Systematic Reviews最新文献

Introduction: When patients report a penicillin allergy (self-reported penicillin allergy, SRPA), clinicians alter their antibiotic management of the patient. However, fewer than 5% of SRPA have life-threatening reactions, and receiving narrower spectrum antibiotics may result in under treatment. Reports from community studies suggest that patients with SRPA are more likely to come to harm, but as SRPA implies exposure to healthcare, it is unclear whether additional harm is as a result of co-morbidities and the need to receive healthcare, rather than a harm in itself. This raises the question of how great an impact SRPA has on hospital and ICU mortality for patients admitted to hospital.

Methods and analysis: A literature search will be performed using MEDLINE, Embase and CINAHL (via OVID) in October 2024. The eligible studies will be of adult hospitalised patients with penicillin allergy compared with their non-allergic counterparts. We will extract demographic and outcome data including whether the patients were treated in ICU and mortality (28-days, in-ICU or in-hospital). If possible, the results will be pooled for a meta-analysis by combining the all-cause mortality of patients at 28 days, in-ICU or in-hospital. Heterogeneity will be assessed using the I² or H² statistics if the number of included studies is less than 10.

Discussion: Previous reports of poor outcomes from SRPA are often based around increased risk of increased antibiotic use and antibiotic resistance. The requirement of SRPA to develop where there is exposure to healthcare and co-morbidities may mean that these outcomes are derived from poorer health rather than from SRPA perse. The impact of SRPA on hospitalised patients is less understood, with outcomes that are well-defined, such as mortality. This review will outline the differences that exist, and a meta-analysis may define the size of any differences.

Systematic review registration: PROSPERO CRD42024537658.

Introduction: Epidermal growth factor receptor (EGFR) mutations are major oncogenic drivers in non-small cell lung cancer (NSCLC), occurring in 30-50% of Asian patients. Neoadjuvant EGFR-tyrosine kinase inhibitors (EGFR-TKIs) may improve surgical outcomes in resectable EGFR-mutant NSCLC, but evidence from small, heterogeneous trials is inconsistent and the overall efficacy and safety remain unclear.

Objectives: To evaluate the efficacy and safety of neoadjuvant EGFR-TKI monotherapy in sensitizing EGFR-mutant NSCLC.

Methods: PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception to June 30, 2025. Prospective studies of neoadjuvant EGFR-TKI monotherapy in adults with genetically confirmed sensitizing EGFR-mutant NSCLC were eligible. Two investigators independently extracted data. Heterogeneity was assessed using Cochran's Q test and the I² statistic. Outcomes were pooled using random-effects (I² > 50%) or fixed-effects (I² ≤ 50%) meta-analyses. The primary outcomes were objective response rate (ORR) and incidence of grade ≥ 3 adverse events (AEs). Secondary outcomes included major pathological response (MPR) rate, pathologic complete response (pCR) rate, and complete (R0) resection rate. Predefined subgroup analyses were performed by age and ethnicity.

Results: Fifteen prospective studies involving 452 patients were included. The pooled ORR was 0.61 (95% confidence interval [CI] 0.54-0.67). The incidence of grade ≥ 3 AEs was 0.11 (95% CI 0.08-0.15), indicating an acceptable safety profile. The pooled MPR and pCR rates were 0.21 (95% CI 0.15-0.29) and 0.11 (95% CI 0.08-0.15), respectively. The pooled R0 resection rate was 0.90 (95% CI 0.86-0.94). ORR was higher in patients aged ≥ 60 years than < 60 years (0.69 vs 0.54, P = 0.01). pCR was higher in Chinese than non-Chinese patients (0.10 vs 0.03, P = 0.04).

Conclusion: Neoadjuvant EGFR-TKI monotherapy was associated with promising efficacy and a manageable safety profile in stage I-III EGFR-mutant NSCLC patients. However, the evidence is derived predominantly from single-arm prospective studies, limiting inference regarding comparative efficacy and survival benefit. Large randomized controlled trials with long-term follow-up are needed to confirm these findings.

Systematic review registration: PROSPERO CRD420251064957.

Background: Evidence from the literature suggests that vitamin D has indirect antimicrobial effects and may be associated with a reduced risk of infections. This study aimed to systematically evaluate the association between vitamin D deficiency and the risk of developing surgical site infections (SSIs).

Methods: All types of studies will be included in the systematic review. Up to December 2025, Medline, Embase, Cochrane, Web of Science, CINAHL, Google Scholar, ClinicalTrials.gov, WHO-ICTRP, Cochrane Central Register of Controlled Trials, and relevant citations will be searched. The primary outcome will be the development of SSIs. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Meta-analysis will be performed using bias-adjusted inverse variance heterogeneity methods. The risk of bias will be assessed using the MASTER scale, and the certainty of evidence will be determined using the GRADE framework.

Discussion: Although many risk factors for SSIs have been identified, the role of vitamin D remains unclear. SSIs impose a significant burden on patients and healthcare systems. This systematic review and meta-analysis aims to comprehensively evaluate the impact of vitamin D on SSI risk by including all relevant studies without language restrictions, using rigorous methodology in accordance with the Cochrane Handbook and PRISMA guidelines. If an association is established, preoperative screening and optimization of vitamin D levels could help reduce the burden of SSIs.

Systematic review registration: PROSPERO registration number 427175.

Introduction: Allergic bronchopulmonary aspergillosis (ABPA) affects millions worldwide, yet current treatment approaches remain suboptimal due to a one-size-fits-all model that fails to account for the significant heterogeneity across affected populations. While corticosteroids and itraconazole are commonly prescribed, there are associated risks and uncertainties regarding efficacy. Additionally, the efficacy of alternatives such as newer and higher activity triazole antifungals, or the place of "biologic" therapies like anti-IL5 antagonists, has not been thoroughly investigated.

Objectives: This review will assess treatment outcomes in patients with ABPA (Population) receiving antifungal or biologic therapies (Intervention) compared with corticosteroids, placebo, or alternative active treatments (Comparator), evaluating lung function (FEV₁), serological markers, exacerbation frequency, patient-reported outcomes, steroid-sparing effects, and adverse events (Outcomes) through a systematic review and network meta-analysis of published peer-reviewed studies.

Inclusion criteria: All articles using the Population, Exposure/Intervention, Comparator, Outcomes, Duration, and Results (PECODR) framework related to human patients published in English from inception to the date of undertaking the study (present) will be included.

Materials and methods: The following literature databases will be searched: MEDLINE, EMBASE, Cochrane Library Trials database, PubMed Central, Web of Science, and Scopus from inception to the present in collaboration with an experienced librarian. The primary researcher will screen the titles and abstracts; deduplication will be performed using Covidence®, and inclusion will be validated by a second checker. Quantitative analyses will be performed to summarise the results as means, frequency tables, and odds ratios of outcomes. Where there is sufficient data, a network meta-analysis will be conducted. The systematic review and network meta-analysis will be undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses for Network Meta-analysis (PRISMA-NMA) framework.

Systematic review registration: PROSPERO CRD42024443073.

Background: Despite the increasing clinical use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), head-to-head evidence across these agents remains limited. This systematic review and network meta-analysis (NMA) will assess the comparative efficacy and safety of GLP-1 RAs and novel co-agonists for weight loss among adults without diabetes.

Methods: We will systematically search the PubMed, Ovid, and Cochrane CENTRAL databases to identify randomized controlled trials (RCTs) comparing a GLP-1 RA/co-agonist to placebo or another GLP-1 RA/co-agonist. We will restrict inclusion to RCTs in adults with overweight or obesity; those including participants with diabetes, specific comorbidities or diseases, or history of bariatric surgery will be excluded. The primary outcome will be weight loss, expressed as relative change from baseline, assessed at 6 months (± 4 weeks) and 1-1.5 years (± 4 weeks). Secondary outcomes will include absolute body weight change, total adverse events, gastrointestinal adverse events, serious adverse events, and death. Pairwise meta-analyses and frequentist NMAs will be conducted using a random-effects model. Treatment rankings for efficacy and safety outcomes will be generated using the surface under the cumulative ranking curve. The validity of the results and the assumptions underlying the analyses will be evaluated using a local and global approach. Study-level quality will be assessed using the Cochrane Risk of Bias (RoB) 2 tool and overall network quality will be assessed using the RoB-NMA tool.

Discussion: We aim to provide an up-to-date synthesis of RCTs assessing the weight loss effects of GLP-1 RAs and co-agonists among adults without diabetes to support future clinical decision-making, guideline development, and policy decisions.

Systematic review registration: PROSPERO CRD420251009368.

Background: Maternal, newborn, and under-five mortality remain significant global health challenges, with 287,000 maternal deaths reported in 2020 and 4.9 million under-five deaths in 2022. The use of artificial intelligence in prediction models has shown great potential in predicting these mortalities. Artificial intelligence (AI)-powered models are capable of processing complex datasets to identify non-linear relationships and patterns, potentially outperforming traditional statistical methods in predictive accuracy, thereby enabling early detections and interventions more specifically. As AI develops rapidly, it is imperative to carry out systematic evaluations and comparisons of the accuracy, sensitivity, and applicability of these models to ensure the most efficient and effective use of AI in reducing mortality in these groups. The objective of this protocol is to outline the methods that will appraise, synthesise, and compare the existing literature in this domain.

Methods: The review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines, implementing a comprehensive search strategy across 14 databases, including PubMed, Embase, and Scopus. The review will refer to the most recent multiple methodological guidelines applicable to this study to determine inclusion and exclusion criteria and the content of the included literature. The articles will then be integrated, assessed, and compared for transparency, standardisation, and fairness, as well as model performance, generalisation, and heterogeneity, in accordance with the aforementioned methodological guidelines. Where possible, meta-analyses of the performance of models meeting specific criteria will also be conducted to better identify more effective models.

Discussion: This protocol outlines the methodology used in a systematic review of artificial intelligence prediction models for predicting maternal, neonatal, and under-five mortality. Key anticipated challenges include comprehensively identifying bias and heterogeneity, establishing reasonable and transparent standards for quantitative synthesis, and addressing statistical dependence introduced multiple models within original studies. To address these, we will apply a structured taxonomy of bias, pre-defined tiered synthesis rules, and methods such as robust variance estimation and bivariate models. We expect that this review will fill important gaps in the field and provide insights that support the advancement of artificial intelligence in maternal and child healthcare.

Systematic review registration: PROSPERO CRD42024569282.

Background: Maternal and child undernutrition is one of the contemporary pervasive and pressing public health crises in developing country, like Ethiopia. It perpetuates a devastating intergenerational cycle that adversely impacts health, cognitive development, and socioeconomic well-being.

Methods: This systematic review analyzed maternal and child undernutrition in Ethiopia from 2015 to 2025. Studies were identified through PubMed, Scopus, Web of Science, and Google Scholar using predefined inclusion criteria. Methodological quality was assessed using the Newcastle-Ottawa Scale, and a random-effects meta-analysis was conducted to estimate prevalence and regional variations.

Results: According to meta-analysis result, maternal undernutrition was 29%, which exceeding national estimates. Among children under-five, stunting stands at 35%, wasting at 14%, and underweight at 24%, with marked disparities across regions. Subgroup analysis identified Tigray, Afar, Amhara, and Somali regions had the highest under-five undernutrition. Stunting was highest in Tigray (40%) and Amhara (38%), wasting in Somali (21%) and Afar (18%), and underweight in Afar (34%) and Tigray (30%). The review categorizes the most key drivers of undernutrition, including inadequate dietary intake, recurrent infections, food insecurity, suboptimal child feeding practices, and insufficient access to healthcare services, further exacerbated by poverty, low maternal education, and inadequate water, sanitation, and hygiene (WASH) conditions.

Conclusions: Multiple interconnected factors contribute to the high prevalences of maternal and child undernutrition in Ethiopia. This urgently calls for comprehensive, multi-sectorial intervention of undernutrition. Addressing these challenges is imperative to achieve Ethiopia's progress toward its national health and national development goals.

Purpose: This paper presents a protocol for a planned systematic review and meta-analysis that will investigate the impact of short rest periods between shifts (i.e., quick returns, <11 h rest) on various outcomes in terms of physical health of workers (e.g., cardiovascular disease, infections, headaches, back pain) and/or mental health of workers (e.g., anxiety, depression, fatigue, sleep problems, insomnia, impaired mental health), as well as sickness absence (proxy of health), work performance (e.g., occupational accidents), social factors (e.g., social support), and psychosocial work-related factors (e.g., job satisfaction). The planned review further aims to identify different types of quick returns, such as evening to day shift and night to evening shift, and examine their relationship to these outcomes provided a sufficient number of studies (e.g., ≥5). The research will identify demographic and methodological factors that may moderate the relationship between quick returns and the specified outcomes.

Methods: A systematic review and meta-analysis will be carried out. Predefined search terms for short rest between consecutive shifts will be developed and employed to identify relevant studies examining quick returns and all aforementioned outcomes. The databases MEDLINE, Web of Science, PsychInfo, EMBASE, ProQuest, BASE, and Cochrane Trials and the 200 first hits in Google Scholar will be searched up to April 2026. Two reviewers will independently screen identified records and assess eligible full texts for inclusions. The risk-of-bias of included studies will be assessed using the Mixed Methods Appraisal Tool (MMAT) for systematic mixed study reviews. A random effects meta-analytic synthesis will be conducted using Comprehensive Meta-Analysis software. The primary measure of effect size will be odds ratio with 95% confidence interval. Heterogeneity will be evaluated using Cochran's Q test and the I² statistics. Publication bias will be assessed using Duval and Tweedie trim and fill procedure. The protocol adheres to PRISMA and MOOSE reporting guidelines and is registered in the International Prospective Register of Systematic Reviews.

Discussion: This planned systematic review and meta-analysis will be the first to synthesize the current evidence systematically and quantitatively regarding the consequences of quick returns, including demographic and methodological moderators. Aggregation of the existing evidence will improve our understanding of the consequences of quick returns and, as such, provide directions for practitioners in terms of possible preventive initiatives and work environment improvements.

Systematic review registration: PROSPERO CRD42024533607.

Objective: Observational studies are increasingly used in health research. Although several studies have examined the performance of propensity score (PS) methods, a critical need remains for a comprehensive synthesis of these approaches. This review aimed to summarize existing evidence and offer practical guidance for researchers to estimate treatment effects in observational studies.

Methods and materials: This narrative synthesis systematic review was conducted in accordance with PRISMA guidelines and included peer-reviewed studies published between 2000 and 2025. Eligible studies reported methodological performance indicators such as treatment effect estimation, bias, mean squared error (MSE), and confidence interval (CI) coverage. All the search results were managed via Zotero to remove duplicates. Two independent reviewers screened titles and abstracts for relevance. Studies were categorized by design, estimand, and the PS method used for comparison.

Results: Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) generally improved covariate balance and acceptable CI coverage across multiple evaluation metrics. Caliper-based optimal and full matching reduce bias and improve covariate balance for odds ratios (ORs) and marginal hazard ratios (MHR). IPTW, particularly when associated with doubly robust (DR) methods or stabilized weights, offers low MSE and reliable inference. PS adjustment is also effective in reducing bias and estimating relative risk (RR). In contrast, PS stratification often underperforms due to its sensitivity to effect size, treatment prevalence, and PS distribution, leading to greater bias and less precise estimates.

Conclusions: PSM, DR-IPTW, and full matching are among the most effective methods for reducing bias, achieving covariate balance, minimizing MSE, and enhancing precision in observational studies.