Systematic Reviews最新文献

Background: Acute malnutrition, including severe acute malnutrition (SAM) and moderate acute malnutrition (MAM), affects over 45 million children under five globally and remains a leading cause of childhood morbidity and mortality. Despite therapeutic feeding programs using ready-to-use therapeutic foods (RUTFs) and fortified blended foods (FBFs), relapse and suboptimal treatment outcomes persist. Emerging evidence links gut microbiota dysbiosis to impaired nutrient absorption and immune function in malnourished children. Probiotic supplementation has been proposed as a strategy to restore microbial balance, enhance intestinal health, and improve nutritional recovery. However, clinical trial evidence remains inconsistent, particularly for children with MAM.

Methods: This protocol outlines a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the effects of probiotic or probiotic-fortified product supplementation in children under five diagnosed with SAM or MAM. Databases to be searched include PubMed, Embase, CENTRAL, CINAHL, Web of Science, and Scopus, along with clinical trial registries. Eligible studies will compare probiotic interventions with placebo, standard care, or no treatment. Primary outcomes include weight gain, weight-for-height z-scores (WHZ), mid-upper arm circumference (MUAC), recovery rate, and time to nutritional recovery. Two reviewers will independently conduct study selection, data extraction, and risk of bias assessment using the Cochrane Risk of Bias 2.0 tool. Random-effects meta-analyses will be performed where appropriate. To explore potential sources of heterogeneity, we will perform subgroup analyses based on factors such as strain, dosage, and duration. Furthermore, sensitivity analyses will be used to test the robustness of the findings against various methodological assumptions and decisions. The overall certainty of the evidence for each outcome will be assessed using the GRADE approach.

Discussion: This will be the first systematic review to rigorously evaluate probiotic supplementation for both SAM and MAM populations using PRISMA 2020 guidelines and GRADE methodology. Strengths include a focus on high-quality RCTs, comprehensive search strategies, and transparent bias and evidence quality assessments. Limitations may include variability in probiotic strains, formulations, dosages, and outcome measures, as well as limited subgroup data.

Systematic review registration: PROSPERO CRD420251091133.

Introduction: Percutaneous coronary intervention (PCI) is a fundamental aspect of coronary artery disease (CAD) management. However, manual PCI (M-PCI) procedures bring potential risks such as long-term radiation exposure, operator fatigue, and injuries, posing a threat of malignancies, orthopedic problems, cataracts, and other medical complications. The recently developed robotic-assisted PCI (R-PCI) system allows PCI to be performed from a protected cockpit, reducing radiation exposure, orthopedic injuries, and contrast media usage and improving stent placement accuracy for patients.

Objectives: This review aims to assess the safety and efficacy of robotic-assisted PCI.

Methods: A comprehensive search was conducted across six databases including PubMed, EBSCO, Cochrane (CENTRAL), Scopus, ScienceDirect, and ProQuest, covering studies published from October 2023 to November 2023. The outcomes of interest included safety assessment through (I) procedure-related adverse event rate and (II) mortality rate, while efficacy was assessed through (I) procedural time, (II) fluoroscopy time, (III) contrast volume, (IV) clinical procedural success, and (V) technical success. Quality appraisal was performed using ROBINS-I, and meta-analysis was conducted using RevMan 5.4.

Results: A search across 6 databases resulted in 15 articles for analysis. We found that R-PCI is superior to M-PCI in reducing fluoroscopy time (MD = -3.68, 95% CI = -6.25 to -1.11, p = 0.005) and contrast volume (MD = -16.79, 95% CI = -22.28 to -11.30, p < 0.00001). However, there is no significant difference in terms of procedure-related adverse events, mortality rate, procedural time, and clinical procedural, and technical success.

Conclusion: R-PCI offers procedural advantages, particularly in reducing fluoroscopy time and contrast use, while demonstrating comparable safety and efficacy to M-PCI. Further, high-quality trials are needed to clarify its long-term clinical impact.

Background: Slow-paced breathing (SPB) has emerged as an intervention to improve cognitive function and prevent cognitive decline. The proposed systematic review aims to consolidate previous literature examining the impacts of SPB across cognitive subdomains when compared to passive and active controls in adults, as well as the mechanisms involved.

Methods: Literature searches will be conducted in MEDLINE(R) ALL, Embase Classic + Embase, Cochrane Central Register of Controlled Trials, PsycINFO, CINAHL Ultimate, and Web of Science. Gray literature sources include preprints and clinical trial registries. Citation tracking will be used as a supplemental search method. RCTs, quasi-randomized trials, and non-randomized interventions with a control or comparison group focused on adult human participants will be included. Studies on pediatric populations or animals will be excluded. The primary outcomes are standardized cognitive test scores and test batteries. Data on the parameters of SPB protocols will also be collected to gain insight into the mechanisms driving observed cognitive changes. Two independent reviewers will blindly complete citation screening, data extraction, risk-of-bias assessment using Covidence, and appraisal of study quality using GRADEpro. Risk of bias will be assessed for non-randomized controlled trials and RCTs using the ROBINS-I and RoB tools, respectively. A narrative synthesis of the findings will be conducted. Results will be stratified based on methodological features such as study design, population demographics, intervention parameters, and cognitive domain. If the data of the included literature permit, a meta-analysis will be performed to compare improvements by (i) cognitive domain, (ii) population demographics, and (iii) parameters of intervention protocols (e.g., duration of inhalation vs. exhalation).

Discussion: SPB is a promising intervention for conferring generalizable cognitive improvements. This review will consolidate early findings, give insight into SPB's efficacy as a clinical intervention, and lay the groundwork for future research into mechanisms and optimal parameters.

Systematic review registration: PROSPERO CRD42024615253.

Introduction: The Surveillance Outbreak Response Management and Analysis System (SORMAS) is an open source digital tool created to enhance real time surveillance and outbreak response especially in resource poor settings like low- and middle-income countries (LMICs). Even though the tool has been deployed in several countries, there is no comprehensive review of the available research reporting its implementation and the evidence on utility and performance as experienced by countries. This review aims to systematically map out available evidence to assess the utility and performance of SORMAS across LMICs systematically.

Methods and analysis: The review will follow the Joanna Briggs Institute (JBI) approach to scoping review. Pubmed, Scopus, Web of Science, Google Scholar and Google will be searched as well as relevant grey literature sources. Studies will be included if they described or evaluated the adoption, implementation, utility or functionality of SORMAS in any LMIC. Studies will be excluded if they just mentioned SORMAS as a digital surveillance tool but did not describe or evaluate it. Titles, abstracts and full text screening will be done. Results will be summarized using descriptive statistics and thematic analysis. Tables and other visual tools will also be used to present the results.

Discussion: The findings of this review will serve as the foundation for understanding how SORMAS is being used in LMICs and the specified context of implementation, as well as the reported performance. Gaps in implementation and research will also be highlighted. These findings will have important implications for policymakers, implementers, and researchers by highlighting best practices, areas needing capacity strengthening, and gaps requiring further investigation.

Systematic review registration: https://doi.org/10.17605/OSF.IO/DV8RJ .

Background: Invasive intra-arterial blood pressure (IABP) monitoring using an arterial catheter carries both risks and practical limitations. Noninvasive blood pressure (NIBP) monitoring using the widely adopted oscillometric automated brachial cuff is performed in nearly all patients in acute care settings at some point, yet its reliability remains in question. Conventional statistical approaches to assessing the global trueness (bias) and precision (standard deviation, SD) of NIBP compared to IABP may not fully capture the risk of harm posed by NIBP's measurement errors to patients, nor its ability to detect blood pressure (BP) values above or below critical thresholds. Moreover, risk factors for poor performance of NIBP warrant further investigation. We will perform a meta-analysis using individual participant data (IPD) to evaluate the clinical suitability of NIBP in acute care settings.

Methods: We will search the Cochrane Library, MEDLINE, and Scopus^™ databases to identify relevant peer-reviewed studies published in full-text English or French from 2000 to June 20, 2024. Studies will be included if they compare brachial cuff NIBP measurements with simultaneous radial, femoral, brachial, or pedal intra-arterial IABP measurements in adult patients in acute care settings. Retrospective studies will be excluded. Authors will be contacted to request IPD. For mean and systolic BP, we will assess the risk of harm associated with measurement error (via a dedicated error grid). As secondary objectives, we will evaluate (i) the bias between NIBP and IABP measurements (pooled estimate, SD, and limits of agreement), (ii) the precision (via within-patient SD, calculated for patients who had multiple paired measurements taken closely in time during stable periods), (iii) the ability of NIBP to detect IABP above or below critical thresholds and to identify response to therapy (via the area under the receiver operating characteristic curve), and (iv) the covariates associated with each of the abovementioned outcomes and with poor performance of NIBP. One-stage generalized linear mixed-effects models will be applied for the analyses. A meta-analysis combining IPD and aggregated data will also be conducted using a two-stage approach. Risk-of-bias assessment will follow the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) guidelines. For each outcome, a subgroup of particular interest will consist of studies with a low risk of bias. No funding is required.

Discussion: This meta-analysis will provide actionable insights to optimize BP monitoring strategies.

Trial registration: PROSPERO CRD42021233707.

Background: Osteoporosis is a progressive degenerative bone condition leading to increased fracture risk. Therefore, osteoporosis acknowledges around 200 million cases, with about 70% of the cases occurring in postmenopausal women. Medicaments are often suggested to treat osteoporotic conditions, but physical exercise also plays an essential role. The current literature highlights multicomponent training (MCT) and high-intensity and high-impact exercises as physical exercise interventions that positively affect postmenopausal women's bone health. Furthermore, there is prior evidence of systematic reviews about the positive effects of both methods on the bone health of this population. Despite this prior evidence, no systematic reviews with metanalytic methods compare the effectiveness of the two interventions.

Methods: and analysis. The study will follow the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and was registered at the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number (CRD42024604930). This systematic review and meta-analysis will include only randomized controlled clinical trials (RCTs), which have verified the effects of one or both physical exercise methods on postmenopausal women's bone mineral density (BMD). The systematic search will be implemented at eight electronic databases, namely PubMed/MEDLINE, Web of Science (WoS), EBSCO, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, CINAHL, and SPORTDiscus, which will be used to retrieve the data of interest. The RCTs' risk of bias (RoB) will be assessed with the RoB 2 Cochrane tool, and between-study heterogeneity will be checked through the analysis of Half-Cauchy distribution. Additionally, a network meta-analysis will be applied to compare the between-studies dose-response on the patients' bone health. The final database search was completed on January 18, 2025.

Discussion: In this study, we hope to find consistent results about the effects of MCT and HIIT in postmenopausal women with osteoporosis. Therefore, we also expect to observe between-intervention effects after the network meta-analysis approaches. A Bayesian network meta-analysis will be conducted using Markov Chain Monte Carlo simulations. Exercise dose will be modeled in METs-min/week to explore dose-response relationships. The deviance information criterion (DIC) will be used to compare model fit. Confidence in the results will be evaluated using the CINeMA framework. This way, this study will significantly impact this field of knowledge.

Ethics and dissemination: The design of this review protocol did not involve patients.

Systematic review registration: PROSPERO CRD42024604930.

Background: Patient and public involvement (PPI) aims to increase the relevance and impact of research by ensuring that outcomes align with the real needs of those involved. In PPI, the public actively participates in all stages of research, which has been shown to improve research quality, empower participants, and enrich researchers' understanding of patients' and the public's lived experiences. However, implementing PPI poses a challenge for many researchers, making training essential as it provides the necessary skills to incorporate PPI meaningfully into their projects. Thus, this review aims to map existing PPI training programs in health research, identifying effective strategies that can be replicated, thereby contributing to the improvement of health research practices.

Methods: The scoping review will adhere to Arksey and O'Malley's six-step framework and the PRISMA Extension for Scoping Reviews (PRISMA-ScR) checklist, with results reported following the GRIPP2-Short Form. This review will follow the JBI guidelines for scoping reviews. A PPI group will be established to contribute to the interpretation and discussion of findings and will also be recognized as co-authors of the article. Searches will be conducted in MEDLINE (Ovid), Embase (Elsevier), EBM Reviews, CINAHL (EBSCO), Scopus, ERIC (EBSCO/ProQuest), Web of Science Core, HealthSTAR (Ovid), and Academic Search Complete. Gray literature searches will be conducted in ASSIA (ProQuest) and Google Scholar. The review will include full-text articles published with no language restrictions, focusing on PPI training programs for health researchers, with no publication date restrictions. Two independent reviewers will screen studies by title and abstract, followed by full-text review.

Discussion: The study aims to identify and systematize the approaches used in PPI training programs, providing a foundation to guide researchers in effective PPI implementation. This review may encourage health researchers to integrate PPI as an essential component throughout the research cycle, aligning studies more closely with patients' needs and experiences. Such alignment has the potential to directly inform public health policies, benefiting the target population.

Systematic review registration: 10.17605/OSF.IO/WBDPE.

Background: Auditory Steady-State Response (ASSR) allows the identification of infants with hearing loss and consequently early intervention. Therefore, it is important to assess the accuracy of ASSR for determining hearing thresholds in infants. This study aimed to systematically review the threshold differences between air-conducted ASSR and behavioural audiometry (BA) in infants.

Methods: The population was infants younger than 2 years; the intervention was ASSR thresholds; the comparator was BA thresholds; and the outcome was the ASSR-BA threshold, i.e., the correction value in dB. PubMed, Web of Science, The Cochrane Central Register of Controlled Trials, and Embase were searched. The risk of bias was evaluated using the Evidence Project risk of bias tool and the Newcastle-Ottawa Quality Assessment Scale. The mean and 95% confidence intervals (CI) were calculated for the threshold differences at four frequencies (0.5, 1, 2, and 4 kHz).

Results: Of 503 articles identified, 10 were eligible for a narrative summary, and seven were included in the meta-analysis, which had a total of 2845 ASSR-BA thresholds. The articles were of moderate quality and showed substantial heterogeneity (I² between 89 and 96%, p < 0.01). The mean differences (± 95% CI) between ASSR thresholds and BA hearing thresholds were 9.24 dB (± 6.45), 7.19 dB (± 4.02), 6.35 dB (± 4.51), and 7.42 dB (± 5.40) at 0.5, 1, 2, and 4 kHz, respectively.

Conclusions: ASSR provides a reasonably accurate prediction of BA thresholds. Given the heterogeneity of the included studies, further research with larger infant populations is needed.

Systematic review registration: The study was pre-registered in PROSPERO and followed PRISMA-P 2015 statement.

Introduction: Cancer is a leading cause of mortality globally. It is increasingly becoming a public health concern in sub-Saharan Africa (SSA) and a major societal and economic problem worldwide. Approximately three quarters of all cancer-related deaths occur in low- and middle-income countries (LMICs), with lung cancer being the most frequently diagnosed cancer in 2022. Given the poor health outcomes associated with late diagnosis, early detection for lung cancer should be prioritised to rekindle hope for improved health outcomes. This is a scoping review protocol paper aimed at mapping evidence on factors influencing early identification of lung cancer in patients in low- and middle-income countries.

Methods and analysis: In conducting the proposed scoping review, we will follow the methodological framework proposed by Arksey and O'Malley and recommendations by Levac et al. We will also be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for scoping reviews (PRISMA-ScR): checklist and explanation. The following electronic databases will be searched: PubMed, Cochrane Library, Scopus, CINAHL, EMBASE, and Google Scholar. The following grey literature sources will be searched: conference proceedings, other relevant government reports, and dissertations/thesis. Key themes from the literature will be extracted and analysed using thematic analysis supported by NVivo version 14. Evidence gathered will be used towards advocating for early screening of patients suspected of lung cancer.

Ethics and dissemination: This review is exempt from ethical approval as it uses data that is in the public domain. Additionally, there will be no human or animal participants in this review; hence, informed consent is not required. The results will be published in peer-reviewed journals, in print, and through conference presentations.

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

Background: Cardiovascular diseases (CVDs) are a leading cause of mortality and disability globally. In Ethiopia, the management of CVDs faces significant challenges, particularly in addressing medication-related problems (MRPs). This systematic review and meta-analysis aims to assess the prevalence of MRPs among CVD patients in Ethiopia.

Methods: The review followed the PRISMA guidelines and was registered in the PROSPERO database (CRD42024501087). A comprehensive search was conducted across databases including PubMed, Hinari, Embase, and Scopus. Studies were included if they focused on the prevalence of MRPs among Ethiopian CVD patients, were observational in design, and were published in English. Quality assessment was performed using the JBI critical appraisal checklist. Data were analyzed using a weighted inverse random-effects model with subgroup analyses conducted based on various study characteristics. Heterogeneity was assessed using the I² statistic and further explored through univariate meta-regression and sensitivity analysis.

Results: From 405 potential studies, 22 met the inclusion criteria, comprising 5700 patient cases and identifying 7780 MRPs. The pooled prevalence of MRPs among CVD patients in Ethiopia was 74% (95% CI 66-81, I² = 98.4%). The average number of MRPs per patient was 1.65 (95% CI 1.48-1.82, I² = 98.3%). Common MRPs included patient noncompliance (18%), ineffective drug therapy (16%), and the need for additional drug therapy (15%). Polypharmacy, poor involvement in therapeutic decisions, advanced age, the presence of comorbidities, and prolonged illness duration were identified as commonly reported contributing factors. Despite significant heterogeneity among studies (I² = 98.4%), subgroup analyses and univariate meta-regression did not identify sample size or study period as significant sources of this variability. Publication bias was suggested by Egger's regression test (p-value < 0.001), though trim-and-fill analysis indicated no adjustments were necessary. Sensitivity analysis confirmed the stability of the pooled prevalence estimate.

Conclusions: The high prevalence of MRPs among CVD patients in Ethiopia highlights the need for targeted interventions to optimize medication management and improve patient outcomes. Healthcare providers should focus on individualized care, regular medication reviews, and patient education to address these problems effectively.