTDiscus, and the China National Knowledge Infrastructure databases through May 2026. Randomized controlled trials enrolling children and adolescents aged 6-18 years with depressive or anxiety symptoms and comparing different types and doses of exercise training will be eligible for inclusion. Study quality will be appraised using the Cochrane Risk of Bias 2.0 tool. Exercise interventions will be categorized by type (e.g., aerobic, resistance, mind-body, and combined exercise-only) prior to dose-response modeling. A Bayesian model-based dose-response network meta-analysis will be performed, with exercise dose quantified as weekly metabolic equivalent of task (MET) minutes (MET-min/week) by integrating intensity, session duration, and frequency. Nonlinear dose-response curves will be fitted for distinct exercise modalities. Meta-classification and regression tree (meta-CART) analysis will be employed to identify potential effect modifiers.

Discussion: This study will systematically evaluate the nonlinear dose-response relationships between exercise dose and changes in depressive and anxiety symptoms in children and adolescents, and estimate dose ranges associated with symptom change across exercise modalities. The findings may help inform future evidence-based recommendations and provide methodological guidance for dose-response research in child and adolescent mental health.

Systematic review registration: This protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD420251174947.