Systematic Reviews最新文献

Background: Chronic obstructive pulmonary disease (COPD) symptoms of dyspnea and chest tightness overlap with some symptoms of panic attacks, the hallmark feature of panic disorder (PD). Our objective was to quantify PD prevalence in COPD from a systematic review and meta-analysis.

Methods: A database search from inception to January 2025 was performed using five electronic databases. Eligible studies utilized structured clinical psychiatric interviews to identify PD in adult populations with COPD derived from inpatient, outpatient, or general population sampling.

Results: Twenty-one studies met inclusion criteria, with most from Asia (k = 9), reporting data from 1847 persons with COPD, 860 healthy controls, and 450 persons with comorbidities other than COPD. The prevalence of PD in persons with COPD was 12.5% (95% confidence interval [CI] 8.2-18.7, I² = 90%), revised to 8.1% (95% CI 5.7-11.6, I² = 73%) after the exclusion of k = 5 outliers. In case-control studies, PD was more prevalent in COPD patients (k = 9, 9.7%; 95% CI 5.9-15.4, I² = 69%) than healthy controls (k = 6, 2.8%; 95% CI 1.7-4.6, I² = 0%). There was no evidence to suggest a higher PD prevalence than in other medical conditions (k = 5, 4.8%; 95% CI 1.8-12.0, I² = 47%).

Conclusions: The pooled estimates of PD in COPD were higher than the general population but markedly lower than suggested by prior narrative reviews. Further research needs to elucidate whether the characteristic symptoms of panic in COPD are similar to PD in non-COPD populations and, secondly, whether they lead to differential healthcare resource utilization and portend a higher risk for adverse outcomes.

Systematic review registration: CRD42024559743.

Background: The burden of type 2 diabetes mellitus (T2DM) is rising rapidly in low- and middle-income countries (LMICs). Diabetic cardiomyopathy (DbCM), defined as myocardial dysfunction occurring independently of coronary artery disease, hypertension, or significant valvular disease, is an important complication of T2DM and may progress to overt heart failure if undiagnosed. While well characterised in high-income settings, DbCM prevalence and distribution in LMICs remain poorly defined. This systematic review aims to estimate the pooled prevalence of DbCM among adults with T2DM in LMICs.

Methods: This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines and the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis. A comprehensive search will be conducted in PubMed, Scopus, Web of Science, Embase, AJOL, and EBSCOhost, supplemented by regional databases and grey literature sources. Observational studies conducted in LMICs that report the prevalence of DbCM among adults with T2DM will be considered. DbCM must be diagnosed using objective cardiac imaging after exclusion of alternative causes of myocardial dysfunction. Two reviewers will independently screen, extract data, and assess risk of bias using a tool adapted for prevalence studies.

Data synthesis and analysis: Where data are sufficiently comparable, pooled prevalence estimates will be calculated using random-effects meta-analysis. Prevalence proportions will be modelled using generalised linear mixed models with a logit link function to account for within- and between-study variability. Statistical heterogeneity will be assessed using the I² statistic and explored through subgroup analyses by demographic, clinical, and regional characteristics. Where meta-analysis is not appropriate, findings will be synthesised using a structured narrative approach.

Expected outcomes: This review is expected to report pooled prevalence estimates of DbCM across LMICs and to describe regional variation. Differences in diagnostic approaches, glycaemic control, diabetes duration, age, sex, and geographical region are anticipated to contribute to heterogeneity and will be explored where data permit.

Conclusion: By synthesising available evidence on the prevalence of DbCM in LMICs, this review will clarify the burden of disease and provide evidence to inform health system planning and guide future research and prevention efforts aimed at reducing diabetes-related heart failure.

Background: Acute respiratory distress syndrome (ARDS) and acute lung injury (ALI) are life-threatening conditions with limited effective pharmacological interventions. Sivelestat sodium, a selective neutrophil elastase inhibitor, has been extensively investigated in ARDS/ALI treatment due to its significant anti-inflammatory properties; however, its therapeutic efficacy remains controversial. As a drug developed and first approved in Japan, most previous meta-analyses have failed to incorporate Japanese literature, potentially introducing substantial language bias. Additionally, Japanese clinical practices may employ different treatment protocols that could offer novel perspectives on sivelestat sodium's application. This systematic review aims to comprehensively evaluate sivelestat sodium's efficacy in ARDS/ALI patients by simultaneously including both English and Japanese clinical literature.

Methods: We will systematically search English databases (Cochrane Library, EMBASE, PubMed) and Japanese databases (Ichushi Web, J-STAGE) for randomized controlled trials comparing sivelestat sodium with placebo or standard therapy in adult ARDS/ALI patients. Two independent reviewers will screen studies, extract data, and assess risk of bias. Primary outcomes include duration of mechanical ventilation and all-cause mortality (28-30 days, ICU, and in-hospital). If sufficient eligible studies are identified, a random-effects model will be employed for meta-analysis. Between-study heterogeneity will be assessed using the I² statistic, and the certainty of evidence will be evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework.

Discussion: This protocol outlines a systematic approach for evaluating sivelestat sodium's efficacy in ARDS/ALI through the integration of English and Japanese literature. Methodological rigor will ensure high-quality evidence synthesis despite challenges in integrating diverse studies. This research addresses a significant gap, as meta-analyses incorporating Japanese publications have been absent for over a decade. The findings will provide evidence-based guidance for clinical practice, inform individualized treatment strategies, optimize sivelestat administration protocols, and identify directions for future research.

Systematic review registration: PROSPERO CRD420251067146.

Background: Sickle cell disease (SCD) is a genetic blood disorder associated with chronic cardiovascular and pulmonary complications, including pulmonary hypertension (PHT), venous thromboembolism (VTE), and cardiac involvement (CI), all of which contribute significantly to premature mortality. Despite their clinical importance, the burden of these conditions in adolescents and adults with SCD remains poorly characterized.

Methods: We conducted a systematic review and meta-analysis to evaluate the prevalence and impact of these complications in SCD patients aged ≥ 10 years. Following PRISMA guidelines, we searched MEDLINE/PubMed, Web of Science, and Scopus for observational studies reporting prevalence or incidence. We did not apply any date or time restrictions to the literature search. Pooled estimates were calculated using random-effects meta-analysis.

Results: The studies yielded from the search were published between January 1, 1974, and October 12, 2023. Seventy-nine studies met the inclusion criteria, of which fifty-nine were included in the meta-analysis. The pooled prevalence estimates were as follows: PHT 30% (95% CI 26-34), VTE 13% (9-18), and CI 24% (17-33), with substantial heterogeneity (I² > 90%) among the studies. PHT was primarily diagnosed via Doppler echocardiography, while VTE was identified through ultrasonography or CT angiography. CI manifestations included diastolic dysfunction and structural abnormalities. These complications were strongly associated with increased mortality and functional impairment.

Conclusion: Chronic cardiovascular and pulmonary complications are highly prevalent in adolescents and adults with SCD, leading to significant morbidity and mortality. Routine screening and early intervention are essential to mitigate disease progression and improve outcomes. Future research should focus on standardized diagnostic criteria and targeted therapies to reduce the burden of these conditions in SCD.

Systematic review registration: PROSPERO CRD42023474623.

Background: Research demonstrates that exercise training is both safe and beneficial for individuals with multiple sclerosis (MS). This is a timely opportunity to update the guidelines for exercise training in MS, as the number of randomized controlled trials (RCTs) examining the effects of exercise training on a range of functional and biomedical outcomes among adults with MS has increased substantially in the past decade. The evidence for updating the guidelines should be gathered through rigorous methodology, thereby ensuring a comprehensive analysis. The objective of this systematic review of the literature will be to evaluate the type and dose of exercise training necessary to improve fitness, biomarkers of health and disease, physical and cognitive functions, symptoms of MS, quality of life, and/or participation in activities of daily life among adults with MS presenting with mild, moderate, or severe disability.

Methods: This protocol for a systematic review follows the PRISMA-P guidelines and was registered on PROSPERO. RCTs of chronic exercise interventions for people with MS will be included. Studies will be excluded if they focus on other neurological conditions, interventions, or if their data are solely qualitative. A systematic and comprehensive search will be conducted across eight electronic bibliographic databases. Retrieved references will be screened by two authors. Data will be extracted into piloted tables and synthesized qualitatively. Methodological quality of the included studies will be determined using the Tool for the Assessment of Study Quality and Reporting in Exercise (TESTEX), and risk of bias will be assessed through the revised Cochrane risk-of-bias tool for RCTs (RoB 2). Finally, the certainty of evidence provided for the outcomes of interest across studies will be evaluated through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines.

Discussion: The evidence gathered and analyzed through this review will be crucial for our next step of updating the exercise guidelines for MS. These updated guidelines will provide people with MS, their families and/or their caregivers, and health care professionals and MS services organizations or advocates, with clear information to promote exercise training among patients with MS. This will subsequently facilitate implementation of exercise training programs into MS care.

Systematic review registration: PROSPERO CRD42025628825.

Background: Hypertension is disproportionately prevalent in African women (48% prevalence rate vs. 34% in men) and poorly controlled (13% control rate in sub-Saharan Africa vs. 23% globally). Digital health platforms (e.g., mHealth, telehealth, telemedicine) have the potential to improve access to hypertension care in Africa, which has a mostly rural population (51.2%). However, gender experiences, needs, and barriers to care are not well researched. A scoping review is a suitable approach to conduct an initial mapping of disparate evidence and identify gaps related to digital health interventions for hypertension in African women. The scoping review can inform future research and policy.

Methods: The protocol has been registered on Open Science Framework and adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review Extension (PRISMA-ScR) and JBI standards. All studies from 2010 through 2025 on women 18 years and older in 54 African nations will be included and will represent significant data on digital health programs. Two reviewers will conduct a faceted search of keywords such as "Hypertension," "Women," "Africa," and "Digital Health" in various databases, grey literature, and resources such as the X platform. Data will be extracted using a standardized form, with quality assessment following Cochrane RoB2 and Newcastle-Ottawa Scale where applicable. The results will be presented by research question (such as barriers and effectiveness) and region, setting, and design of study and will be intended for sharing with scientific and public communities.

Discussion: This review will map digital health interventions for hypertension management, systematically examining gender-based barriers and socioeconomic factors. Quantitative outcomes (e.g., blood pressure control rates, treatment adherence) and qualitative findings (e.g., themes of user acceptability, trust in digital health platforms) will be synthesized to identify evidence gaps and inform the development of equitable, gender-responsive digital health tools and policies. Study heterogeneity is a limitation, mitigated by a rigorous search.

Conclusion: This protocol ensures transparent reporting, with amendments documented in OSF. Findings will guide stakeholders to improve hypertension control.

Background: Dexmedetomidine and lidocaine are commonly used adjuvants in postoperative pain management; however, their comparative efficacy is unclear. This meta-analysis compared the effects of intravenous dexmedetomidine and lidocaine on postoperative analgesia and recovery.

Methods: Cochrane Library, Medline, Embase, and Google Scholar were searched from their inception to July 1, 2024, to identify relevant randomized controlled trials (RCTs) comparing intravenous dexmedetomidine and lidocaine in adult patients undergoing non-cardiac surgery under general anesthesia. The primary outcomes were the postoperative pain score at 24 h and postoperative opioid consumption. The secondary outcomes included early postoperative pain scores, intraoperative opioid/anesthetic requirements, hemodynamic parameters, recovery characteristics, and inflammatory markers.

Results: Twenty-four studies (1,697 patients) were included. There was no significant difference between dexmedetomidine and lidocaine in terms of pain scores at 24 h (mean difference [MD]: 0.01, p = 0.88) or overall postoperative opioid consumption (standardized MD[SMD]: -0.51, p = 0.06). However, dexmedetomidine was associated with lower pain scores at 2-4 h postoperatively (MD:-0.41, p = 0.02), reduced intraoperative anesthetic agent requirements (SMD:-1.1, p = 0.004), a longer time to rescue analgesic (MD: -29.93 min, p < 0.00001), and improved quality of recovery scores (SMD: 1.72, p = 0.01). Dexmedetomidine resulted in lower heart rate and blood pressure compared to lidocaine, without differences in other recovery characteristics and inflammation.

Conclusion: Both dexmedetomidine and lidocaine are effective adjuvants for improving postoperative outcomes. Nevertheless, dexmedetomidine has shown advantages in terms of early pain control, reduced anesthetic requirements, and improved quality of recovery. The choice of these agents should be based on individual patient factors and specific surgical procedures.

Evidence synthesis (ES) involves rigorous, reproducible methodologies, which are increasingly being presented as 'Living' systematic reviews. As such, ES are critical to evidence-informed decision-making processes, such as the development, implementation, evaluation and monitoring of health technology assessments, practice guidelines and policies. However, the ES process is time-intensive, typically requiring months or years and extensive manual effort. Technological advancements, particularly artificial intelligence (AI), offer opportunities to automate various ES steps, potentially increasing efficiency and reducing costs. AI tools and platforms, including large language models (LLMs), facilitate faster ES through advanced natural language processing (NLP) capabilities. Despite their potential, AI tools have limitations, including risks of automation bias and lack of true semantic understanding, requiring careful evaluation to ensure trustworthiness. We conducted the first scoping review to update and map all data science tools, including LLMs, which are either being developed and/or deployed to optimise ES steps and assess their impact in both low- and middle-income countries (LMICs) and high-income countries (HICs). Our scoping review identified 137 studies and 388 of such AI tools and platforms to respond to the World Health Organization's call for safe and ethical AI in health, documenting the current landscape to identify barriers and facilitators to equitable and sustainable access for glocal researchers. We further outline three recommendations: (1) promote collaborative AI platforms ensuring equity of access to include gap regions identified (Latin America, Africa, Middle East), (2) establish evaluation standards for methods testing and reporting, and (3) emphasise human input and multidisciplinary capacity building for developing and implementing AI tools in ES.

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).

Background: Although diabetes mellitus is an established risk factor for acute myocardial infarction (AMI), epidemiological studies showed wide variations in the incidence of AMI in people with diabetes and inconsistent time trends. The objectives of the present systematic review were as follows: (i) to analyze the age-sex-adjusted incidence of both non-fatal and fatal AMI in people with diabetes compared to those without diabetes, (ii) to investigate corresponding time trends, and (iii) to identify sex differences.

Methods: A systematic literature search was performed in the literature databases MEDLINE, Embase, and LILACS until July 19, 2023, to identify population-based studies reporting the incidence of AMI in people with diabetes compared to those without diabetes according to our predefined inclusion criteria.

Results: In total, 28 population-based cohort studies were included in this review. In women with diabetes, the incidence of AMI ranged from 102 to 690 per 100,000 person-years, and in men with diabetes from 206 to 1630. Estimates comparing people with and without diabetes ranged from 1.55 (95% CI 1.44-1.67) to 14.37 (8.43-24.47) in women and from 1.33 (1.18-1.51) to 4.17 (2.72-6.37) in men. Over the past four decades, the incidence of AMI declined in almost all studies in people without diabetes, but only in half of the studies in people with diabetes. There was considerable heterogeneity with regard to the definition of AMI, the population with diabetes, and geographic differences.

Conclusion: Incidence of AMI in people with diabetes remained significantly higher than in those without diabetes. A reduction in the incidence of AMI over time was observed in some, but not all reviewed studies in people with diabetes. There was no discernible trend of estimates comparing people with and without diabetes. These findings underscore the necessity for additional initiatives to prevent coronary heart disease in people with diabetes. The observed discrepancy in study results is presumably attributable to variations in the population and regional contexts, as well as to disparate methodological approaches. More standardized studies employing comparable methodologies are therefore required.

Systematic review registration: PROSPERO CRD42 02014 5562.